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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
What is the MOA of NK1-RA?
Inhibits the substance P/NK1 receptor
26
What are the types of NK-1 receptor antagonist?
1. Aprepitant 2. Fosaprepitant 3. Netupitant + palanosetron 4. Rolapitant
27
Indications for NK1 RA?
Acute and delayed N/V * Used for prevention of CINV **NOT** treatment
28
DDIs of NK1 RAs?
All are CYP3A4 inhibitors except rolapitant (CYP2D6 inhibitor)
29
What are NK1-RAs formulated with?
1. 5HT3-RA 2. DEXAMETHASONE
30
ADR of NK1-RA?
1. Diarrhea 2. Fatigue 3. Weakness 4. Hiccups
31
What CS are used for CINV?
Dexamethasone andmethylprednisolone
32
ADR of CS?
1. Anxiety 2. Insomnia 3. Euphoria 4. Increased appetitie 5. Fluid retention
33
What are the types of DAs?
**Benzamides:** metoclopramide **Phenothiazines:** Proclorperazine, Chlorpromazine, Promethazine **Butyrophenones:** Haloperidol, droperidol
34
MOA of DAs
Block dopamine receptors in the CTZ
35
Indications for DAs?
Mild to moderate N/V used for breakthrough CINV
36
General ADRs of DAs?
Sedation Lethargy EPS
37
BBW of metoclopramide?
Tardive dyskinesisa (DC if s/s of TD)
38
BBW of droperidol?
QT prolongations
39
How should promethzine be administered?
Deep IM injection or oral * IV -> necrosis and extravasation
40
MOA of olanzapine?
Blocks multiple neurotransmitters, including dopamine, serotonin, catecholamines, acetylcholine, and histamine
41
Indiation of olanzapine?
High emetogenic regiments and breakthrough CINV?
42
ADR of olanzapine?
Sedation Dry mouth DZ Postural hypotension
43
What is the drug of choice for anticipatory NV?
Benzos (Lorazepam) * Used for breakthrough
44
Dosing of olanzapine?
10 mg po daily x 4 days
45
Dosing of lorazepam?
Lorazepam 1-2 mg IV/PO/SL q4-6 h prn or 1 dose prior to chemo
46
ADR of benzos?
1. Sedation 2. Short term memory loss
47
What are the cannabinoids?
1. Donabinol (C3) 2. Nabilone (C2)
48
ADRs of cannabinoids?
Drowsiness, dizziness, euphoria, dysphoria, increased appetite, hallucinations, cannabinoid hyperemesis syndrome * Chronic use
49
Non pharm for CINV?
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
How should you counsel on NV
1. Always say “may cause N/V” 1. Do Not say “it will cause N/V” 1. “We have good medications that control it well” 1. Can consider eating small, bland meals to help prevent 1. If they have breakthrough nausea, what can they use 1. If N/V is still not controlled, call MD

Therapeutics IV (39 decks)

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