Treating N/V

Question 1

Drugs in Neurokinin (NK) -1 Receptor Antagonists

• MOA

Answer 1

• Aprepitant: Emend
• Fosapreptitant
• Should use in combo w/ other antiemetics: serotonin antagonist and corticosteroids
• MOA: block substance P, which is thought to activated a pathway in the brain that cause n/v

Question 2

Anzemet

• Route
• Dose:

Answer 2

DOLasetron

• IV and PO
• 100 mg single dose 30(IV) - 60(PO) min prior to chemo

Question 3

Kytril
Sancuso

• Route
• Dose:
• Patch: avoid

Answer 3

Granisetron

• IV/PO/Transdermal (Sancuso)
• Dose: 1mg IV or 1-2mg PO
• Patch: 1 patch Q24-48H b/4 chemo. Can be wore for up to 7 days. Avoid sun

Question 4

Zofran

• Route
• Dose:

Answer 4

Ondansetron

• IV/IM/PO/ODT (thin strip Zuplenz)/sol’n
• 8 mg can be repeated q8h

Question 5

Aloxi

• Rec to use if concern of:
• Route
• Half life
• Dose

Answer 5

PaLONosetron

• Use this if worry about QT prolongation
• IV/PO
• Longer half life 36-48H
• Dose: 0.25mg IV or 0.5mg PO 30 min prior to chemo

Question 6

Decadron(R)

• ppx dose:
• tx dose:

Answer 6

Dexamethazone

• PPX dose: 8mg IV or 12 mg PO prior to chemo;
  8 mg PO QD for 2-4 days
• Treatment dose: 10-20 mg IV/PO Q4-6H

Question 7

Medrol

Answer 7

Methylprednisolone

Question 8

Corticosteroids

• Drugs
• Common ADEs

Answer 8

• Dexamethaxone: Decadron
• Methylprednisolone: Medrol
• Use alone or w/ 5HT3 antagonists

SEs

• Upset stomach
• Anxiety
• Trouble sleeping
• Increased BG (hyperG) when used for several days

Question 9

Emend

IV

• Metabolize
• Level of emetogenic
• Dose:

PO

• Dose
• Use in combo with
• DDI

Answer 9

Fosaprepitant: IV

• Prodrug rapidly convert to aprepitant
• Highly emetogenic chemo
• Injection (On D1 = 115 mg IV given over 15-30 min

Aprepitant: PO

• 125 mg D1; then 80 mg D2 and D3
• Use in combo w/ dexamethasone and ondansetron

DDI
- Inducer

Question 10

Marinol

• Class
• Control Schedule
• Dosage Frequency
• Storage
• Indications

Answer 10

DRONabinol

• Class: cannabinoids
• Schedule III
• Take TID-QID
• Refrigerated
• Indication: stimulate appetite in AIDS pt, CINV

Question 11

Cesamet

• Class
• Control Schedule
• Dosage Frequency
• Storage

Answer 11

Nabilone

• Class: cannabinoids
• Schedule II
• BID
• Storage: RT

Question 12

Reglan

• Class
• MOA:
• ADEs:
• Special SEs
• Never give it to

Answer 12

Metoclopramide

• Class: Benzamides
• MOA: blocks dopamine in brain that contain the vomiting center.
• ADEs: diarrhea, drowsiness, anxiety, depression
• Extrapyramidal (spasms): Benadryl can help ease some ADEs
• Never give to parkinson’s disease

Question 13

Antihistamines

• Drugs
• ADEs

Answer 13

• Benadryl and hydroxyzine

ADEs

• Mild relaxation
• Drowsiness
• Dry mouth, constipation (anti-cholinergic)

Question 14

Benadryl

Answer 14

Diphenhydramine

Question 15

Atarax

Answer 15

Hydroxyzine

Question 16

Benzodiazepines

- Drugs

Answer 16

• Lorazepam: ativan
• Alprazolam: xanax
• Not very effective in tx n/v in chemo => usually combo

Question 17

Ativan

Answer 17

Lorazepam

• 0.5-1mg PO Q6-8H

Question 18

Xanax

Answer 18

Alprazolam

• Calm the brain

Question 19

Sancuso

• Dose

Answer 19

Granisetron transdermal

• Dose: 1 patch Q24-48H before chemo. Patch can be wore for up to 7 days. avoid sun

Question 20

Zuplenz

Answer 20

Odansetron ODT thin strip

Question 21

Akynzeo

Answer 21

Netupitant + Palonosetron