Side effect management

Question 1

CINV

Answer 1

chemotherapy-induced nausea and vomiting

• administer antiemetics at least 30 minutes prior
• provide take home meds: ondansetron, prochlorperazine, metoclopramide

Question 2

patient factors which increase risk of nausea and vomiting:

Answer 2

1) female gender
2) < 50 years old
3) dehydration
4) history of motion sickness
5) history of nausea and vomiting with prior regimens

Question 3

3 subtypes of CINV

Answer 3

1) acute
2) delayed
3) anticipatory

Question 4

Acute CINV

Answer 4

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

Question 5

Delayed CINV

Answer 5

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)

Question 6

Anticipatory CINV

Answer 6

RISK FACTORS:
: history of CINV with previous chemo regimen

ONSET:
: before chemo

DRUG THERAPY:
: benzodiazepines

Question 7

5HT-3 RAs

Answer 7

• ondansetron
• granisetron
• dolasetron
• palonosetron

Question 8

NK1-RA

Answer 8

• aprepitant PO
• fosaprepitant IV
• rolapitant

Question 9

other antiemetics

Answer 9

• netupitant/palonosetron (Akynzeo)
• olanzapine
• dexamethasone

Question 10

ANTIEMETIC REGIMEN for HIGH EMETIC RISK

Answer 10

Use 3 drugs

• NK1-RA + 5HT3-RA + dexamethasone
• netupitant/palonosetron (Akynzeo) + dexamethasone
• olanzapine + palonosetron + dexamethasone

Question 11

ANTIEMETIC REGIMEN FOR MODERATE EMETIC RISK

Answer 11

Use 2 or 3 drugs

• NK1-RA + 5HT3-RA + dexamethasone
• 5HT3-RA + dexamethasone
• netupitant/palonosetron + dexamethasone
• olanzapine + palonosetron + dexamethasone

Question 12

ANTIEMETIC REGIMEN FOR LOW EMETIC RISK

Answer 12

Use 1 drug (any except NK1-RA)

• 5HT3-RA
• dexamethasone
• prochlorperazine
• metoclopramide

Question 13

substance P/NK-1 receptor antagonists

Answer 13

• inhibit substance P/neurokinin-1 receptor
• augment the antiemetic activity of the 5HT3 receptor antagonists and corticosteroids to inhibit acute & delayed phases of emesis

Question 14

aprepitant & fosaprepitant

Answer 14

Emend

• aprepitant PO
• fosaprepitant IV
• 3A4 inhibitors
• doses of dexamethasone should be increased with concurrent use

Question 15

netupitant + palonosetron

Answer 15

Akynzeo
- substance P/NK-1 receptor antagonist

• PO capsules
• 300/0.5mg one hour before chemo

Question 16

5HT3-receptor antagonists

Answer 16

• 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

Question 17

ondansetron

Answer 17

Zofran
PO: 16-24mg
IV: 8-16mg

Question 18

palonosetron

Answer 18

Aloxi

IV: 0.25mg

Question 19

dexamethasone

Answer 19

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

Question 20

Hand-Foot Syndrome

Answer 20

• 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

Question 21

Hypercalcemia of Malignancy SYMPTOMS

Answer 21

• nausea
• vomiting
• fatigue
• dehydration
• renal failure
• mental status changes