Oncology Supportive Care – Study Notes

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ANTIEMETICS
Risk factors contributing to patient experiencing vomiting during chemotherapy
Management of chemotherapy and radiation induced nausea and vomiting
Points to keep in mind when beginning with an appropriate antiemetic regimen

ANTIEMETICS

Nausea: is expressing/feeling discomfort that may or may not be followed by vomiting.
Retching: is the movement itself of the muscles during the act of vomiting, but without actual expulsion of vomitus.
Vomiting/emesis: is the expulsion of gastric content passing through the mouth.
Acute vomiting: occurs 0-24 hours from chemotherapy.
Delayed Vomiting: occurs after 24 hours after chemotherapy.
Anticipatory vomiting: happens with patients going to get chemo treatment, or with those patients who suffered from vomiting with previous sessions.
Breakthrough emesis: is when vomiting occurs even though the patient is on prophylactic antiemetics.
Refractory emesis: is when using the same antiemetic treatment that failed last session.

Risk factors contributing to patient experiencing vomiting during chemotherapy

PATIENT FACTORS

MEDICATIONS FACTORS

RADIATIONS FACTORS

Management of chemotherapy and radiation induced nausea and vomiting

Prophylactic should be administered before moderately/high sessions.
Schedule antiemetics for delayed nausea and vomiting and rescue antiemetics should be available.
Patients need to be protected for:
a. Three days for highly emetogenic regimens
b. Two days for moderately emetogenic regimens

Points to keep in mind when beginning with an appropriate antiemetic regimen

  • For multidrug regimens, select antiemetic therapy according to the drug with the highest emetic risk.
  • For highly emetogenic The most common antiemetic regimen is the combination of a neurokinin 1 (NK1) receptor antagonist, a serotonin receptor antagonist, and dexamethasone.  Adding a corticosteroid to a serotonin receptor antagonist for highly (or moderately)emetogenic anticancer therapy increases efficacy.
  • For moderately emetogenic chemotherapy, the most common antiemetic regimen now includes a  serotonin receptor antagonist and dexamethasone. Addition of an NK1 receptor antagonist may be considered after risk assessment.
  • Single-agent phenothiazine, butyrophenone, or steroids are used for mildly emetogenic regimens and are given on either a scheduled or an as-needed basis for prolonged symptoms (i.e., breakthrough symptoms).
  • Consider using a histamine-2 blocker or proton pump inhibitor for dyspepsia (which can mimic nausea).
  • Cannabinoids are generally used after other regimens have failed.
  • Potential drug interactions between antineoplastic agents or antiemetics and other drugs should always be considered.
  • Follow-up is essential. Learn from mistakes.
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