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PHM 703- Oncology, Hematology > Supportive Care In Oncology: CINV > Flashcards

Supportive Care In Oncology: CINV Flashcards

1
Q

Two pathways of CINV

A

Peripheral and central

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2
Q

Peripheral pathway of CINV properties (what it’s mediated by, where it originates, how soon after chemo is it activated, what type of emesis is it associated with)

A

mediated by serotonin
originates in GI tract
activated in the first 24hrs after chemo
associated with acute emesis

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3
Q

Central pathway of CINV properties (what it’s mediated by, where it originates, what type of emesis is it associated with)

A

mediated by NK-1
occurs primarily in the brain
predominantly involved in delayed CINV

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4
Q

Classes of CINV: acute

A

occurs within first 24 hours after chemo

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5
Q

CINV classes: delayed

A

occurs 24hrs-several days after chemo (days 2-5)

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6
Q

CINV classes: breakthrough

A

occurs despite prophylaxis

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7
Q

CINV classes: anticipatory

A

occurs before a treatment as a conditioned response to the occurrence of CINV in a previous cycle

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8
Q

CINV classes: refractory

A

recurring in subsequent cycles of therapy, excluding anticipatory CINV

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9
Q

Risk factors for CINV

A

age <50, female, emetic potential of chemo (high >90%, moderate >30-90% for IV, ≥30% moderate for PO), little or no previous alcohol use, history of CINV/prone to motion sickness, emesis during pregnancy

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10
Q

Emesis prevention for acute/delayed CINV with parenteral agents: high risk, preferred regimen

A

Day 1: Olanzapine, dexamethasone, NK1RA, 5-HT3 RA
Days 2-4: Olanzapine, dexa, aprepitant (if PO formulation given on day 1)

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11
Q

Exception with IV formulation of aprepitant

A

If the IV formulation is used, DO NOT ADMINISTER AFTER DAY 1!

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12
Q

Emesis prevention for acute/delayed CINV with parenteral agents: moderate risk

A

Day 1: dexamethasone, 5-HT3 RA
Days 2-3: dexa or 5-HT3 RA

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13
Q

Emesis prevention for acute/delayed CINV with parenteral agents: low risk

A

Dexamethasone
Metoclopramide
Prochlorperazine
5-HT3 RA

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14
Q

Emesis prevention for acute/delayed CINV with parenteral agents: minimal risk

A

No prophy

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15
Q

Emesis prevention for acute/delayed CINV with oral agents: high-moderate risk

A

5-HT3 RA

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16
Q

Emesis prevention for acute/delayed CINV with oral agents: low-minimal risk

A

PRN antiemetics

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17
Q

Breakthrough emesis treatment

A

Add one agent from a different drug class to regimen with ATC dosing
Consider antacid therapy if patient has dyspepsia

18
Q

Breakthrough emesis treatment options

A

Olanzapine, lorazepam, dronabinol, 5-HT3 RA, prochlorperazine, dexamethasone, metoclopramide, scopolamine

19
Q

What med should you NOT use for breakthrough emesis and why?

A

Palonosetron, because it has a long half-life (40 hours!)

20
Q

Anticipatory emesis treatment

A

Prevention is key!
Avoid strong smells that trigger symptoms
Lorazepam
Behavioral therapy

21
Q

Dexamethasone place in therapy

A

Part of the backbone in parenteral CINV regimens

22
Q

Dexamethasone AEs

A

Insomnia
Dyspepsia
Hyperglycemia
HTN

23
Q

5-HT3 RAs used in CINV

A

Ondansetron, palonosetron, granisetron

24
Q

5-HT3 RAs place in therapy for CINV

A

Ondansetron and granisetron are used in acute
Palonosetron used in acute and delayed

25
Q

5-HT3 RA AEs

A

HA, constipation, QTc prolongation

26
Q

NK1 RAs used in CINV

A

Aprepitant
Fosaprepitant
Rolapitant
Fosnetupitant
Netupitant

27
Q

NK1 RAs role in CINV treatment

A

Prevention, not treatment

28
Q

NK1 RAs DDI

A

Inhibition of 3A4 and 2C9; decrease dexa dose to 8mg QD on days 2-4 (exception is rolapitant)

29
Q

Rolapitant dosing schedule exception

A

Don’t administer rolapitant <2 week intervals due to extended half-life (1 week)

30
Q

NK1 RAs AEs

A

Fatigue, GI upset, HA, hiccups

31
Q

Olanzapine place in CINV treatment

A

Prevention and breakthrough

32
Q

Olanzapine AEs

A

Sedation: administer at HS and consider lower dose in elderly
Hyperglycemia
Fatigue
QTc prolongation
Weight gain/metabolic AEs

33
Q

Prochlorperazine, metoclopramide, promethazine place in CINV therapy

A

Breakthrough

34
Q

Prochlorperazine and promethazine AEs

A

drowsiness, constipation

35
Q

Metoclopramide AEs

A

drowsiness, diarrhea, QTc prolongation, tardive dyskinesia (don’t use >12 weeks)

36
Q

Lorazepam, alprazolam place in CINV treatment

A

Anticipatory CINV or breakthrough CINV with an anxiety component

37
Q

BZDs AEs

A

Sedation, dizziness

38
Q

When to give BZDs in CINV

A

Night before or morning of chemo (or both)

39
Q

Dronabinol place in CINV therapy

A

Refractory disease

40
Q

Dronabinol AEs

A

Sedation
Euphoria/hallucinations
Palpitations
Flushing
Cough

41
Q

Scopolamine place in CINV therapy

A

Breakthrough

PHM 703- Oncology, Hematology (15 decks)

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