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70 Cards in this Set
- Front
- Back
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What chemotherapy agents puts patients in group 5 (>90%)?
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Carmustine
Cyclophosphamide (>1500mg/m2) Most nitrogen mustards Cyclophosphamide/doxorubicin Cisplatin >50mg/m2 Dacarbazine Streptozocin |
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What chemotherapy agents puts patients in group 4 (60-90%)?
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Anthracycllines
Carboplatin |
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What chemotherapy agents puts patients in group 1 (<10%)?
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Vinca alkaloids
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List the 5-HT3 Receptor Antagonists
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Ondansetron
Granisetron Dolasetron Palonosetron |
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List the NK-1 Receptor Antagonists
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Aprepitant
Fosaprepitant |
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List the corticosteroids used as antiemetics
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Dexamethasone
Methylprednisone |
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What are the side effects of 5-HT3 receptor antagonists?
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Constipation
Diarrhea Headache Light-headedness |
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What is the mechanism of action of 5-HT3 receptor antagonists?
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Inhibits peripheral and central serotonin receptors
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True or false: 5-HT3 receptor antagonists work well for delayed emesis
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False. 5-HT3 receptor antagonists are less effective for delayed emesis (except for Palonosetron)
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Which 5-HT3 receptor antagonist can be used for delayed emesis?
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Palonosetron
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Palonosetron
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Aloxi
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Granisetron
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Kytril
Sancusco |
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Ondansetron
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Zofran
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What information should you tell your patient when using Sancusco?
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Indicated for up to 5 days
Avoid sun exposure to application site during use and for 10 days after removal. |
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What is a unique adverse effect of Palonosetron?
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QTc prolongation <1%
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Palonosetron IV dose
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0.25mg 30min before chemo
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Palonosetron PO dose
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0.50mg 1 hour before chemo
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Dolasetron
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Anzemet
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Dolasetron IV dose
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100mg 30min before chemo
Then 100mg IV QD (if used for more than one day) |
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Dolasetron PO dose
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100mg PO 1 hour before chemo
Then 100mg PO QD (if used for more than one day) |
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Ondansetron IV dose
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8-32mg 30min before chemo (then 8-32mg PO QD, if used for more than one day)
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Ondansetron PO dose
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8-32mg 30min before chemo (then 8-32mg PO QD , if used for more than one day)
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Granisetron IV dose
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10mcg/kg 30 min before chemo (max 1mg) or
1mg before chemo (then 1mg IV QD, if used for more than one day) |
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Granisetron PO dose
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Prevention of CINV or radiation induced N/V:
2mg 1 hour before chemo or radiation OR 1mg 1 hour before chemo and 1mg 12 hours later (then 2mg PO QD or 1mg PO BID, if used for more than one day) |
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Granisetron (Sancusco)transdermal dosing
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One patch 24-48 hours before chemo.
The patch can be worn for up to 7 days. Remove the patch a minimum of 24 hours after completion of chemo. |
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What are the adverse drug reactions of Aprepitant and Fosaprepitant?
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Hiccups
Fatigue Constipation Headache Anorexia |
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NK-1 receptor antagonists provide a synergistic effect when combined with..
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5-HT3 receptor antagonists and
Corticosteroids |
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NK-1 receptor antagonists are indicated for
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Acute or delayed emesis with moderately and highly emetogenic chemotherapy in combination with 5-HT3 receptor antagonists and corticosteroids
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Combination of corticosteroids with_______ improves efficancy of acute antiemetic regimen
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5-HT3 receptor antagonists
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List the dopamine receptor antagonists.
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Metoclopramide
Prochlorperazine Thiethylperazine Chlorpromazine Droperidol Haloperidol Olanzepine |
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What is the MOA of dopamine receptor antagonists?
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D2 receptor antagonistm at CTZ.
Also posses antihistaminic and anticholinergic activities. |
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What is the concern about IV promethazine?
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Injectable promethazine can cause severe chemical irritation and damage to tissues
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metoclopramide
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Reglan
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Reglan
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metoclopramide
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prochlorperazine
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Compazine
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Compazine
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prochlorperazine
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promethazine
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Phenergan
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Phenergan
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promethazine
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Which dopamine receptor antagonist has a black box warning? What is the BBW?
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Droperidol
Black box warning: QT prolongation, torsades de pointes |
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What are the side effects of Dopamine receptor antagonists?
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EPS: dystonia, akathesia, tardive dyskinesia
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What is the MOA for cannabinoids?
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Stimulation of CB1 subtype of cannabinoid receptors at the vomiting center
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What is the dose of dronabinol?
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3.5mg TID to QID
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What are the side effects of dronabinol and which populations should this drug be avoided in?
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SE: euphoria, somnolence, anxiety, palpitations, tachycardia, vasodilation
Caution in pts with history of abuse and elderly |
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What are the side effects of Nabilone?
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Dizziness
Drowsiness Euphoria Coordination disturbance |
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Which patients should nabilone be avoided in?
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Patients with heart disease, history of abuse, psychiatric disorders, elderly
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Metoclopramide dose
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IV: 1-2mg/kg/dose 30 min before chemo
Then Q2H x 2 doses Then Q3H x 3 doses |
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Prochlorperazine IM dose
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IM: 5-10mg IM Q3H to Q4H PRN
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Prochlorperazine IV dose
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IV: 2.5-10mg IV Q3H to Q4H PRN
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Prochlorperazine PO dose
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5-10mg TID to QID
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Promethazine Dose:
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IM/IV/PO/PR: 12.5-25mg repeated Q4H-Q6H if needed.
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Aprepitant
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Emend
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Aprepitant IV dosing
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IV (fosaprepitant): 115mg 30 min before chemo on first day of chemo only, as a substitute for 125mg PO dose of of aprepitant
Then aprepitant 80mg PO daily for days 2-3 |
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Aprepitant PO dosing
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125mg 1 hour before chemo
Then 80mg QD for 2 days |
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Dexamethasone dosing
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12mg PO or IV day 1
8mg PO QD days 2-4 |
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Dexamethasone dosing for prevention of radiation induced N/V:
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4mg PO daily (upper abdomen)
or 2mg PO TID (total body radiation) start before radiation |
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High Risk (>90%) Prophylactic Treatment
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5-HT3 antagonist day 1 AND steroid days 1-4 AND NK-1 antagonist days 1-3
+/- benzodiazepine days 1-4 +/-H2 blocker or PPI |
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Moderate risk (60-90%) Prophylaxis treatment
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Day 1: 5-HT3 antagonist (palonosetron day 1 only) AND steroid +/- NK-1 antagonist*
+/- benzodiazepine +/- H2 blocker or PPI Day 2-3 (NK-1 antag used on day 1): NK-1 antagonist* AND/OR 5-HT3 antagonist AND/OR steroid +/- benzodiazepine +/- H2 blocker or PPI Days 2-3 (NK-1 antag not used on day 1): 5-HT3 antagonist AND/OR steroid +/- benzodiazepine +/- H2 blocker or PPI |
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Low Risk (10-30%)Prophylaxis Treatment
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Steroid OR metoclopramide OR prochlorperazine on day 1
+/-benzodiazepine +/- H2 blocker or PPI |
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Minimal Risk (<10%) Prophylaxis treatment
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No routine prophylaxis needed
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Treatment guidelines for delayed emesis with high emetogenic potential
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Continue prophylaxis for 2-3 days post completion of chemotherapy cycle
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Treatment guidelines for delayed emesis with moderate emetogenic potential
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Prevention depends on antiemetic agent used:
Palonosetron x 1 day +/- steroid +/- lorazepam +/- H2 blocker or PPi Aprepitant x 2-3days +/- steroid +/- lorazepam +/- H2 blocker or PPI Steroid or 5-HT3 antagonist +/-lorazepam +/- H2 blocker or PPI |
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For breakthrough pain, how should you modify the current regimen?
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Add an agent from a different class
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For Radiation induced emesis, what should be used to treat it?
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5-HT3 antagonist +/- steroid
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what are the cervical muscles of the neck?
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platysma and SCM
Platysma --> Cervical Branch of Facial N (CN VII) SCM --> Occiptal a. & Superior Thyroid a. & Motor: accessory n And Sensory: cervical plexus. |
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What are the consequences of chemotherapy induced nausea and vomiting?
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Dehydration/ electrolyte disturbances
Aspiration pneumonia Malnutrition and weight loss Decrease in QOL, physical functioning Refusal of treatment or noncompliance with cancer treatment Economic burden (ER, hospital admission) |
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What kinds of neurotransmitters are released as a result of chemotherapy?
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Serotonin
Dopamine Histamine Acetylcholine Endorphins Cannabinoids GABA Substance P |
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What are the major neuroreceptors associated with nausea and vomiting?
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Serotonin
Dopamine |
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What are the types of emesis?
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Acute
Delayed Anticipatory Breakthrough Refractory Radiation-induced |
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What are the patient specific risk factors for emesis?
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Female> male
Age: young age <50 years History of N/V with prior chemotherapy, motion sickness, or pregnancy Chronic alcohol intake history (non-alcoholic drinkers) Anxiety |
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What are the treatment specific risk factors for emesis?
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Emetogenecity
Chemotherapy regimen (repetitive dose, combination therapy, rapid infusion rate) Radiation field (site, dose, exposure) |
