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Questions and Answers
Which corticosteroid is commonly used in the management of chemotherapy-induced nausea and vomiting?
What is the mechanism of action of dexamethasone in the context of CINV?
Which medication is used for prophylaxis of delayed nausea and vomiting associated with chemotherapy administration in combination with dexamethasone?
Which substances are man-made forms of THC used as therapeutic options when CINV is refractory to other antiemetics?
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Which neurotransmitter is believed to be the primary mediator of the delayed phase of CINV?
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Which drug is an NK1 receptor antagonist indicated as part of a multiple drug regimen for prophylaxis of nausea and vomiting associated with high-dose cisplatin-based chemotherapy?
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What is the standard of care for chemotherapy-induced nausea and vomiting (CINV) in patients receiving moderate to highly emetogenic chemotherapy?
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Which medication is recommended as the first-line therapy for nausea and vomiting of pregnancy (NVP) in pregnant patients?
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What are the most common side effects associated with 5-HT3 receptor antagonists used for managing CINV, PONV, and radiation-induced nausea and vomiting?
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In the management of motion sickness, what is considered first-line treatment?
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What is the medical term for severe nausea and vomiting during pregnancy?
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For children receiving high or moderate risk chemotherapy, which combination of medications should be administered?
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Study Notes
Chemotherapy-Induced Nausea and Vomiting (CINV)
- Dexamethasone is the most commonly used corticosteroid in the management of CINV.
- Dexamethasone is effective in preventing both cisplatin-induced acute emesis and delayed nausea and vomiting.
- Dexamethasone is used alone or in combination with 5-HT3-RAs.
Postoperative Nausea and Vomiting (PONV)
- Dexamethasone is used in the management of PONV, either as a single agent or in combination with 5-HT3-RAs.
Metoclopramide
- Metoclopramide is used for its antiemetic properties in patients with diabetic gastroparesis.
- Metoclopramide is used with dexamethasone for prophylaxis of delayed nausea and vomiting associated with chemotherapy administration.
Cannabinoids
- Nabilone (Cesamet) and dronabinol (Marinol) are therapeutic options when CINV is refractory to other antiemetics.
- Nabilone and dronabinol are man-made forms of THC (tetrahydrocannabinol) from cannabis.
Neurokinin 1 Receptor Antagonists
- Substance P is a peptide neurotransmitter with a preferred receptor, NK1.
- Aprepitant and fosaprepitant (injectable form of aprepitant) are NK1 receptor antagonists.
- NK1 receptor antagonists are indicated as part of a multiple drug regimen for prophylaxis of nausea and vomiting associated with high-dose cisplatin-based chemotherapy.
5-Hydroxytryptamine-3 Receptor Antagonists (5-HT3-RAs)
- 5-HT3-RAs (dolasetron, granisetron, ondansetron, and palonosetron) are used in the management of CINV, PONV, and radiation-induced nausea and vomiting.
- Common side effects of 5-HT3-RAs include constipation, headache, and asthenia.
Disorders of Balance
- Scopolamine is effective for the prevention of motion sickness and is considered first-line for this indication.
Antiemetic Use During Pregnancy
- Initial management of nausea and vomiting of pregnancy (NVP) often involves dietary changes and/or lifestyle modifications.
- Pyridoxine (10–25 mg one to four times daily) is recommended as first-line therapy with or without doxylamine (12.5–20 mg one to four times daily).
- Ondansetron, promethazine, and metoclopramide have similar effectiveness for hyperemesis gravidarum, although ondansetron may be better tolerated due to less adverse effects.
Hyperemesis Gravidarum
- Hyperemesis gravidarum is a medical term for severe nausea and vomiting during pregnancy.
- Symptoms may lead to dehydration, weight loss, and electrolyte imbalance.
Antiemetic Use in Children
- For children receiving chemotherapy of high or moderate risk, a corticosteroid (such as dexamethasone) plus 5-HT3-RAs should be administered.
- There is greater emphasis on rehydration measures than on pharmacologic intervention for nausea and vomiting associated with pediatric gastroenteritis.
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Description
Learn about the usage of dexamethasone, a common corticosteroid, in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea and vomiting (PONV). Understand its effectiveness when used alone or in combination with other medications like 5-hydroxytryptamine-3 receptor antagonists.
