Side effect management Flashcards
CINV
chemotherapy-induced nausea and vomiting
- administer antiemetics at least 30 minutes prior
- provide take home meds: ondansetron, prochlorperazine, metoclopramide
patient factors which increase risk of nausea and vomiting:
1) female gender
2) < 50 years old
3) dehydration
4) history of motion sickness
5) history of nausea and vomiting with prior regimens
3 subtypes of CINV
1) acute
2) delayed
3) anticipatory
Acute CINV
RISK FACTORS: \: female gender \: <50 yo \: dehydration \: history of motion sickness \: history of nausea/vomiting in prior regimens
ONSET:
: within 24h after chemo
MAJOR NEUROTRANSMITTERS:
: serotonin
DRUG THERAPY:
: 5HT-3 receptor antagonists
Delayed CINV
RISK FACTORS: \: anthracyclines \: platinum analogs \: cyclophosphamide & ifosfamide \: any chemo with high risk for causing acute CINV
ONSET:
: 1-7 days after chemo
MAJOR NEUROTRANSMITTERS:
: substance P
DRUG THERAPY:
: NK1 receptor antagonists
: corticosteroids
: palonosetron (only 5HT-3 RA with labeled indication for delayed emesis)
Anticipatory CINV
RISK FACTORS:
: history of CINV with previous chemo regimen
ONSET:
: before chemo
DRUG THERAPY:
: benzodiazepines
5HT-3 RAs
- ondansetron
- granisetron
- dolasetron
- palonosetron
NK1-RA
- aprepitant PO
- fosaprepitant IV
- rolapitant
other antiemetics
- netupitant/palonosetron (Akynzeo)
- olanzapine
- dexamethasone
ANTIEMETIC REGIMEN for HIGH EMETIC RISK
Use 3 drugs
- NK1-RA + 5HT3-RA + dexamethasone
- netupitant/palonosetron (Akynzeo) + dexamethasone
- olanzapine + palonosetron + dexamethasone
ANTIEMETIC REGIMEN FOR MODERATE EMETIC RISK
Use 2 or 3 drugs
- NK1-RA + 5HT3-RA + dexamethasone
- 5HT3-RA + dexamethasone
- netupitant/palonosetron + dexamethasone
- olanzapine + palonosetron + dexamethasone
ANTIEMETIC REGIMEN FOR LOW EMETIC RISK
Use 1 drug (any except NK1-RA)
- 5HT3-RA
- dexamethasone
- prochlorperazine
- metoclopramide
substance P/NK-1 receptor antagonists
- inhibit substance P/neurokinin-1 receptor
- augment the antiemetic activity of the 5HT3 receptor antagonists and corticosteroids to inhibit acute & delayed phases of emesis
aprepitant & fosaprepitant
Emend
- aprepitant PO
- fosaprepitant IV
- 3A4 inhibitors
- doses of dexamethasone should be increased with concurrent use
netupitant + palonosetron
Akynzeo
- substance P/NK-1 receptor antagonist
- PO capsules
- 300/0.5mg one hour before chemo
5HT3-receptor antagonists
- work by blocking serotonin both peripherally on vagal nerve terminals and centrally in chemoreceptor trigger zone
- may be given once prior to chemotherapy on day 1
ondansetron
Zofran
PO: 16-24mg
IV: 8-16mg
palonosetron
Aloxi
IV: 0.25mg
dexamethasone
Decadron
HIGH RISK
- 12mg PO/IV on day 1 + multi day regimen
- 20mg PO/IV on day 1 + multi day regimen
MODERATE RISK
- 12mg PO/IV on day 1 then 8mg PO/IV days 2-3
LOW RISK
-12mg PO/IV on days of chemo
Hand-Foot Syndrome
- palmar-plantar erythrodyesthesia
- 5-FU & capecitabine
- cytarabine
- liposomal doxorubicin
- multi-targeted TKIs: sorafenib + sunitinib
- redness, swelling, tenderness, pain, blisters, peeling of palms and soles
- dose reductions or delay treatment
- cooling procedures/compresses for temporary relief
- emollients for hands/feet
- corticosteroids/pain meds for inflammation and pain
Hypercalcemia of Malignancy SYMPTOMS
- nausea
- vomiting
- fatigue
- dehydration
- renal failure
- mental status changes
