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Therapeutics IV > N/V - Block 4 > Flashcards

N/V - Block 4 Flashcards

1
Q

What are the consequences of N/V?

A

Impacts:
* QOL
* Overall survival
* Healthcare costs
* Future adherence to therapy

  1. Dehydration
  2. Malnurition
  3. Electrolyte imbalances
  4. Aspiration pneumonia
  5. Mucosal tears
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2
Q

What is Nausea?

A

Unpleasant sensation in stomach and/or throat

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3
Q

What is retching?

A

Labored movement of muscles associated with vomiting w/o expulsion of vomitus

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4
Q

What is vomiting?

A

Physical expulsion of stomach contents via mouth

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5
Q

What is acute CINV?

A

Occuring within 24 hrs of chemo admin

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6
Q

What is delayed CINV?

A

Occurs at least 24 hrs post chemotherapy admin often peaking between 48-72 hrs

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7
Q

What is breakthroug CINV?

A

Occurs within 5 days post chemo despite antiemetic regimen requiring rescue therapy

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8
Q

What is refractory CINV?

A

Occurs in subsequent chemo cycles despite max antiemetic protocol

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9
Q

What is anticipatory CINV?

A

Triggered by sensory stimuli associated wth chemo administration

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10
Q

What are the patient related RF?

A
  1. Younger than 50
  2. Femal
  3. Hx of motion sickness
  4. Hx of n/v in pregnancy
  5. Poor control of nv in chemo
  6. Hx of chronic alcoholism (decreases incidence of emesis)
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11
Q

Tx specifc facotrs of CINV?

A
  1. Emetogenicity of drug
  2. Dose
  3. Infusion rate, cycle, and time of infusion
  4. Radiation therapy
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12
Q

Med that are at high risk for emesis (>90%)?

A
  1. Cisplatin
  2. Cyclophosphamide
  3. AC combo
  4. Dacarbazine/nitrogen mustards
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13
Q

Med that are at med risk for emesis (30-90%)?

A
  1. Carboplatin
  2. Antracyclines monotherapy
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14
Q

Med that are at low risk for emesis (10-30%)?

A
  1. Taxanes
  2. 5-FU
  3. Topoisomerase inhibitors
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15
Q

Med that are at minimal risk for emesis (<10%)?

A
  1. Bevacizumab
  2. Bleomycin
  3. Vinca alkaloids
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16
Q

What is the primary goal for antiemetics?

A

Prevention is key, no NV throughout period of emetic risk

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17
Q

What is the duration of emetic risk?

A

Moderately emetogenic: 2 days
High emetogenic: 3 days

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18
Q

What are factors that need to be considered for antiemetic tx?

A
  1. Patient hx anf RF
  2. 5-HT3-Ras given in equipotent doses (IV=PO)
  3. ADRs of antiemetics
  4. Antiemetics should be scheduled for delayed N/V for select chemo regimens
  5. Dyspepsia may require PPI or H2RA
  6. Follow up is essential
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19
Q

MOA of seratonin (5HT3) receptor antagonists?

A

Block serotonin receptors on sensory vagal fbers in the gut wall blocking acut phase CINV?

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20
Q

Types of 5-HT3 receptor antagonists?

A
  1. Dolasetron
  2. Granisetron
  3. Ondansetron
  4. Palonosetron
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21
Q

ADR of 5-HT3 receptor antagonist?

A
  1. HA
  2. Constipation
  3. QT prolongation
22
Q

What 5-HT3 receptor antagonist is indicated for acute n/v?

A

Palonosetron
* Can be used for delayed N/V in moderate emetogenic agents

23
Q

How are all 5-HT-RAs equivalent?

A
  1. BAse decision on formulary
  2. Cost
  3. ADRs
24
Q

What is different about granisetron?

A

Transderal pathc (Sancuso): 34.3 mg, delivers 3.1 mg of drug Q24h for 7 days
* Approed for delayed N/V

25
Q

What is the MOA of NK1-RA?

A

Inhibits the substance P/NK1 receptor

26
Q

What are the types of NK-1 receptor antagonist?

A
  1. Aprepitant
  2. Fosaprepitant
  3. Netupitant + palanosetron
  4. Rolapitant
27
Q

Indications for NK1 RA?

A

Acute and delayed N/V
* Used for prevention of CINV NOT treatment

28
Q

DDIs of NK1 RAs?

A

All are CYP3A4 inhibitors except rolapitant (CYP2D6 inhibitor)

29
Q

What are NK1-RAs formulated with?

A
  1. 5HT3-RA
  2. DEXAMETHASONE
30
Q

ADR of NK1-RA?

A
  1. Diarrhea
  2. Fatigue
  3. Weakness
  4. Hiccups
31
Q

What CS are used for CINV?

A

Dexamethasone andmethylprednisolone

32
Q

ADR of CS?

A
  1. Anxiety
  2. Insomnia
  3. Euphoria
  4. Increased appetitie
  5. Fluid retention
33
Q

What are the types of DAs?

A

Benzamides: metoclopramide
Phenothiazines: Proclorperazine, Chlorpromazine, Promethazine
Butyrophenones: Haloperidol, droperidol

34
Q

MOA of DAs

A

Block dopamine receptors in the CTZ

35
Q

Indications for DAs?

A

Mild to moderate N/V used for breakthrough CINV

36
Q

General ADRs of DAs?

A

Sedation
Lethargy
EPS

37
Q

BBW of metoclopramide?

A

Tardive dyskinesisa (DC if s/s of TD)

38
Q

BBW of droperidol?

A

QT prolongations

39
Q

How should promethzine be administered?

A

Deep IM injection or oral
* IV -> necrosis and extravasation

40
Q

MOA of olanzapine?

A

Blocks multiple neurotransmitters, including dopamine, serotonin, catecholamines, acetylcholine, and histamine

41
Q

Indiation of olanzapine?

A

High emetogenic regiments and breakthrough CINV?

42
Q

ADR of olanzapine?

A

Sedation
Dry mouth
DZ
Postural hypotension

43
Q

What is the drug of choice for anticipatory NV?

A

Benzos (Lorazepam)
* Used for breakthrough

44
Q

Dosing of olanzapine?

A

10 mg po daily x 4 days

45
Q

Dosing of lorazepam?

A

Lorazepam 1-2 mg IV/PO/SL q4-6 h prn or 1 dose prior to chemo

46
Q

ADR of benzos?

A
  1. Sedation
  2. Short term memory loss
47
Q

What are the cannabinoids?

A
  1. Donabinol (C3)
  2. Nabilone (C2)
48
Q

ADRs of cannabinoids?

A

Drowsiness, dizziness, euphoria, dysphoria, increased appetite, hallucinations, cannabinoid hyperemesis syndrome
* Chronic use

49
Q

Non pharm for CINV?

A
  1. Small ligt meas and bland foods
  2. Avoid unpleasant stimuli
  3. Monitor hydration status
  4. Relief band devices and acupressure
  5. Massage and aromatherapy
50
Q

How should you counsel on NV

A
  1. Always say “may cause N/V”
  2. Do Not say “it will cause N/V”
  3. “We have good medications that control it well”
  4. Can consider eating small, bland meals to help prevent
  5. If they have breakthrough nausea, what can they use
  6. If N/V is still not controlled, call MD

Therapeutics IV (39 decks)

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