Drugs for CINV

Question 1

Substance P/NK1 Receptor Antagonists

Answer 1

• Aprepitant
• Fosaprepitant*
• Rolapitant
• Netupitant/Palonsetron
• Fosnetupitant/Palonsetron

Question 2

Substance P/NK1 Receptor Antagonist MOA, indications, interactions, ADRs

Answer 2

• MOA: selectively inhibit NK1-R blocking substance P
• Indications: prevention of acute and delayed CINV
• Interactions: look up on onc rotation (Danny T)
• ADRs: fairly well tolerated*

Question 3

Serotonin Antagonists and MOA

Answer 3

-1st gen: ondansetron, granisetron, dolasetron
-2nd gen: palonosetron
MOA: inhibits serotonin at 5-HT in vagus nerve, small bowel, CTZ

Question 4

Serotonin Antagonists Indications and ADRs

Answer 4

• Indications: prevention of ACUTE CINV** –> less helpful for delayed**
• SCHEDULE these, no PRN**
• ADRs: HA and constipation m/c, QTc prolongation (not palonosetron) most severe**

Question 5

Other antiemetic agents

Answer 5

• Dexamethasone

- Devil’s Lettuce

Question 6

Dexamethasone

Answer 6

• MOA unknown
• Effective for acute and delayed CINV
• Highly effective for mild-mod emetogenic chemo agents

Question 7

Medical Marijuana

Answer 7

• Dronabinol (Schedule III)
• Nabilone (Schedule II)
• Synthetic analogs of THC
• Used for tx when other therapies haven’t worked
• Used for both prevention and tx of CINV

Question 8

Marijuana Pk and Pd

Answer 8

• Pk- minimal

- Pd- Additive sedation w other CNS depressants, low doses ETOH can inc [THC]

Question 9

Marijuana ADRs

Answer 9

• Dry mouth
• Sedation/impaired driving
• Orthostatics/dizziness
• Ataxia
• Agitation and confusion common in older pts