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OU Module Hem/Onc Spring 2019 > Exam 2 CINV > Flashcards

Exam 2 CINV Flashcards

1
Q

Risk factors for N/V

A
  • female
  • previous N/V
  • having motion sickness
  • young
  • non-smoker
  • having previous chemo
  • non-drinker
  • have anxiety
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2
Q

Agents with High Emetogenic Potential

A
  • Cisplatin
  • Carboplatin ≥ AUC 4
  • Doxorubicin ≥ 60 mg/m2
  • Anthracylines + cyclophosphamide
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3
Q

Agents with Moderate Emetogenic Potential

A
  • Carboplatin AUC < 4

- Oxaliplatin

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4
Q

pathophysiology of N/V

A
  • Serotonin released from enterochromaffin cells in GIT ; activates 5-HT3 receptors that stimulate the CTZ
  • Dopamine stimulates CTZ
  • Substance P stimulate GIT and vomiting center
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5
Q

Which drugs are more likely to cause delayed N/V?

A
  • platinum drugs
  • anthracyclines
  • cyclophosphamide / ifosphamide
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6
Q

prevention of N/V

A
  • 5HT3 antagonist
  • NK-1 antagonist
  • steroid
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7
Q

5-HT3 Receptor Antagonists MOA

A

Selectively block 5-HT3 receptors peripherally on vagal nerve terminals (i.e., in GI mucosa) and centrally in the CTZ

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8
Q

Ondansetron dosing

A
  • IV: 8mg

- PO: 16mg

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9
Q

Granisetron dosing

A
  • IV: 1mg

- PO: 2mg

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10
Q

adverse effects of Ondansetron and Granisetron

A
  • headache

- constipation

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11
Q

Palonosetron dosing

A

0.25 mg IV x 1 dose over 30 min. prior to chemotherapy

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12
Q

Palonosetron uses

A
  • moderately delayed emetogenic chemotherapy

- moderately and highly acute emetogenic chemotherapy

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13
Q

What is the Gold standard for prevention of acute CINV from moderate to highly emetogenic chemotherapy?

A

5-HT3 Antagonists

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14
Q

Emend® (Aprepitant) dosing

A
  • oral: 125 on day 1, 80 mg on days 2 and 3

- IV: 150 on day 1

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15
Q

NKI1 MOA

A

selectively blocks the binding of substance P at the NK1 receptor in the central nervous system

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16
Q

Rolapitant (Varubi®) dosing

A

180 mg PO 1 hour before chemotherapy

17
Q

Rolapitant uses

A

select moderate emetogenic regimens especially in those who have failed standard CINV treatment regimens

18
Q

Netupitant + Palonosetron NEPA (Akynzeo®) dosing

A

Fixed dose combination of netupitant 300 mg plus palonosetron 0.5 mg PO only

19
Q

Netupitant + Palonosetron NEPA (Akynzeo®) uses

A

highly emetogenic chemotherapy

20
Q

metoclopramide uses

A
  • Low emetogenic chemo
  • Moderate-highly emetogenic chemotherapy if cannot tolerate 5HT3 ant.
  • Breakthrough CINV
21
Q

Phenothiazines (prochlorperazine & promethazine) uses

A
  • low emetogenic chemotherapy

- Breakthrough CINV

22
Q

Butyrophenones: Olanzapine (Zyprexa®) uses

A
  • May be as effective as NK-1 antagonist for
    prevention of CINV
  • Can be used in combination with 5HT3 antagnoists and dexamethasone for prevention of CINV
  • Alternative agent for refractory CINV (treatment)
23
Q

Olanzapine (Zyprexa®) MOA

A

Block DA2 (dopamine) receptors

24
Q

Olanzapine (Zyprexa®) ADE

A
  • Sedation
  • hypotension
  • EPS (less than phenothiazines)
25
Q

Corticosteroids uses

A
  • Used in combination with 5HT3 antagonist in moderately to highly emetogenic chemotherapy
  • Can be used as single agent in low emetogenic chemotherapy
26
Q

Cannabinoids uses

A

Used as 2nd/3rd line breakthrough CINV in younger patients

27
Q

Benzodiazepines uses

A
  • Prevention of anticipatory N/V

- Adjuvant treatment in highly emetogenic chemotherapy

28
Q

Acute CINV High

Emetogenicity treatment

A
  • Aprepitant / Fosaprepitant*
  • 5HT3 antagonist
  • Dexamethasone
29
Q

Acute CINV Moderate

Emetogenicity treatment

A
  • Aprepitant / Fosaprepitant*
  • 5HT3 antagonist
  • Dexamethasone
30
Q

Acute CINV Low

Emetogenicity treatment

A

Dexamethasone single agent

31
Q

Delayed CINV High

Emetogenicity treatment

A

Aprepitant (80mg dose)@ days 2 & 3 + Dexamethasone days 2, 3 & 4

32
Q

Delayed CINV Moderate

Emetogenicity treatment

A

Aprepitant (80mg dose)@ days 2 & 3 +/- Dex days 2 & 3 OR dexamethasone* alone days 2 & 3
OR 5HT3 antagonist alone days 2 & 3 (if NK-1 antagonist not used)

OU Module Hem/Onc Spring 2019 (4 decks)

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