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Oncology Exam 2 > Emesis > Flashcards

Emesis Flashcards

1
Q

Complications of Emesis

A 
o	Dehydration
o	Electrolyte and acid-base imbalance
o	Nutrient depletion – Weight loss
o	Declined quality of life
o	Declined performance status
o	Poor compliance with chemotherapy – May result in failure of chemotherapy
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2
Q

Neurotransmitters in Emesis

A

o Serotonin Type 3 (5HT-3)
o Dopamine Type 2 (D2)
o Neurokinin (NK1)

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3
Q

Define Acute Emesis

A

within 0-24 hours of chemo

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4
Q

Define Delayed Emesis

A

Begins 24 hours after chemo and can last up to 5 days

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5
Q

Define Anticpatory Emesis

A

Learned response to chemo; has to do more with cortex

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6
Q

Define Breakthrough Emesis

A

N/V through prophylaxis

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7
Q

Emesis Risk Factors

A

o Intrinsic emetogenicity of chemotherapy
o Combination of chemotherapy
o Dose of the drug
o Rate of administration
o Younger patients**
o Women > Men**
o Heavy alcohol associated with reduced risk**

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8
Q

Metoclopramide MOA

A

 Block dopamine receptors at the CTZ
 Prokinetic effect by increasing gut motility
 Serotonin receptor antagonist at the higher doses

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9
Q

Metoclopramide ADR

A

Diarrhea, EPS and sedation

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10
Q

Metoclopramide Use

A

Acute and delayed

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11
Q

Phenothiazine MOA

A

Block dopamine receptor at CTZ

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12
Q

Phenothiazine ADR

A

Sedation
Hypotension
EPS

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13
Q

Phenothiazine Drugs

A

Prochloperazine and promethazine

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14
Q

Butyrophenones MOA

A

Block dopamine receptor

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15
Q

Butyrophenones ADR

A

Sedation
Hypotension
EPS

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16
Q

Butyrophenone Drugs

A

Haloperiodol

Droperidol

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17
Q

Canabinoids MOA

A

Unknown

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18
Q

Canabinoids ADR

A 
Sedation
Euphoria
Hypothension
Dry mouth
Disorientation
19
Q

Canabinoids Drugs

A

Dronabinol

Nabilone

20
Q

Benzodizipines MOA in Antegrade Amnesia

A

• Works by preventing any short-term memory so helps patients handling traumatic events by not remembering it

21
Q

Benzodiazipines ADR

A

Hypotension
Amnesia
Sedation

22
Q

Corticosteroids MOA

A

PG blocking action

Changes in cellular permeability

23
Q

Corticoteroid ADRs

A

 Minimal with short duration (less than 5 days)
 May include euphoria, anxiety, insomnia (take AM), fluid retention, hyperglycemia (induces gluconeogenesis), GI upset
 Demargination

24
Q

Define Demargination

A
  • Signal sent to bone marrow to make bands/baby neutrophils
  • Segs are the first line of defense. These are typically attached to the blood vessels, go into the blood and get to the site
  • When giving steroids, the segs get detached and come available in the blood = demargination
25
Q

5HT3 Receptor Antagonists MOA

A

 Central serotonin receptor antagonism

 Peripheral serotonin receptor antagonism

26
Q

5HT3 Receptor Antagonists ADR

A

(pretty well tolerated): headache, transient transaminase elevations, constipation, hiccups

27
Q

5HT3 Receptor Antagonists General

A

Oral and IV are equal
Whole class has similar efficacy
SHORT ACTING
EX: ondansatron (all end in setron)

28
Q

Palonosetron Use, half-life, ADR, dosing

A

Use: moderate or highly emetogenic chemotherapy
Longgggg half-life 40 hours
ADR: headache, constipation, prolonged QT
SHOULD NOT DO ANOTHER DOSE FOR 7 DAYS

29
Q

Substance P/Neurokinin 1 Receptor Antagonists Use

A

Prevention of moderate or high chemotherapy regimens

All end in pitant

30
Q

Substance P/Neurokinin 1 Receptor Antagonists ADRs

A 
Tiredness
Nausea
Hiccups
Constipation or diarrhea
Loss of appetite
Elevated LFTs
31
Q

Aprepitant Dosing

A

Day 1: Aprepitant 125 mg PO, dexamethasone 12 mg PO/IV, and 5HT3 antgonists PO/IV

Day 2-3: aprepitant 80 mg PO and dexamethasone 8 mg PO

Day 4: dexamethasone 8 mg PO

32
Q

Olanzapine Brand Class and MOA

A

Zyprexa
Thiobenzodiazepine
Potent antagonists of 5HT3A/2C, dopamine, histamine and alpha 1 adrenergic

33
Q

Olanzapine Use

A

Moderate-severe N/V

Prevention and breakthrough emesis

34
Q

Olanzapine Black Box Warning

A
  • Death in patients with dementia-related psychosis
  • Type II diabetes and hyperglycemia
  • Life threatening arrhythmias
  • EPS
35
Q

What Drugs cause Delayed Emesis?

A

Cisplatin
Anthracyclines
Cyclophosphamide
Carboplatin

36
Q

Prevention Regimen in High Risk Acute

A

Start Day 1

  1. Aprepitant 125 mg + Ondansatron (5HT3) + dexamethasone (12 mg)
  2. Olanzapine + Palonosetron + dexamethasone
37
Q

Prevention Regimen in High Risk Delayed

A

Start Day 2-3

  1. Aprepitant + dexamethasone
  2. Olanzapine
38
Q

Prevention Regimen in Moderate Risk Acute

A

Palonosetron + Dexamethasone +/- aprepitant

39
Q

Prevention Regimen in Moderate Risk Delayed

A

Dexamethasone
Metoclopramide or 5HT3
Olanzapine

40
Q

Prevention Regimen in Low Risk Acute

A

Dexamethasone, prochloperazine, metoclopramide or short acting 5HT3

41
Q

Prevention Regimen in Minical Risk

A

PRN antiemetics no scheduled

42
Q

Prophylaxis before Chemotherapy?

A

5HT3 short acting (ondansetron or palonosetron)

43
Q

Treatment of Anticipatory Emesis

A

Lorazepam
Alprazolam
(benzodiazepines)

44
Q

Treatment of Breakthrough Emesis

A

Prochloperazine –> 5HT3 –> dexamethasone

Oncology Exam 2 (10 decks)

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