Clinical N/V

Question 1

Pt - specific risk factors

Answer 1

• anxiety (past & expected N)
• women
• YOung (<50 yr)
• PMH of Motion sickness
• pregnancy induced N/V
• inconsistent anti-emetic tx
• prior chemo with good v poor control
• history of EtOH abuse has a protective effect

Question 2

regimen-specific risk factors

Answer 2

• dose related tox
• emetogenic drug categories
  (high = >90%, medium = 30-90%, low = 10-30%, minimal = < 10%)

multidrug regimens - drug with highest level determines risk

risk incr c pt specific factors

Question 3

Prophylaxis

Answer 3

anticipatory - benzo
actue - IV @ infusion center prior to chemo
delayed - receive an Rx to take as scheduled
breakthru - Rx for PRN (different MOA than prophylaxis med)

Question 4

Anti-emetic drug classes

Answer 4

• corticosteroids
• 5HT3 receptor antagonists
  ( -setron: ondanSETRON, dolaSETRON)
• NK1 receptor antagonists
  ( -pitant: aprePITANT, fosprePITANT, netuPITANT)
• antihistamine (diphenhydramine, promethazine, prochlorerazine)
• muscarine acetylcholine receptors (scopolamine, diphenhydra, promethazine)
• dopamine (haloperidol, metoclopramide, olanzapine)
• cannabinoid (dronabinol, nabilone)
• GABA (lorazepam)

Question 5

Mucositis meds

Answer 5

palifermin
keratinocyte growth factor

• separate from chemo by 24 hrs each side
• magic mouthwash

Question 6

counseling tips

Answer 6

• good oral hygiene
• bland oral rinses / toothpaste (no EtOH, cinnamon, mint)
• oral antimicrobials if routine hygiene is not possible
• topical anesthetics

Question 7

7 steps to a happy mouth :)

Answer 7

1. routine gentle dental care
2. artificial saliva & water-soluble jellies to lubricate the mouth
3. saline or baking soda mouth wash to sooth pn & remove food particles (to avoid infection)
4. plenty of liquids (min 3 litres/day)
5. avoid foods that aggravate mucous legions
6. no smoking
7. suck on some ice cubes

Question 8

Non-vesicant extravasation tx

Answer 8

local dry/cold compress

Question 9

vessicant / irritant

localize & neutralize

Answer 9

• anthracycline
• antibiotics (mitomycin, dactinomycin)
• alkylating agents

apply dry/cold compress
specific antidotes when available

Question 10

vessicant / irritant

disperse & dilute

Answer 10

• vinca alkaloids
• taxanes
• platin salts

warm/dry compress
promote drug diffusion, and improve absorption