Ready To Study: Cancer Pharmacology Continued

Question 1

You have an emetic center in your brain and it is located in the medulla.

Answer 1

Emetic Center

Question 2

The emetic center receives input and data received from areas of the body. Each area responds to certain stimuli and is modulated by specific neurotransmitters.
What are the four areas of the body?

Answer 2

1. GI Tract
2. Vestibular apparatus
   Location: Ears
3. Chemoreceptor Trigger Zone (CTZ) Location: Brain
4. Cerebral Cortex
   REMEMBER: it’s important to know that nausea because it has different causes there are different medications that work based on which of those tracts that is being stimulated to cause the nausea and vomiting.

Question 3

This location in the body has chemo receptors that detect chemicals and stretch receptors that detect being over full. the gut is lucky that it has those chemo receptors and that is the primary source/primary route for toxin ingestion.
What pathway to the emetic center of the brain is this?

Answer 3

GI Tract
Ex. Have you ever eaten so much that you feel like throwing up? That is because you are stimulating those stress receptors.

Question 4

Nausea and vomiting is triggered by vagus nerve stimulation.
The neurotransmitters involved include: serotonin, acetylcholine, histamine and substance P [amino acid]
What pathway to the emetic center of the brain is this?

Answer 4

GI Tract

Cranial Nerve X is the Vagus this increases peristalsis???

Question 5

GI tract chemoreceptors are the major mediators of toxic effects of some chemotherapy drugs. If your patient is on _______ even when the drug is given IV. It doesn’t have to be something that the patient is taking orally it can be an IV medication that is still stimulating those chemo receptors in the gut so you have to know which medication to give to prevent and treat nausea. Hopefully the physician ordering the chemo is aware of that too. What pathway to the emetic center of the brain is this?

Answer 5

CISPLATIN
GI Tract
REMEMBER: if you have a patient that is on Cisplatin IV for chemo you will want to give them a medication that works on the GI pathway for nausea and vomiting.
Study Tip: This is IMPORTANT. This is something to look out for when you are working on a floor where you give chemotherapy.

Question 6

This pathway is located in the medulla it communicates with the emetic center and the chemoreceptors sense chemicals in blood and is very sensitive to any increase in blood levels and when substances are detected, nausea and vomiting is triggered.
What pathway to the emetic center of the brain is this?

Answer 6

Chemoreceptor Trigger Zone (CTZ)

Study Tip: Nausea and vomiting prevents the absorption of the toxins and hopefully this happens before the amount of toxin that is absorbed is going to be harmful to the organism.

Question 7

These are controlled by opioid related nausea and vomiting related to stimulation of dopamine receptors.
The neurotransmitters involved include: Dopamine and Serotonin
What pathway to the emetic center of the brain is this?

Answer 7

Chemoreceptor Trigger Zone (CTZ)

Ex. If you a pt that has opioid induced n/v you want to give them a medication that works on the chemoreceptor trigger zone.

Question 8

Motion sickness is stimulated by motion and body position so that means you get car sick, sick on an airplane, or sick on the ocean, and there are specific medications that treat that.
What pathway to the emetic center of the brain is this?

Answer 8

Vestibular Apparatus

Question 9

This pathway senses neurotoxins such as ETOH (ethyl alcohol). When you go out with your friends on the weekend,this is what prevents you from drinking yourself to death this is why you throw up.
What pathway to the emetic center of the brain is this?

Answer 9

Vestibular Apparatus
Ex. The person can drink too much, too fast, and get ahead of this protective mechanism and they end up dying from alcohol poisoning.

Question 10

Taste, sight, smell, and memory of past experiences with nausea.
This is called anticipatory nausea.
The neurological pathways are not well understood here.
What pathway to the emetic center of the brain is this?

Answer 10

Cerebral Cortex

Study Tip: I can tell you that taking a DEEP BREATH and thinking about something else does help with this.

Question 11

What are the definitions for the mnemonic VOMIT which helps you remember the causes of nausea and vomiting?

Answer 11

Vestibular Apparatus
Obstruction
-Opioids cause decreased bowel motility
Mental 
-Dysmotility aka motion sickness
Infection or Irritation of the gut
-Gastrointestinal 
Toxins or Taste 
- Memories of past nauseating irritants to the senses.

Question 12

______ drugs work against the pathways that lead to throwing up.

Answer 12

Anti-Emetics

Question 13

These medications works against throwing up by increasing the rate of gastric emptying and enhances lower esophageal tone LES tone. This is the mechanism of action of what therapeutic classification of medications?

Answer 13

Anti-emetics for the GI tract pathway

Ex. Metoclopramide/Reglan

Question 14

The medication ________ is used for people with tube feedings, diabetic gastroparesis, also chemo-induced nausea and vomiting.

Answer 14

Metoclopramide/Reglan

Ex. Metoclopramide/Reglan causes increase gastric motility. This is an anti-emetic for the GI tract pathway.

Question 15

This medication inhibits impulses from inner ear to vestibular pathway for control of motion sickness. This is the mechanism of action of what therapeutic classification of medications?

Answer 15

Anti-emetics for the Vestibular Apparatus Pathway

Question 16

This medication works on the CNS to prevent nausea and vomiting specifically used for nausea and vomiting associated with chemotherapy. This is the mechanism of action of what therapeutic classification of medications?

Answer 16

Anti-emetics for the Cerebral Cortex and Medulla.

Question 17

Usually well absorbed from GI tract.
Distribution not known.
Excreted in urine and feces.
So you have to make sure that your patient is peeing and pooping normally.
These are the pharmacokinetics for what therapeutic classification of medication?

Answer 17

Anti-Emetics

Study Tip: Monitor Output

Question 18

These drugs get metabolized by the liver so you have to watch liver function.
These are the pharmacokinetics for what therapeutic classification of medication?

Answer 18

Anti-Emetics

Study Tip: Monitor Liver Function Test results.

Question 19

This class of medications stimulate the sympathetic nervous system because this class of drugs affects the parasympathetic nervous system. These drugs are used for motion sickness. 
What class of anti-emetics is this?

Answer 19

Anticholinergics

Ex. Scopolamine

Question 20

This class of medications blocks acetylcholine receptors in the vestibular apparatus but they also dry out GI secretions to (decrease or increase) GI irritation. 
What class of anti-emetics is this?

Answer 20

Anticholinergics

Question 21

__________ is a medication that is used for sea sickness and sometimes people will get a prescription for this medication if they are going on an airplane, a long trip, if they have car sickness, or motion sickness.

Answer 21

Scopolamine

Study Tip: This is an Anticholinergic.

Question 22

This class of medications inhibits vestibular apparatus stimulation. These are commonly strongly anti-cholinergic and DO NOT work for opioid induced nausea.
What class of anti-emetics is this?

Answer 22

Antihistamines - H1 receptor blockers
IMPORTANT: Poor choice of antiemetic drug to treat opiate induced N/V, though often used.
Ex. Promethazine or Phenergan

Question 23

The medication _________ can work very well as an anti-emetic for some patient’s and it might have side effects for other people.

Answer 23

Promethazine or Phenergan
Ex. It is just unique to the individual and if somebody doesn’t have a good experience with that they we will switch them to a different anti-emetic. This is an old medication though and it’s pretty cheap so that might be one reason why it might be used.

Question 24

This class of medications can be used for opioid related nausea and vomiting. These drugs have weak anti-cholinergic effects but it blocks dopamine receptors in the chemoreceptor trigger zone aka CTZ
What class of anti-emetics is this?

Answer 24

Antidopaminergics

Ex. Prochlorperazine/Compazine

Question 25

What is the name of the drug that blocks dopamine receptors in the chemoreceptor trigger zone aka CTZ?

Answer 25

Prochlorperazine/Compazine

Question 26

This class of medications stimulates GI motility to increase excretion of some anti-neoplastic drugs.
What class of anti-emetics is this?

Answer 26

Prokinetics

Question 27

This class of medications is used to treat nausea and vomiting associated with chemotherapy and post-op nausea and vomiting. 
What class of anti-emetics is this?

Answer 27

Serotonin receptor blockers
Zofran
REMEMBER: These meds do not have any effect on the mood enhancing drugs that are used for some psych patients so you don’t have to worry about that. Ex. selective serotonin reuptake inhibitor (SSRI’s)

Question 28

This class of medications are the active chemicals in marijuana and can be useful for nausea and vomiting associated with chemotherapy. They are also used to treat anorexia and weight loss in patients with AIDs and cancer. 
What class of anti-emetics is this?

Answer 28

Tetrahydrocannabinoids
Ex. Actually some of the patients can be pretty happy and fun when you give them Marinol which is the name of a mediation with the Tetrahydrocannabinoids in it.

Question 29

This medication is a GI Stimulant. This medication can cause extrapyramidal movements especially in young adults with long term use which means they have symptoms that look like Parkinson’s Disease.
What anti-emetic drug used for the treatment of cancer is this?

Answer 29

Metoclopramide (Reglan
Study Tip: Patient’s that have been on Reglan for a long term that have Parkinson’s like symptoms and then we stop the Reglan and their symptoms go away.
Ex. A husband had researched all of his wives meds and kept telling the doctors that it was her Reglan that made her tremor and they ignored him until he found the one doctor that would listen and they took her off the medication and her symptoms went away.

Question 30

This medication is an antagonistic substance that causes receptors in the brain to be activated. This medication increases the anti-emetic action of Zofran. This is a miscellaneous anti-emetic. The side effects include headaches, dizziness, insomnia, GI disturbance, and it could cause contraceptives not to work.
What anti-emetic drug used for the treatment of cancer is this?

Answer 30

Aprepitant / Emend
Ex. Zofran is like the most important kid in class right now, this is a very popular anti-emetic so this would be given in addition to that to make it work better.

Question 31

This medication is the only commercially available THC derivative. This is the active ingredient for marijuana, it has been used to treat nausea and vomiting since 1985. It is usually used after other medications have failed.
What anti-emetic drug used for the treatment of cancer is this?

Answer 31

Dronabinol / Marinol > THC

Question 32

This medication is an anti-emetic but I t is also used to stimulate appetite and weight gain. Look it up in your drug guide, and look at the dosages for different usages, often times the dosages will be different depending on what it’s being used for and the ONLY contraindication for this drug is if they are allergic.
What anti-emetic drug used for the treatment of cancer is this?

Answer 32

Dronabinol / Marinol > THC

Question 33

This is the MOST POPULAR anti-emetic being used RIGHT NOW.
Ondansetron (Zofran)-seen the most frequently in hospitals
Palonosetron (Aloxi)
Granisetron (Kytril)-might see this one in hospitals
Dolasetron (Anzemet)
What class of anti-emetics is this?

Answer 33

Serotonin Blockers aka

5-HT3 Receptor Blockers

Question 34

This is the one that I was talking about that seems to be the most popular right now. Ondansetron / Zofran the most and ________ in a close second place.

Answer 34

Granisetron

Question 35

5-HT3 is just the chemical name for ________. These drugs have a very specific action so as a result the drug will have no serious drug interactions or adverse effects they are usually given within the first 24-48 hours of chemotherapy and have been shown to be very effective against nausea and vomiting. They are given for post-op nausea and vomiting.

Answer 35

Serotonin > Serotonin Blocker Drugs
Study Tip: This is a very expensive drug, but it’s very effective, sometimes it’s used even when other older, cheaper drugs could be just as effective like Compazine.

Question 36

Contraindications:
A known drug allergy
If they are allergic to it.
Drug specific contraindications.
No other contraindications.
These are the contraindications for what classification of drugs?

Answer 36

anti-emetic class

Question 37

Headache (has a higher occurrence in cancer patient), dizziness, drowsiness, fatigue, weakness; some of these anti-emetic drugs have a sedative effect.
These are the adverse effects of anti-emetic drugs that affect what body system?

Answer 37

CNS

Question 38

Constipation, diarrhea, dry mouth, abdominal pain, increase liver enzymes and what that means that when there is damage to liver cells there are enzymes that are released from the liver increase and so the # of those in the blood will go up as a consequence.
These are the adverse effects of anti-emetic drugs that affect what body system?

Answer 38

Gastrointestinal

Question 39

Extrapyramidal reactions is what I was talking about when talking about with Metoclopramide (Reglan) which can cause Parkinson’s like symptoms and if the symptoms in time and stop the medication those symptoms will go away.
These are the adverse effects of anti-emetic drugs that affect what body system?

Answer 39

Neurological

Question 40

Antiemetics can have an _______ effect when given with other medications that are CNS depressants.

Answer 40

additive
Ex. Metoclopramide can alter GI absorption of other drugs and that makes sense right, because it stimulates peristalsis so it will cause drugs to move more quickly through the GI tract.

Question 41

Anti-Emetic drugs interact with these medications which depress the CNS these include: opioids, such as ___________ and any type of sedative or hypnotic drug.

Answer 41

diphenhydramine / Benadryl

Question 42

What do you do as the nurse if you have a patient that has a creatinine clearance less than 40ml/min or a renal impairment and they are on Metoclopramide /Reglan?

Answer 42

Lower dose of metoclopramide (by 50%) if creatinine clearance is at 40ml/min

Question 43

Always assess because we want to make sure that the medication is doing what we want it to do.
Assess for nausea, vomiting, and fluid and electrolyte imbalances after administering this therapeutic classification of medications.

Answer 43

Anti-Emetics

Question 44

Caution patient to avoid activities requiring alertness when using anti-emetics because they can cause sedation. Tell the patient about the additive CNS effects especially with alcohol. That means no ETOH for the patient while on these medications.
What nursing intervention is this considered?

Answer 44

Patient Education

Question 45

Tell the patient about dry mouth prevention: mouth rinses, oral hygiene, sugarless gum and candy can help stimulate saliva production.
What nursing intervention is this considered?

Answer 45

Patient Education

Question 46

Nausea R/T abnormal metabolites secondary to Cancer, or cancer medications AEB aversion to food, gagging, increased swallowing, report of nausea and c/o sour taste in mouth.
What part of the nursing process is this?

Answer 46

Nursing Diagnosis - NANDA

Question 47

Patient will state relief of nausea within 30 minutes of receiving intervention.
What part of the nursing process is this?

Answer 47

Planning

Question 48

Once you perform your interventions, you need to remember to go back and document that the pt had n/v or document if it was _______. Then you document that you administered the med and whether or not they had nausea and vomiting . If they did have nausea or vomiting document your interventions and then go back to evaluate and document if it was effective.

Answer 48

Premedication Ex. “the patient said that the massage made the nausea go away” patient states that the ginger root made the sensation of the nausea go away, because nausea is subjective so you will have to get the patient’s input on that always remember to go back and evaluate after you have intervened. Just like with pain assessment.
This is IMPORTANT!

Question 49

Pre-medicate for patient receiving ________. Give an anti-emetic beforehand and then routinely for 24-48 hours following this treatment.

Answer 49

Chemotherapy

Question 50

ALWAYS provide oral care after emesis.

Is this a collaborative or independent nursing intervention?

Answer 50

Independent
Study Tip: This is a wash cloth to wash their face and hands after they have an emesis. I think that is so disgusting when that doesn’t get done.

Question 51

Non-pharmacological interventions include:
acupressure
acupuncture
music therapy
distraction therapy
Is this a collaborative or independent nursing intervention?

Answer 51

Independent
Study Tip: Music therapy can be done if they have some favorite music that helps to relax them, they can bring that in and listen to it. I haven’t seen acupressure & acupuncture done in the hospital they would probably have to seek that on their own, but you can recommend it.

Question 52

Administer appropriate medications. Anti-emetics or other medications.
Is this a collaborative or independent nursing intervention?

Answer 52

Collaborative

Study Tip: This is collaborative because you need an order for the medications.

Question 53

Patient will explain methods that can be used to decrease nausea and vomiting (N&V)
What part of the nursing process is this?

Answer 53

Planning

Study Tip: if you are looking for an educational goal and you have someone going home or someone who is not going home.

Question 54

Determine cause/risk for N/V. Determine are they on any medications that might cause them to have n/v. The first set of interventions are set for any pt that have an increased risk for n/v.
Is this a collaborative or independent nursing intervention?

Answer 54

Independent
Study Tip: Ex. we are looking at our cancer patient that is getting chemo we know that they are on medications that cause nausea and vomiting.

Question 55

Implement appropriate dietary measures.
Dietary Restrictions:
NPO and small frequent meals.
Low-fat.
Avoid spicy, fatty, or highly salty foods.
For some patient’s giving them salty foods helps with the nausea, but fatty foods DO NOT help with nausea
Is this a collaborative or independent nursing intervention?

Answer 55

Independent and Collaborative
Giving these foods as snacks is something that you can do independently.
It can be considered collaborative because you do need a diet order but if you have a pt that you think they need to stop eating (NPO) right now for some reason, you can do that and let the physician know afterwards.

Question 56

Administer appropriate medications. Anti-emetics or other medications.
Is this a collaborative or independent nursing intervention?

Answer 56

Collaborative

Study Tip: This is collaborative because you need an order for the medications.

Question 57

Non-pharmacological:
acupressure
acupuncture
music therapy
distraction therapy
Is this a collaborative or independent nursing intervention?

Answer 57

Independent
Study Tip: Music therapy can be done if they have some favorite music that helps to relax them, they can bring that in and listen to it. I haven’t seen acupressure & acupuncture done in the hospital they would probably have to seek that on their own, but you can recommend it.

Question 58

ALWAYS provide oral care after emesis.

Is this a collaborative or independent nursing intervention?

Answer 58

Independent
Study Tip: This is a wash cloth to wash their face and hands after they have an emesis. I think that is so disgusting when that doesn’t get done.

Question 59

Pre-medicate for patient receiving ________. Give an anti-emetic beforehand and then routinely for 24-48 hours following this treatment.

Answer 59

Chemotherapy

Question 60

Once you perform your interventions, you need to remember to go back and document that the pt had n/v or document if it’s called ______. Then you document that you administered medications and whether or not they had nausea and vomiting. If they did have nausea or vomiting document your interventions and then go back to evaluate and document if it was effective.

Answer 60

premedication
Ex. “the patient said that the massage made the nausea go away” or “patient states that the ginger root made the sensation of the nausea go away” Nausea is subjective so you will have to get the patient’s input on that always remember to go back and evaluate after you have intervened. Just like with pain assessment.