Chemotherapy induced nausea and vomiting

2. INTRODUCTION
PATHOPHYSIOLOGY
THERAPEUTIC TARGETS & MANAGEMENT
SPECIAL CIRCUMSTANCES
REFERRENCES

6. Acute: within 24 hours
Delayed: >24 hours
Anticipatory: occurs before chemotherapy administration
Breakthrough: nausea and vomiting that occur despite
appropriate prophylaxis; requires the use of rescue medications.
Refractory: nausea & vomiting that occurs in subsequent
cycles despite adequate prevention.

7. WHY its
happening?
WHY they are
different in
timelines?

8. CTZ
CPG
Somatos
ensory
cortex

10. VOMITING
CHEMO THERAPUTIC DRUGS

11. Release of SUBSTANCE P from
CNS
SUBSTANCE P binds to NK1R in
CNS & PNS
Stimulate Vomiting Centre
CHEMO THERAPUTIC DRUGS
VOMITING

28.  Oral formulation has
similar efficacy as IV
 Higher doses like
0.75 mg doesn’t offer
additional benefit
 As a single agent
Palonosetron is more
efficacious than
ondansetron or
Granisetron

30.  mainstay in the prevention of
both acute and delayed CINV
 appropriate doses of
dexamethasone for use with
highly and moderately
emetogenic therapy (in the
absence of an NK1 antagonist)
are 20 mg and 8 mg,
respectively
 With NK1 Antagonists ( CYP3A4
inhibitor)--- dexa dose – 12mg
(Except Rolapitant)

47. ACUTE CINV-
5HT3
DELAYED CINV –
SUBSTANCE P, D2
01
ANTICIPATORY:
BZD
02
BREAKTHROUGH:
Alternate regimens
to be tried.
03