Nausea section Flashcards
Dronabinol properties
Antiemetic + appetite stimulant
3 types of emesis and time course
1) acute emesis (within 1-2 hours of chemo and peaking 4-6 hours after)
2) delayed emesis (24 hours after chemo)
3) anticipatory emesis (prior to treatment as conditioned response)
Categories of emetic risk in chemo drugs
- highly emetic
- moderately emetic
- low emetogenicity
- minimally emetic
highly emetogenic chemotherapy regimens
- cisplatin
- ## anthracyclines combined with cyclophosphamide (AC in breast cancer)
the four categories of drugs with the highest therapeutic index for management of chemo induced nausea and vomiting
1) 5-HT3 receptor antagonists
2) neurokinin-1 receptor antagonists
3) steroids
4) olanzapine
What are the NK1R antagonists?
- aprepitant
- fosaprepitant
- rolapitant
- netupitant
antiemetic therapy for highly emetogenic chemo
1) NK1R antagonist
2) 5-HT3 receptor antagonist
3) dexamethasone
4) olanzapine
antiemetic therapy for moderately emetogenic chemo
3 drug regimen
1) NK1R antagonist
2) 5-HT3 receptor antagonist
3) dexamethasone
antiemetic therapy for low emetogenic chemo
single agent dexamethasone OR single agent 5-HT3 receptor antagonist
antiemetic therapy for minimally emetogenic chemo
No treatment
Management of anticipatory emesis
- behavioral therapy and/or benzos
medication recommended for rescue therapy
- olanzapine 5-10 mg daily for 3 days
Antiemetic activity of cannabinoids
Modest, so not useful for chemo
Is medical marijuana recommended for nausea?
Not recommended for management of CINV and is not included in the most recent guidelines for CINV from NCCN, ASCO, or MASCC/ESMO
Is more zofran better?
There is a plateau in therapeutic efficacy at a definable dose level for each drug, and further dose escalation does not improve outcome [19].
A single dose of a 5-HT3 receptor antagonist prior to chemotherapy is therapeutically equivalent to a multiple-dose schedule for control of acute nausea and emesis
efficacy of oral vs IV 5-HT3 receptor antagonist
- equivalent
What are the 5-HT3 antagonists?
- ondansetron
- palonosetron
- granisetron
- dolasetron
Most effective 5-HT3 receptor antagonist
- palonosetron (30 to 100-fold higher affinity for the 5-HT3 receptor and a significantly longer half life (40 hours))
Dosing schedule of NK1 receptor antagonists
1 or 3 day administration
aloxi generic name
palanosetron
NK1 receptor antagonist we typically use
Aprepitant (Cinvanti)
fosaprepitant duration
3 days
NK1 receptor antagonist SE profile in general
well tolerated
MEC and HEC
moderately and highly emetogenic chemo
zyprexa dosing
5 mg careful with 10
Cinvanti generic name
Aprepitant
