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42 Cards in this Set

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These agents prevent the release of serotonin from enterochromaffin cells in the GI mucosa, to inhibit the afferent transmission to the CNS via vagal and spinal sympathetic nerves; also block sertonin stimulation at the CTZ and other CNS structures
5-HT3 antagonists (setron)
Side effects of 5-HT3 antagonists
HA, C/D, fatigue, dry mouth, transient asx increase in LFTs
5HT3 antagonist that has been shown to be effective in preventing delayed nausea and vomiting
This agent inhibits substance P binding which is an excitatory transmitter in the GI tract
Aprepitant [neurokinin-1 antagonist]
Aprepitants effects on CYP
inhibits cyp3a4

induces cyp2c9
Aprepitant side effects
asthenia, fatigue, hiccups

Aprepitants indication
in combo w/ other antiemetics for prevention of acute and delayed N/V
Potentiates the antiemetic properties of 5HT3 antagonists and may improve patients mood
Sometimes used as single agents against mild/moderately emetogenic chemotherapy
Treatment of choice in treating N/V in patients receiving radiation to the brain, and also used orallyh for delayed N/V
Dexamethasone (reduces cerebral edema)
This agent is classified as a D2 receptor antagonis, and is a weak competitive antagonist at 5HT3 receptors
Metoclopramide indications
adjunctive therapy for prevention of delayed N/V due to constipation
Metoclopramide actions
-increases lower esop sphincter pressure
-enhances rate of gastric emptying
Metoclopramide side effects
akasthisia, dystonic rxns, sedation, fatigue
Difference between aliphatic phenothiazines (chlorpromazine) and piperazines (prochlorperazine)
aliphatic: sedation and anticholinergic effects

piperazines: less sedation but greater EPS
Prochlorperazine uses
-preventing nausea associated w/ radiation
-treating N/V attributed to very low/mod emetogenic chemo agents
Prochlorperazine side effects
EPS, sedation, hypotension
Example of a butyrophenone
Droperidol side effects
black box warning for potential QT interval prolongation

EPS, akathisia, hypotension
Unclear mechanism but thought to inhibit endorphins in the emetic center and prevent prostaglandin synthesis
Used for prevention and treatment of anxiety and anticipatory N/V and decrease severity of EPS, especially akathisia associated with dopaminergic receptor antiemetics
Alprazolam is effective when given in combo with these agents
metoclopramide, methylprednisolone
BZDs side effects
perceptual disturbances, visual disturbances, anterograde amnesia
What is the general recommendation regarding combination therapy
5HT3 antagonist + corticosteroid
Example of G-CSF and GM-CSF
filgrastim (neupogen)

pegfilgrastim (neulasta)
Filgrastim mechanism of action
stimulates production of neutrophils
Filgrastim side effects
bone pain, HTN, swelling
Pegfilgrastim dosing compared to filgrastim
once per chemo cycle compared to daily administration
Example of GM-CSF
Sargramostim mechanism of action
promotes proliferation of granulocytes (neutrophils and eosinophils), as well as monocytes/macrophages
Granulocyte colony stimulating factors overall use
shorten duration of neutropenia, but little effect on morbidity
When is erythropoetin not recommended?
erythropoietin level ?200 MU/ml
This agent can be used for the prophylaxis of thrombocytopenia
interleukin-11 (oprelvekin)
Interleukin-11 side effects
fluid retention, possible arrhythmias
This is the treatment of choice for systemic treatment in patients undergoing bone marrow transplant
morphine patient controlled analgesia (PCA)
What patients is crytotherapy recommended for?
patients receiving bolus 5FU

(place ice chips 5mins before administration 5FU bolus and continuing for 30 mins)
Mixture of polyvinylpyrrolidone, sodium hyaluronate, and glycyrrhetinic approved by the FDA as a medical device; found to be safe and effective in improving pain scores, swallowing, and nutritional endpoints
Recombinant form of keraticnocyte growth factor (KGF) that binds to cell-surface receptors to stimulaate epithelial cell proliferation, differentation, and upregulation of cytoprotective mechanisms
Shortened the incidence and duration of mucositis; reduced need for analgesic meds; dcreased need for parenteral nutrition
Treatment of diarrhea caused by C.diff
metronidazole 500mg po q8hx 10-14d

Vancomycin 125mg po q6h x 10days
Treatment of acute diarrhea caused by irinotecan
Treatment of late diarrhea caused by a metabolite of irinotecan
high-dose loperamide 4mg