Misc.
If you are admitted to TOH, you can still receive all anti-cancer treatments.
No
Stimuli that can induce emesis affect this major center
Vomiting Center
Constipation and prolonged QTc are two side effects we worry about with this class of anti-emetics
Serotonin Receptor (5-HT3) Antagonists: eg: ondansetron (Zofran) and Netupitant- Palonosetron (Akynzeo)
This is the cutoff to classify nausea/vomiting as acute or delayed?
24 hours
This is the best place to locate Ontario specific information about drug funding, regimens, and best practice management on nausea and vomiting in the oncology setting.
Cancer Care Ontario website
Drugs are the main stimuli for this region outside the BBB?
Chemoreceptor Trigger Zone
This drug is best used preventatively and earlier daily doses with food are preferred due to its side effect profile
Dexamethasone
This type of nausea is a conditioned response prior to receiving treatment, often a result of past negative experiences with treatment
Anticipatory
Who is more likely to experience chemotherapy induced emesis:
1) A 30 year old female on 2nd line therapy
2) A 78 year old man with treatment naive prostate cancer
Patient 1
We target these two main receptors in the GI tract for N/V?
5-HT3, NK1
Dopamine Receptor antagonist are used in this type of nausea/vomiting
Breakthrough, as needed
CCO classifies treatments by emetogenic potential. How many levels are there?
4: High (>90% of patients)
Moderate (30-90%)
Low (10-30%)
Minimal (<10%)
Cancer Care Ontario does not recommend cannabinoids as first-line antiemetic therapy but suggests they may be used for this specific type of CINV.
Refractory CINV
There are 7 neurotransmitters involved in emesis, we target mainly these 3 in chemotherapy induced N/V?
Serotonin, dopamine, & Substance P
This class of drugs is a great add on for persistent nausea and vomiting, and can also help with insomnia, agitation, and anxiety
Antipsychotics eg: olanzapine or methotrimeprazine
Regimens with minimal emetogenicity generally require only this type of anti-nausea dosing?
Breakthrough (or as needed)
Patients with a history of this condition have a lower risk of developing acute CINV due to desensitization of the central nervous system to emetic stimuli.
Chronic alcohol use
In addition to the CTZ, we try to target these stimuli of the vomiting center with anti-emetic therapy?
Peripheral receptors (GI tract), cortex (emotions, smells, tastes)
This class of drugs will require dose reductions of dexamethasone by 50%
Neurokinin receptor antagonists eg: Aprepitant (Emend) or Netupitant- Palonosetron (Akynzeo)
Simply changing this property of a drug can affect its emetogenicity
Dose