Nausea and Vomiting
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1
High ematogenicity for IV chemotherapy
>90%
2
Medium ematogenicity for IV chemotherapy
30-90%
3
low ematogenicity for IV chemotherapy
10-30%
4
Minimal ematogenicity for IV chemotherapy
<10%
5
Moderate to high ematogenicity for oral chemotherapy
>30%
6
Minimal-low ematogenicity for oral chemotherapy
<30%
7
CINV risk factors
<50 years old
female
history of morning sickness/motion sickness
history of poor CINV control
depression/anxiety
female
history of morning sickness/motion sickness
history of poor CINV control
depression/anxiety
8
CINV acute phase
enterocromaffin cells of GI tract damaged, serotonin release, activate 5HT3 receptors to cause NV
9
CINV delayed phase
dopamine/substance p release activating NK1 receptors to cause NV
10
CINV high risk gold standard prevention
Quadruplet therapy
5HT3RA
dexamethasone
NK1RA
olanzapine
all given day 1, olanzapine and dexamethasone continued days 2-4
5HT3RA
dexamethasone
NK1RA
olanzapine
all given day 1, olanzapine and dexamethasone continued days 2-4
11
CINV med risk gold standard
double therapy
5HT3RA
dexamethasone
either one continued for 2-3 days
5HT3RA
dexamethasone
either one continued for 2-3 days
12
CINV low risk gold standard
5HT3RA or dexamethasone given one time for prevention of acute NV
13
CINV high to moderate oral gold standard
5HT3RA daily
14
CINV low-med oral gold standard
metaclopramide
prochlorperazine
or 5HT3RA
daily as needed
prochlorperazine
or 5HT3RA
daily as needed
15
treatment for anticipatory CINV
lorazepam
16
What are the drugs that end in "pitant"?
NK1RAs, used for high emesis chemotherapy. Aprepitant, rolapitant, etc
17
Max IV dose of ondansetron?
16mg
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