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![Anti-emetic Agents
• 5-hydroxytryptamine3 [5-HT3] receptor
antagonists
• Neurokinin 1 (NK-1) receptor antagonists:
Aprepitant
• Corticosteroids](https://image.slidesharecdn.com/cinv-180918042535/75/Chemotherapy-induced-Nausea-and-Vomiting-CINV-Dhaval-joshi-13-2048.jpg)
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Chemotherapy induced Nausea and Vomiting (CINV) - Dhaval joshi
The document discusses chemotherapy-induced nausea and vomiting (CINV), outlining its impact on patient quality of life and compliance, with classifications of nausea and vomiting types and management strategies. It details various anti-emetic agents and specific recommendations for preventing CINV in different scenarios, including multi-day and pediatric chemotherapy. A case study is provided, highlighting a patient receiving the R-CHOP regimen, with questions addressing emetogenic potential, risk factors, and appropriate anti-emetic premedication.
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Chemotherapy induced Nausea and Vomiting (CINV) - Dhaval joshi
- 1. Chemotherapy Induced Nausea &Vomiting Dhaval B. Joshi
- 3. Background • Systemic chemotherapy– very frequently causes nausea and vomiting • Affects Patient’s Quality of life • Leading to poor compliance
- 4. Factors affecting CINV Specifictherapeutic agents used Dosage of the agents Schedule and ROA of the agents Target of the RT Individual patient variability
- 6. Few imp. Pointson NV • More nausea than vomiting • Younger r more likely to have Nausea than older • Younger women more prone than others
- 7.
- 8. Classification of Emesiscausing Chemotherapeutic Agents
- 10.
- 13. Anti-emetic Agents • 5-hydroxytryptamine3[5-HT3] receptor antagonists • Neurokinin 1 (NK-1) receptor antagonists: Aprepitant • Corticosteroids
- 14. Anti-emetic Agents • Metoclopramide •Butyrophenones • Phenothiazines • Cannabinoids • Olanzapine • Benzodiazepines
- 15. Management • High emetogenicchemotherapy • Moderate emetogenic chemotherapy • Low/ Minimal emetogenic chemotherapy
- 16. Recommendations for preventing Emesisfor different conditions • Multiday Chemotherapy: 5-HT3 Anta + steroid • Combination Chemotherapy/ Concurrent Chemotherapy and Radiation Therapy: Combinations of anti-emetics
- 17. Paediatric Patients • Combinationof a 5-HT3 antagonist and corticosteroid is suggested before chemotherapy
- 18. Anticipatory CINV • TheNCCN guidelines provide recommendations for additional medical treatment, including the following: • Alprazolam, PO: 0.5–2 mg TID, beginning the night before treatment; or • Lorazepam, PO: 0.5–2 mg, given the night before and the morning of treatment
- 19. Delayed CINV • NCCNconsiders intravenous palonosetron the most effective 5-HT3 antagonist for preventing delayed CINV and • Recommends using aprepitant in patients undergoing chemotherapy with an anthracycline
- 20.
- 21. General rule ofthumb • Cisplatin – Index agent used in clinical trials as high emetogenic • If you have mixture of varying levels of emetogenic potential, err on the side of the caution
- 22. General rule ofthumb • Make sure to wait at least for 30 minutes after completion of IV anti-emetic pre-medications before starting chemotherapy infusions • Anti-emetics aren't for only Day-1
- 23. General rule ofthumb • Palanosatron and NK-1 antagonists are used only for patients receiving high or moderate emetogenic chemotherapy • If patient develops breakthrough CINV, add agent from different drug class that was not used prophylactically
- 24. General rule ofthumb • Avoid trigger foods • Recommend frequent snacking in between meals • Look towards patient’s hydration status
- 25. Case study • ABis 35 yrs old F with newly diagnosed stage III Large B cell Lymphoma. She has PMHx of HTN, DM and severe motion sickness. • Chemotherapy regimen ordered: R-CHOP every 3 weeks for 6 cycles
- 26. Case study • Rituximab375 mg/m2 • Cyclophospahmide 750 mg/m2 IV on day 1 • Doxorubicin 50 mg/m2 IV on day 1 • Vincristine 1.4 mg/m2 IV on day 1 • Prednisone 100 mg PO daily day 1-5
- 27. Case study Take homeMedications: • Prochlorperazine 10 mg PO q6-8 hrs as needed for breakthrough nausea • Docusate 100 mg PO daily as needed for constipation • Magic mouth wash QID as needed for mouth care
- 28. Questions 1. How wouldyou classify the emetogenic potential of R-CHOP regimen? a.) Highly emetogenic b.) Moderately emetogenic c.) Low emetogenic d.) Minimally emetogenic e.) Not emetogenic
- 29. Questions 2. What riskfactors does AB have for the development of CINV? a.) Age b.) Gender c.) Highly emetogenic chemotherapy d.) Motion sickness history e.) All of the above
- 30. Questions 3. Which isthe appropriate anti-emetic premedication regimen for AB? ????
- 31.