제 7장. 비뇨기계 항암제 사용법 편집하기 (부분)

=== Nausea & Vomiting control ===
- The most common side effect

- Type

Acute: <24h

Delayed >24h

anticipatory of emesis

- Risk Factors

Young

Female

heavily pretreated patients without a history of alcohol or drug use

history of motion or morning sickness

- Highly emetogenic drugs (>90%)

Cisplatin 

- moderately emetogenic drugs (30-90% risk)

Carboplatin, Mitoxantrone, and Ifosfamide

- low-risk (10-30%) agents

Docetaxel, Gemcitabine, Paclitaxel, Etoposide,

- minimal risk (<10%)

antibodies, bleomycin, and vinblastine

1) Anticipatory emesis
:① chemotherapy 24시간 전에 발생: psychologic mechanism 관여
:② 치료: Lorazepam 0.5-1.5mg 2-3일전부터 투여

2) 발생 시간에 따른 분류

:① acute chemotherapy induced emesis
:- chemoTx 1-2hr후에 발생
:- 5HT3 antagonist:
::Kytril (Granisetron): 3mg IV or 2mg PO, Zofran
::(Ondansetron): 8mg IV or 16mg PO,
::Anzemet (Dolesetron): 100mg IV or PO, Navoban
::(Tropisetron): 5mg IV & 5days PO
::Aloxi (Palonosetron): 0.25mg IV 1회
::Dexamethasone 20mg IV
::Metochlopramide

:② Delayed
:- chemoTx 24-72시간 이후
:Emend (aprepitant)

3) Antiemetics order내기
:(1) High emetogenetics (90% 이상)-(e.g Bladder cancer시 GC chemo, MVAC chemo)

{| class="wikitable"
!Day1
!Day2
!Day3
!Day4
|-
|Emend 125mg DB
|Emend 80mg DB
|Emend 80mg DB
|
|-
|5HT3 antagonist IV
|
|
|
|-
|Dexa 10mg IV/p.o
|Dexa 10mg IV/p.o
|Dexa 10mg IV/p.o
|Dexa 10mg IV/p.o
|}
:(2) Moderate emetogenetics (30-90%) (e.g Prostate cancer 시 Mitoxantrone+PD chemo)
{| class="wikitable"
!Day1
!Day2
!Day3
|-
|5HT3 antagonist IV
|5HT3 antagonist p.o
|5HT3 antagonist p.o
|-
|Dexa 10mg IV
|Dexa 10mg IV
|Dexa 10mg IV
|}