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36 Cards in this Set
- Front
- Back
CINV
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chmotherapy indeuced nause vomiting
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Potential mechanisms for CINV
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stim of chemoreceptor trigger zone (CTZ-outside of bbb), peripheral mechanisms (damage GI mucosa or neurotransmitter receptors), Cortical mechanisms (direct cerebral activation, indirect-psychogenic mechanisms, vestibular mechanism, alt of taste and smell
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Central mechanism for CINV
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chemotherapeutic agent activates the CTZ located in the area postrema in th ebrainstem. Activated CTZ invokes release o various neurotransmitters, which activate brainstem vomiting centers
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Peripheral mechanism for CINV
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chemotherapeutic agent causes GI irritation and damage to GI mucosa, resulting in release of neurotransmitters(serotonin). Activated receptors mediated by vagal afferents send signals to brainstem vomiting center
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Role of Neurptransmitters in CINV Pathway
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Dopamine
Histamine Serotonin-main chemo Substance P- next biggest chemo Acetylcholine |
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Serotonin (5HT3) receptor Antagonists
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blocks serotonin both centrally and peripherally. Effective for acute NV but not anymore effective for delayed NV than other therapies. most effective if given 30 min before chemo. incr efficacy when given with corticosteroids (to 90%) synergistic effect
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5HT3 Receptor antagonists Adverse Events
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Headache, constipation, diarrhea, EKG changes (concern only w/ prior arrhyth)
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Examples of 5HT3receptor
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Ondansetron (Zofran), Graisetron (Kytril), Granisetron (Sancuso)patch lasts 7 days, Dolasteron (Anzemet), Palonosetron (Aloxi)-IV dose lasting 3-5 days
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Neurokinin-1 Receptor Antagonists
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Inhibit Substance P
Indicated for the prevention of acute and delayed CINV in combo w/ serotonin antagonists and corticosteroids |
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Drug Interactions: Steroids
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Steroids should be decr by 50% IV and 25% PO
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Aprepitant
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elev
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Dopamine Receptor Antagonists
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Phenothiazines-prochlorperazine (compazine), promethazine (phenergan)
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Phenothiazines
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effective for delayed NV
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Adverse events with Phenothiazines
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Akathisia
dystonia sedation |
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Substitued Benzamides
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blocks dopamine inthe CTZ and peripherally: incr esophageal sphincter tone, improves gastric emptying, incr transit through small bowel
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Adverse Events with Substituted Benzamides
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EPS, restlessness, sedation, fatigue, nausea and diarrhea (dexamethasone may decr diarrhea)- if serotonin failed
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Prochlorperazine
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more potent but has more Side Effects
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Benzodiazepines
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Possess amnesic, anxiolytic and sedative properties. Used for anticipatory nausea, no effective for preventing emesis and usu given w/ other antiemetics. Retrograde amnesia
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Corticosteroids
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incr apetite, improve mood and sense of well being. Immunosuppression. May incr diff of WBC and therefore is nor given in acute myelogenous leukemia.
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Adverse events with Corticosteroids
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mood changes, anxiety, euphoria, headache, metallic taste, abdominal discomfort
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Cannabinoids
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Dronabinol (Marinol)
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Dronabinol (Marinol)
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Les effective than metoclopramide but more effective than phenothiazines. Beneficial in younger pts.
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Anticholinergics
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Scopalomine. Used for nausea assoc with movements
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Growth Factors
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Reg's hematopoiesis. Also has effects on mature cells
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Examples of commercially available CSFs
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Granulocyte colony stimulating
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Activity of G- CSF Filgrastim (Neupogen)
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supports prolif of neurophils
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Advers effects with Filgrastim
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bone pain
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Pegylated Filgrastim (neulasta)
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larger chemical structure makes clearance longer and allows administration once after chemo
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GM-CSF Sargramostim (Leukine)
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Stimulates CFU-GM and CFU-GEMM to increase neutrophils, macros, monos, and eos. No clin signifigant activity on other cell lines
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Sargramostim Adverse Events
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Feverm headache, myalgias, arthralgias
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Activity of EPO Erythropoietin (procrit/Epogen)
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enhances RBS production (inc HCT), Decr need for RBC transfusions. Patients should have HB <10 or Hct<30%. Requires 2-6 wks to see response. Monitor iron stores
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Indications of EPO
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end stage renal disease
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Adverse events of EPO
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Hypertension, headache
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Darbopoietin (AraNesp)
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larger molecule with more carb groups ro allow for slower elimination
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IL-11 Activity
dinosaur |
promotes megakaryocyte production. Prevents severe thrombocytopenia.
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Adverse Events with IL-11
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Atrial Arrhythmias, peripheral edema, tachycardia
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