1 / 19

MANAGEMENT OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

MANAGEMENT OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING. Aim-complete control of N/V. MULTIDISPLINARY MGT GENERAL CONSIDERATIONS-R/o Medical causes,Adequate Hydration, Correct Metab disturb,Diet, Anxiety Appropriate Pharm Intervention Patient Support,Educatn,Tech Expertise

ginata
Download Presentation

MANAGEMENT OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. MANAGEMENT OF CHEMOTHERAPY INDUCED NAUSEA AND VOMITING

  2. Aim-complete control of N/V • MULTIDISPLINARY MGT • GENERAL CONSIDERATIONS-R/o Medical causes,Adequate Hydration, Correct Metab disturb,Diet, Anxiety • Appropriate Pharm Intervention • Patient Support,Educatn,Tech Expertise • Behavioural/Psychotherapeutic interventn. • Emetic Classif-High’ Intermediate and Low

  3. Surgical / Other Mgt • Thermal Ablation of Area Pastrema-CTZ • Use of Bioband and Relband • Use of Acupuncture • Psychotherapeutic Intervention-Hypnosis, Mind diversion,Systemic desensitization

  4. Pharmacological mgt • Most common intervention in CINV. • Based on Neurochemical control of Vom. • MOA-Competitive blockade of Receptors; Serotonin-5HT3,Dopamine-D2,Histamine H1,H2,Opoids,Acetylcholine,Substance P –NK1(Neurokinin type 1) • Mainstay of CINV prevention • Single or Combination Therapy

  5. Phenothiazines-1950 • MOA= #Dopamine D2 R[CTZ,CNS,?PNS] • Aliphatic P-Chlorpromazine,Methotrimeprazine. >Autonomic/Anticholin Effects • Piperazine P- >Antiemetic Axn Prochlorperazine,Fluphenazine,Perphenazine. >Extrapyramidal Rxn[dystonia etc] • Prochlorp-10-15%,limited role.

  6. Butyrophenones –Haloperidol/Droperidol • D2 R Antagonist. • Struct and Pharm similar PTZ • Superior to PTZ • ADR –Sedation, Extrap Rxn

  7. Corticosteroids-Dexamethasone/ Methylprednisolone • MOA- ? # Brain Prostaglandin synthesis • Low and Interm emetogenic regimen • ADR –Euphoria,insomnia,Fluid retention

  8. Cannabinoids;-Levonantradol Tetrahydrocannabinol, Nabilone. • MOA = ? CNS depression • Limited to oral admin • ADR -Sedation, Orth Hypotention,Ataxia • Superior to Ptz,low dose Metoc and Halop • Synthetics for investig use only

  9. Substituted Benzamides-Metoclopramide • MOA -D2 R Antagonist CNS • -5HT3 R Antagonist[weak] • -Periph Axn >Gastric Emptying and direct smooth msl and cholinomimetic axn • Most effective against Acute vomiting. • High dose>40% Efficacy. Cheap • ADR–Sedation,Diarrhoea,Extrapyram Rxn

  10. Benzodiazepines-Diazepam/Lorazepam • MOA-Anxiolytic,Sedative, Amnesic CNS effect • Major use=Adjunct to other antiemetics • Prev/Treat of ANV and Anxiety • ADR –Sedation,Amnesia,Hypotention

  11. Antihistamines-[H1H2] Promethazine,Chlorpheniramine • Effective for Vestibular mediated N/V • No effect on CINV • Prevents Extrapyramidal Rxn of Antiemetics • ADR –Sedation, Anticholinergic effects

  12. 5HT3[5 Hydroxytryptamine type 3] /Serotonin Rec Antagonists- • Granisetron,Ondansetron,Dolasetron,Tropisetron. • MOA-# 5HT3 R Centrally and Peripherally • 40-60%. Most Effective single agent • For Highly Emetogenic Chemotherapy • ADR –Headache,Transaminase elevat • Expensive,??Delayed emesis

  13. Substance P Antagonist-NK1 R [Neurokinin] Aprepitant[Emend] • MOA- # NK I R in CNS • Especially Acute/Delayed Emesis • 5HT3 Ant + CORTIC + Aprep DOC –A Em • MISCELLANEOUS AGENTS= ACTH,BARBITURATES,SCOPOLAMINE,DOMPERIDONE .

  14. Combination Therapy • Standard of care for control of CINV • MOA –Several sites and MOA • High therapeutic index >75%. < Drug ADR • D2 R Ant + Corticost/ + Benzodiaz • 5HT3 R Ant + Corticost + NKI R Ant • 5HT3 R Ant + Corticosteroid • Route,Dose and Schedule=Antiem Select

  15. Acute and Delayed Emesis • Patient Counseling • Prophylactic Combination Antiemetic therapy. High to Moderate Emetogenic drug • Continue Antiemetics for 4-7days after

  16. Anticipatory N/V • Refractory to std antiemetics • Best approach –Prevention using pharm agent from initiation of Chemotherapy • Benzodiazepine[Lorazepam] -Prevention • Psychotherapy –Hypnosis,Mind diversion,Systemic desensitization

  17. Conclusion • Prevention and control of N/V are paramount in the treatment of cancer patients b/c of the various complication and withdrawal from useful and curative antineoplastic treatment.

  18. STOP NAUSEA AND VOMITING! • THANK YOU

More Related