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36 Cards in this Set

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CINV
chmotherapy indeuced nause vomiting
Potential mechanisms for CINV
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
Central mechanism for CINV
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
Peripheral mechanism for CINV
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
Role of Neurptransmitters in CINV Pathway
Dopamine
Histamine
Serotonin-main chemo
Substance P- next biggest chemo
Acetylcholine
Serotonin (5HT3) receptor Antagonists
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
5HT3 Receptor antagonists Adverse Events
Headache, constipation, diarrhea, EKG changes (concern only w/ prior arrhyth)
Examples of 5HT3receptor
Ondansetron (Zofran), Graisetron (Kytril), Granisetron (Sancuso)patch lasts 7 days, Dolasteron (Anzemet), Palonosetron (Aloxi)-IV dose lasting 3-5 days
Neurokinin-1 Receptor Antagonists
Inhibit Substance P
Indicated for the prevention of acute and delayed CINV in combo w/ serotonin antagonists and corticosteroids
Drug Interactions: Steroids
Steroids should be decr by 50% IV and 25% PO
Aprepitant
elev
Dopamine Receptor Antagonists
Phenothiazines-prochlorperazine (compazine), promethazine (phenergan)
Phenothiazines
effective for delayed NV
Adverse events with Phenothiazines
Akathisia
dystonia
sedation
Substitued Benzamides
blocks dopamine inthe CTZ and peripherally: incr esophageal sphincter tone, improves gastric emptying, incr transit through small bowel
Adverse Events with Substituted Benzamides
EPS, restlessness, sedation, fatigue, nausea and diarrhea (dexamethasone may decr diarrhea)- if serotonin failed
Prochlorperazine
more potent but has more Side Effects
Benzodiazepines
Possess amnesic, anxiolytic and sedative properties. Used for anticipatory nausea, no effective for preventing emesis and usu given w/ other antiemetics. Retrograde amnesia
Corticosteroids
incr apetite, improve mood and sense of well being. Immunosuppression. May incr diff of WBC and therefore is nor given in acute myelogenous leukemia.
Adverse events with Corticosteroids
mood changes, anxiety, euphoria, headache, metallic taste, abdominal discomfort
Cannabinoids
Dronabinol (Marinol)
Dronabinol (Marinol)
Les effective than metoclopramide but more effective than phenothiazines. Beneficial in younger pts.
Anticholinergics
Scopalomine. Used for nausea assoc with movements
Growth Factors
Reg's hematopoiesis. Also has effects on mature cells
Examples of commercially available CSFs
Granulocyte colony stimulating
Activity of G- CSF Filgrastim (Neupogen)
supports prolif of neurophils
Advers effects with Filgrastim
bone pain
Pegylated Filgrastim (neulasta)
larger chemical structure makes clearance longer and allows administration once after chemo
GM-CSF Sargramostim (Leukine)
Stimulates CFU-GM and CFU-GEMM to increase neutrophils, macros, monos, and eos. No clin signifigant activity on other cell lines
Sargramostim Adverse Events
Feverm headache, myalgias, arthralgias
Activity of EPO Erythropoietin (procrit/Epogen)
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
Indications of EPO
end stage renal disease
Adverse events of EPO
Hypertension, headache
Darbopoietin (AraNesp)
larger molecule with more carb groups ro allow for slower elimination
IL-11 Activity

dinosaur
promotes megakaryocyte production. Prevents severe thrombocytopenia.
Adverse Events with IL-11
Atrial Arrhythmias, peripheral edema, tachycardia