Pharm: Random Topics: Emesis with chemo

Question 1

Vomiting risk of chemo drugs
High:
Mod:
Low: 
Min

Answer 1

• High: cisplatin, cyclophosphamide >1500
• Mod: -rubicin, cyclophaphamide <1500
• Low: -taxel, mitoxantrone, methotrexate
• Min: -tine, beva/rituximab

Question 2

Serotonin (5HT) anatagonists
-
-
-
-
SE

Answer 2

• Ondansetron (zofran), dolasetron (anzemet), granisetron (granisol),
palonosetron (aloxi)-longest half life

SE: QT prolongation, correct hypo kalemia and magnesemia prior

Question 3

Corticosteriods

Answer 3

dexamethasone, methylprenisolone (deop-medrol)

Question 4

Neurokinin 1 receptor antagonist

Answer 4

Aprepitant (EMDEND) can pass thought the BBB to bind to Substance P and NK receptors, used to decreased N/V

Question 5

DA receptor antagonist
drug:
SE:

Answer 5

• Metoclopramide (reglan)

* SE: extrapyridimal symptoms, sedation, restlessness, fatigue- doesn’t use a lot due to se

Question 6

➢ Phenothiazines

Answer 6

Phenothiazine: Blocks H1, not histamine
Peochlorperazine (compazine): Inhibits chemotrigger zone

just know its avb

Question 7

➢Cannabiniods

Answer 7

• Dronabinol (marinol)

* Nabilone (cesamet)

Question 8

➢Guideline Overview

Answer 8

➢Guideline Overview

Question 9

Time of onset for N/V:
acute:
delayed:
anticipatory:

Answer 9

• Acute= initial 24hrs after chemo
• Delayed= later than 24hrs after chemo
• Anticipatory=days to hours before chemo

Question 10

Tx for prophylaxis:

Acute:
Delayed:
Anticipatory:

Answer 10

1. Acute
   • High= 5-HT antagonist+corticosteroid+aprepitant(EMEND)
   • Anthracycline & cyclophosphamide (AC)= 5-HTantagonist+dexamethasone +aprepitant(EMEND)
   • Moderate other than AC= 5-HT antagonist+corticosteroid
   • Low= corticosteroid
   • Minimal= none
2. Delayed
   • High= corticosteroid+aprepitant(EMEND)
   • Anthracycline & cyclophosphamide (AC)= dexamethasone or aprepitant(EMEND)
   • Moderate other than AC= corticosteroid or 5-HT antagonist
   • Low= none
   • Minimal= none
3. Anticipatory
   - just add Lorazepam