chemotherapy induced nausea &vomiting
DESCRIPTION
brief discuss about nausea & vomiting generally & go through management of CINVTRANSCRIPT
C.I.N.V
Nausea & vomiting: Nausea is usually defined as the inclination
to vomit or as a feeling in the throat or epigastric region alerting an individual that vomiting is imminent ( subjective ).
Vomiting is defined as the ejection or expulsion of gastric contents through the mouth, often requiring a forceful event (reflexive )
Retching is the contraction of the abdominal wall,diaphragm &thoracic muscle wihtout expulsion
Nausea Autonom
ic sympto
ms
Retching
Contraction
Vomiting Contraction + forced
expel of Gicontent
Pathophysiology
Nausea & vomiting are complex interaction from different systems
Central vomiting
center (medulla)
CTZ(5-
HT3 ,D2,NK1
Gastrointestinal(vi
sceral afferents(
5-HT3,D2,N
K1
Cerebral cortex
(sensory)
Vestibular system
(H!, muscarini
c )
•Types & causes :
GI or intraperitonealCardiac Neurologic Therapy induced Endocrine/metabolic Others ( CINV , PONV , NVP , motionskiness )
•How are we manage ?!
DESIRED OUTCOME The overall goal of antiemetic therapy
is to prevent or eliminate nausea and vomiting; this should be accomplished without adverse effects or with clinically acceptable adverse effects.
Pharmacological
Non pharmacological
•General treatment approach :
Removal or treatment of the under lying cause
Correction of dehydration & electrolyte disturbances (oral hydration preferred if possible )
When we choose Drug treatment we use drugs that target receptors involved (may use combination )& also we need alternative forms of medication wit different route of administration (IM ,IV ,SC ,Suppository….etc)
•Non pharmacological ttt:
It is including :1. Dietary approaches (small meal ,
high protein , avoid spicy or fatty food eat dry blended food, using herbal remedy , multivitamins intake )
2. Psychotherapy & hypnosis 3. Acupressure & electric-acupoint
stimulation by wearing briclet affecting this area
•Pharmacological Anti emetic classes :
• cyclazine• Diphenhydramine
Antihistaminic
• Phenothiazine(chloropromazine)• Butyrophenone(haloperidol)
•Benzamides(metaclopromide , domperdione )
antidopaminergic
• Granisetron• ondansetron• Palonosetrone
Serotonin antagonists
Neurokinin 1 antagonist
•Aprepitant •Fosaprepitant
•Cont,.:
•Dexamethasone Corticosteroides
• Aloprozolam • Lorazepam
Benzodiazipens
• nabilone• Dronabinol
Cannabinoids
1 • Types of CINV
2 • Risk stratification
3 • How to manage (guidelines )
CINV
•Types :1. Acute onset : 0-24hrs after chemo
administration .2. Delayed onset : occurs more than 24hrs
after chemo administration 3. Anticipatory vomiting : is triggered by
sights ,smells , sounds & is a conditioned response & mainly after uncontrolled N&V by chemo
4. Breakthrough emesis occurs despite prophylactic ttt
5. Refractory emesis refers to emesis that occurs during cycles when antiemetic prophylaxis have failed in pervious cycles
•Risk stratification :
Patient related
risk factors
Emetogenicity of chemotherapy
agents
Radiation exposure
•Patients related risk :Patient’s age (younger or those
younger than 50 years Female sexHX of motion skiness or NVP Poor control of N&V in pervious
chemo cycles HX of chornic alcoholism (+ve
risk ↓incidence)
Chemo related:
Radiation: Radiation can also cause N&V , the
incidence & severity vary according the site & size of the radiation field :
a. Mildly emetogenic (radiation to head , neck or extremities )
b. Moderate (radiation to upper abdomen ,pelvis or craniospinal )
c. High (total body ,total nodal & upper half body irradiation )
How to manage: