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42 Cards in this Set
- Front
- Back
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
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5-HT3 antagonists (setron)
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Side effects of 5-HT3 antagonists
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HA, C/D, fatigue, dry mouth, transient asx increase in LFTs
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5HT3 antagonist that has been shown to be effective in preventing delayed nausea and vomiting
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Palonosetron
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This agent inhibits substance P binding which is an excitatory transmitter in the GI tract
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Aprepitant [neurokinin-1 antagonist]
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Aprepitants effects on CYP
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inhibits cyp3a4
induces cyp2c9 |
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Aprepitant side effects
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asthenia, fatigue, hiccups
DDD |
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Aprepitants indication
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in combo w/ other antiemetics for prevention of acute and delayed N/V
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Potentiates the antiemetic properties of 5HT3 antagonists and may improve patients mood
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corticosteroids
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Sometimes used as single agents against mild/moderately emetogenic chemotherapy
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corticosteroids
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Treatment of choice in treating N/V in patients receiving radiation to the brain, and also used orallyh for delayed N/V
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Dexamethasone (reduces cerebral edema)
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This agent is classified as a D2 receptor antagonis, and is a weak competitive antagonist at 5HT3 receptors
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metoclopramide
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Metoclopramide indications
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adjunctive therapy for prevention of delayed N/V due to constipation
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Metoclopramide actions
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-increases lower esop sphincter pressure
-enhances rate of gastric emptying |
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Metoclopramide side effects
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akasthisia, dystonic rxns, sedation, fatigue
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Difference between aliphatic phenothiazines (chlorpromazine) and piperazines (prochlorperazine)
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aliphatic: sedation and anticholinergic effects
piperazines: less sedation but greater EPS |
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Prochlorperazine uses
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-preventing nausea associated w/ radiation
-treating N/V attributed to very low/mod emetogenic chemo agents |
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Prochlorperazine side effects
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EPS, sedation, hypotension
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Example of a butyrophenone
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droperidol
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Droperidol side effects
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black box warning for potential QT interval prolongation
EPS, akathisia, hypotension |
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Unclear mechanism but thought to inhibit endorphins in the emetic center and prevent prostaglandin synthesis
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dronabinol
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Used for prevention and treatment of anxiety and anticipatory N/V and decrease severity of EPS, especially akathisia associated with dopaminergic receptor antiemetics
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BZDs
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Alprazolam is effective when given in combo with these agents
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metoclopramide, methylprednisolone
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BZDs side effects
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perceptual disturbances, visual disturbances, anterograde amnesia
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What is the general recommendation regarding combination therapy
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5HT3 antagonist + corticosteroid
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Example of G-CSF and GM-CSF
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filgrastim (neupogen)
pegfilgrastim (neulasta) |
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Filgrastim mechanism of action
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stimulates production of neutrophils
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Filgrastim side effects
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bone pain, HTN, swelling
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Pegfilgrastim dosing compared to filgrastim
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once per chemo cycle compared to daily administration
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Example of GM-CSF
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Sargramostim
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Sargramostim mechanism of action
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promotes proliferation of granulocytes (neutrophils and eosinophils), as well as monocytes/macrophages
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Granulocyte colony stimulating factors overall use
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shorten duration of neutropenia, but little effect on morbidity
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When is erythropoetin not recommended?
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erythropoietin level ?200 MU/ml
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This agent can be used for the prophylaxis of thrombocytopenia
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interleukin-11 (oprelvekin)
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Interleukin-11 side effects
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fluid retention, possible arrhythmias
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This is the treatment of choice for systemic treatment in patients undergoing bone marrow transplant
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morphine patient controlled analgesia (PCA)
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What patients is crytotherapy recommended for?
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patients receiving bolus 5FU
(place ice chips 5mins before administration 5FU bolus and continuing for 30 mins) |
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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
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Gelclair
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Recombinant form of keraticnocyte growth factor (KGF) that binds to cell-surface receptors to stimulaate epithelial cell proliferation, differentation, and upregulation of cytoprotective mechanisms
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Palifermin
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Shortened the incidence and duration of mucositis; reduced need for analgesic meds; dcreased need for parenteral nutrition
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Palifermin
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Treatment of diarrhea caused by C.diff
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metronidazole 500mg po q8hx 10-14d
Vancomycin 125mg po q6h x 10days |
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Treatment of acute diarrhea caused by irinotecan
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atropine
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Treatment of late diarrhea caused by a metabolite of irinotecan
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high-dose loperamide 4mg
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