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26 Cards in this Set

  • Front
  • Back
Causes of nausea and vomiting
1.Gastrointestinal--gastric outlet obstruction, radiation, uremia, hepatic metastasis

2.Central nervous system--drug induced (opiates, chemotherapy), increased intracranial pressure, anticipatory nausea and vomiting, severe pain

3. Metabolic--hypercalcemia, hypoadrenalism
Chemotherapy induced emesis:

Acute emesis
Occurring within the first 24 hours
Chemotherapy induced emesis:

Delayed emesis
Beginning at least 24 hours after administration of cancer chemotherapy.
Chemotherapy induced emesis:

Anticipatory nausea and vomiting
Conditioned response linked to experiencing poor emetic cotrol with previously administered chemotherapy
4 risk factors for N & V
1)Age < 40 years old

2)Women > Men

3)Emetic potential of drug MOST IMPORTANT

4)Alcoholics with less N/V

5) Previous history of vomiting after prior doses of chemotherapy.

6) Anxiety/Depression with INCR. N/V potential
How to Order antiemetics prophylactically?
a. Begin 30 minutes prior to chemotherapy

b. Continue around the clock while receiving chemotherapy

c. Provide as needed antiemetics for 12-24 hours after chemotherapy and longer (72 hours) for agents with delayed N/V, as with cisplatin, mitomycin-c
New therapy for acute and delayed N&V:

Emend (Aprepitant)

125 mg po Day 1 prior to chemo with Decadron 12 mg po

80 mg po days 2-4 with decadron 8 mg po

With other antiemetic drugs!
Emend (Aprepitant)

Drug Interactions
CYP 3A4 inhibitor
Increases decadron levels therefore the dose reduction
Decreases INR
Decreases effect of Oral contraceptives
Emend (Aprepitant)

Approval for and use with which chemo drugs
Approval with Cis-pt.

Usefull with highly emetogenic:
Anti-Emitics for Very High >90%
PO: Ondansetron 16-24 mg
PO: Granisetron 2 mg

IV: Palonosetron 0.25 mg
IV: Dolasetron 200 mg
IV: Ondansetron 16-20 mg
IV: Granisetron 10 mcg/kg

With: Decadron 10-20 mg
Optional: Ativan 1mg
Anti-Emetics for High 60-90%
PO: Ondansetron 16 mg
PO: Granisetron 1 mg

IV: Palonosetron 0.25 mg
IV: Dolasetron 100-200 mg
IV: Ondansetron 16-20 mg
IV: Granisetron 10 mcg/kg

With: Decadron 10-20 mg
Optional: Ativan 1mg
Anti-Emetics for Moderate 30-60%
PO: Ondansetron 16 mg
PO: Granisetron 1 mg

IV: Ondansetron 8mg

With: Decadron 10-20 mg
Optional: Ativan 1mg
Anti-Emetics for Low 10-30%
Very Low < 10%

Compazine 10mg

Optional: Decadron 10-20 mg
Optional: Ativan 1mg
Anti-Emetics for Anticipatory
Ativan 1mg
Delayed N/V prophylaxis treatment NON 5-HT3

Metoclopramide 0.5 mg/kg po QID X 4 days
Dexamethasone 8 mg po BID X 2 days then 4 mg po BID for 2 days
Delayed N/V prophylaxis treatment 5-HT3

Ondansetron 8 mg BID
Dexamethasone 8mg IM BID on days 2 and 3 and 4 mg IM BID on day 4
SIADH (Syndrome of Inappropriate Anti-diuretic Hormone)

1) Nausea and Malaise
2) Headache Lethrgy and obtundation (NON Responsive)
3) Seizure and coma if plasma Na < 115- 120 mEq/L

Too much Free H2O diluting Sodium
1)Hyponatremia (serum sodium <135 mEq/L)
2)Hypotonicity (plasma osmolality <280 mOsm/kg)
3)Inappropriately concentrated urine (>100 mOsm/kg water)
4)Elevated urine sodium concentration (>20 mEq/L), except during sodium restriction
• Volume restriction to 1 liter per day or less
• Strict I & O’s
• Daily Na at a minimum
• Monitor of neurologic deterioration
• IV fluids of at least not use D5W alone
• Moderately affected person or non-responder to water restriction (Na < 125) should receive demeclocycline
SIADH: Demeclocycline Dosage
150 mg cap

1 to 2 QID (600 - 1200mg/day)

Delayed onset 3-6 days
SIADH: Na < 115 Treatment?
3% IV Saline

LUNG Cancer: Stage IV & IIIB

Chemo General Guidelines:

Supportive care: median survival 3-4 months
• Utilize chemotherapy for a maximum of 8 cycles

• Monitor for response after 2-3 cycles at a time with CT scans. CXR on a regular basis can give a general sense of tumor response

• Discontinue therapy if tumor enlarges in size

• Discontinue therapy if tumor size is stable for 2-3 cycles (maint tx not required)

• Continue if shrinking to incr. lifespan and QOL
LUNG Cancer: Stage IV & IIIB

Dosage: Carboplatin (AUC)
Carboplatin (AUC= 6 to 8) Day 1 q3-4 weeks


Paclitaxel 175 mg/m2 IV over 3 hours Day 1 (higher dose with neutropenia)
LUNG Cancer: Stage IV & IIIB

Dosage: Carboplatin/Paclitaxel
CrCl dosing formula
CrCl=((140-Age)IBW)/(72*SCr) multiply by 0.85 for women

Carboplatin dose = target AUC * (CrCl + 25)
LUNG Cancer: Stage IV & IIIB

Toxocities: Carboplatin/Paclitaxel


LUNG Cancer: Stage IV & IIIB

Pretreatment: Carboplatin/Paclitaxel
anti-emetics: dexamethasone 20 mg po 12 & 6 hours

Pre-paclitaxel: pepcid 20 mg & benadryl 25 mg IV prior to paclitaxel