SlideShare una empresa de Scribd logo
1 de 19
Descargar para leer sin conexión
chemotherapy induced Nausea &vomiting
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
Autonomic
symptoms
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
Gastrointestin
al(visceral
afferents(5-
HT3,D2,NK1
Cerebral
cortex
(sensory)
Vestibular
system
(H!,
muscarinic )
•Types & causes :
 GI or intraperitoneal
 Cardiac
 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.
PharmacologicalNon
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
• DiphenhydramineAntihistaminic
• Phenothiazine(chloropromazine)
• Butyrophenone(haloperidol)
• Benzamides(metaclopromide , domperdione )
antidopaminergic
• Granisetron
• ondansetron
• Palonosetrone
Serotonin
antagonists
Neurokinin 1
antagonist
•Aprepitant
•Fosaprepitant
•Cont,.:
• DexamethasoneCorticosteroides
• 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 sex
 HX 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 :
chemotherapy induced Nausea &vomiting
chemotherapy induced Nausea &vomiting
chemotherapy induced Nausea &vomiting

Más contenido relacionado

La actualidad más candente

Oncology clinical pharmacy from practice to research
Oncology clinical pharmacy from practice to researchOncology clinical pharmacy from practice to research
Oncology clinical pharmacy from practice to researchNoha El Baghdady
 
Chemotherapy of breast cancer
Chemotherapy of breast cancerChemotherapy of breast cancer
Chemotherapy of breast cancerDr Sachin Prakash
 
Up-to-date management of chemotherapy induced Nausea and vomiting
Up-to-date management of chemotherapy induced Nausea and vomiting Up-to-date management of chemotherapy induced Nausea and vomiting
Up-to-date management of chemotherapy induced Nausea and vomiting Tareq Salah
 
breast cancer pharmacotherapy
breast cancer pharmacotherapybreast cancer pharmacotherapy
breast cancer pharmacotherapySugunapharmd
 
Principles of cancer chemotherapy
Principles of cancer chemotherapyPrinciples of cancer chemotherapy
Principles of cancer chemotherapySufyan Akram
 
Basic principles of cancer chemotherapy
Basic principles of cancer chemotherapyBasic principles of cancer chemotherapy
Basic principles of cancer chemotherapyswathisravani
 
Drug induced liver disorders for Pharm.D
Drug induced liver disorders for Pharm.DDrug induced liver disorders for Pharm.D
Drug induced liver disorders for Pharm.DSoujanya Pharm.D
 
Drug Induced Liver Disorder
Drug Induced Liver DisorderDrug Induced Liver Disorder
Drug Induced Liver DisorderMerlinMathews3
 
Guidelines for rational use of antibiotics in surgical prophylaxis
Guidelines for rational use of antibiotics in surgical prophylaxisGuidelines for rational use of antibiotics in surgical prophylaxis
Guidelines for rational use of antibiotics in surgical prophylaxisDrLakshmiGayathripha
 
PRINCIPLES OF CANCER CHEMOTHERAPY
PRINCIPLES OF CANCER CHEMOTHERAPYPRINCIPLES OF CANCER CHEMOTHERAPY
PRINCIPLES OF CANCER CHEMOTHERAPYBashir BnYunus
 
ADR chemotherapy.chemotherapy adverse effect
ADR chemotherapy.chemotherapy adverse effect ADR chemotherapy.chemotherapy adverse effect
ADR chemotherapy.chemotherapy adverse effect somayyeh nasiripour
 
Drug induced kidney disease (injury)
Drug induced kidney disease (injury)Drug induced kidney disease (injury)
Drug induced kidney disease (injury)Dr. Ankit Gaur
 
Inflammatory Bowel Disease - Pharmacotherapy
Inflammatory Bowel Disease - Pharmacotherapy Inflammatory Bowel Disease - Pharmacotherapy
Inflammatory Bowel Disease - Pharmacotherapy Areej Abu Hanieh
 
Drug induced kidney disease
Drug induced kidney diseaseDrug induced kidney disease
Drug induced kidney diseaseswathisravani
 
Antidotes and its clinical application
Antidotes and its clinical applicationAntidotes and its clinical application
Antidotes and its clinical applicationkritijain857168
 
Management of adverse effects of cancer chemotherapy 1
Management of adverse effects of cancer chemotherapy  1Management of adverse effects of cancer chemotherapy  1
Management of adverse effects of cancer chemotherapy 1Dr. Pooja
 
Venous thromboembolism for Pharm.D
Venous thromboembolism for Pharm.DVenous thromboembolism for Pharm.D
Venous thromboembolism for Pharm.DSoujanya Pharm.D
 

La actualidad más candente (20)

Oncology clinical pharmacy from practice to research
Oncology clinical pharmacy from practice to researchOncology clinical pharmacy from practice to research
Oncology clinical pharmacy from practice to research
 
Chemotherapy of breast cancer
Chemotherapy of breast cancerChemotherapy of breast cancer
Chemotherapy of breast cancer
 
Up-to-date management of chemotherapy induced Nausea and vomiting
Up-to-date management of chemotherapy induced Nausea and vomiting Up-to-date management of chemotherapy induced Nausea and vomiting
Up-to-date management of chemotherapy induced Nausea and vomiting
 
breast cancer pharmacotherapy
breast cancer pharmacotherapybreast cancer pharmacotherapy
breast cancer pharmacotherapy
 
CINV dr salah mabrouk khallaf
CINV dr salah mabrouk khallafCINV dr salah mabrouk khallaf
CINV dr salah mabrouk khallaf
 
Principles of cancer chemotherapy
Principles of cancer chemotherapyPrinciples of cancer chemotherapy
Principles of cancer chemotherapy
 
Basic principles of cancer chemotherapy
Basic principles of cancer chemotherapyBasic principles of cancer chemotherapy
Basic principles of cancer chemotherapy
 
Drug induced liver disorders for Pharm.D
Drug induced liver disorders for Pharm.DDrug induced liver disorders for Pharm.D
Drug induced liver disorders for Pharm.D
 
Drug Induced Liver Disorder
Drug Induced Liver DisorderDrug Induced Liver Disorder
Drug Induced Liver Disorder
 
Guidelines for rational use of antibiotics in surgical prophylaxis
Guidelines for rational use of antibiotics in surgical prophylaxisGuidelines for rational use of antibiotics in surgical prophylaxis
Guidelines for rational use of antibiotics in surgical prophylaxis
 
10.ANTICANCER DRUGS
10.ANTICANCER DRUGS10.ANTICANCER DRUGS
10.ANTICANCER DRUGS
 
Treatment of ibd
Treatment of ibdTreatment of ibd
Treatment of ibd
 
PRINCIPLES OF CANCER CHEMOTHERAPY
PRINCIPLES OF CANCER CHEMOTHERAPYPRINCIPLES OF CANCER CHEMOTHERAPY
PRINCIPLES OF CANCER CHEMOTHERAPY
 
ADR chemotherapy.chemotherapy adverse effect
ADR chemotherapy.chemotherapy adverse effect ADR chemotherapy.chemotherapy adverse effect
ADR chemotherapy.chemotherapy adverse effect
 
Drug induced kidney disease (injury)
Drug induced kidney disease (injury)Drug induced kidney disease (injury)
Drug induced kidney disease (injury)
 
Inflammatory Bowel Disease - Pharmacotherapy
Inflammatory Bowel Disease - Pharmacotherapy Inflammatory Bowel Disease - Pharmacotherapy
Inflammatory Bowel Disease - Pharmacotherapy
 
Drug induced kidney disease
Drug induced kidney diseaseDrug induced kidney disease
Drug induced kidney disease
 
Antidotes and its clinical application
Antidotes and its clinical applicationAntidotes and its clinical application
Antidotes and its clinical application
 
Management of adverse effects of cancer chemotherapy 1
Management of adverse effects of cancer chemotherapy  1Management of adverse effects of cancer chemotherapy  1
Management of adverse effects of cancer chemotherapy 1
 
Venous thromboembolism for Pharm.D
Venous thromboembolism for Pharm.DVenous thromboembolism for Pharm.D
Venous thromboembolism for Pharm.D
 

Destacado

cinv (chemotherapy induced nausea & vomiting)
cinv (chemotherapy induced nausea & vomiting)cinv (chemotherapy induced nausea & vomiting)
cinv (chemotherapy induced nausea & vomiting)Mohamed Abdulla
 
Vomiting
VomitingVomiting
VomitingRIPS-14
 
Eczema - A Case Presentation (by Dr. Julius King Kwedhi)
Eczema - A Case Presentation (by Dr. Julius King Kwedhi)Eczema - A Case Presentation (by Dr. Julius King Kwedhi)
Eczema - A Case Presentation (by Dr. Julius King Kwedhi)Dr. Julius Kwedhi
 
Scabies presentation 2
Scabies presentation 2Scabies presentation 2
Scabies presentation 2Hatton27
 
Akynzeo+a+better+or+bitter+pill+for+the+prevention+of+cinv (1)
Akynzeo+a+better+or+bitter+pill+for+the+prevention+of+cinv (1)Akynzeo+a+better+or+bitter+pill+for+the+prevention+of+cinv (1)
Akynzeo+a+better+or+bitter+pill+for+the+prevention+of+cinv (1)Nelson Origa
 
Osteo-Arthritis Information Booklet
Osteo-Arthritis Information BookletOsteo-Arthritis Information Booklet
Osteo-Arthritis Information BookletPankaj Singh
 
4 Osteo Arthritis 2010
4 Osteo Arthritis 20104 Osteo Arthritis 2010
4 Osteo Arthritis 2010NorthTec
 
Supportive Care of Cancer
Supportive Care of CancerSupportive Care of Cancer
Supportive Care of CancerChirag Dave
 
Chemotherapeutic agents pharmacology /certified fixed orthodontic courses by...
Chemotherapeutic agents  pharmacology /certified fixed orthodontic courses by...Chemotherapeutic agents  pharmacology /certified fixed orthodontic courses by...
Chemotherapeutic agents pharmacology /certified fixed orthodontic courses by...Indian dental academy
 

Destacado (20)

cinv (chemotherapy induced nausea & vomiting)
cinv (chemotherapy induced nausea & vomiting)cinv (chemotherapy induced nausea & vomiting)
cinv (chemotherapy induced nausea & vomiting)
 
Nausea and vomiting
Nausea and vomitingNausea and vomiting
Nausea and vomiting
 
Vomiting
VomitingVomiting
Vomiting
 
Vomiting
VomitingVomiting
Vomiting
 
Eczema - A Case Presentation (by Dr. Julius King Kwedhi)
Eczema - A Case Presentation (by Dr. Julius King Kwedhi)Eczema - A Case Presentation (by Dr. Julius King Kwedhi)
Eczema - A Case Presentation (by Dr. Julius King Kwedhi)
 
Scabies
ScabiesScabies
Scabies
 
Scabies ppt
Scabies pptScabies ppt
Scabies ppt
 
Scabies presentation 2
Scabies presentation 2Scabies presentation 2
Scabies presentation 2
 
Akynzeo+a+better+or+bitter+pill+for+the+prevention+of+cinv (1)
Akynzeo+a+better+or+bitter+pill+for+the+prevention+of+cinv (1)Akynzeo+a+better+or+bitter+pill+for+the+prevention+of+cinv (1)
Akynzeo+a+better+or+bitter+pill+for+the+prevention+of+cinv (1)
 
Ethics of Scientific publication
Ethics of Scientific publicationEthics of Scientific publication
Ethics of Scientific publication
 
Emesis /CINV
Emesis /CINVEmesis /CINV
Emesis /CINV
 
Osteo-Arthritis Information Booklet
Osteo-Arthritis Information BookletOsteo-Arthritis Information Booklet
Osteo-Arthritis Information Booklet
 
Eczema Rangeen
Eczema RangeenEczema Rangeen
Eczema Rangeen
 
t 2006
t 2006t 2006
t 2006
 
4 Osteo Arthritis 2010
4 Osteo Arthritis 20104 Osteo Arthritis 2010
4 Osteo Arthritis 2010
 
Supportive Care of Cancer
Supportive Care of CancerSupportive Care of Cancer
Supportive Care of Cancer
 
Infective endocarditis
Infective endocarditis Infective endocarditis
Infective endocarditis
 
ECZEMA and nIMPETIGO
ECZEMA and nIMPETIGOECZEMA and nIMPETIGO
ECZEMA and nIMPETIGO
 
Vomiting ppt (lcps)
Vomiting ppt (lcps)Vomiting ppt (lcps)
Vomiting ppt (lcps)
 
Chemotherapeutic agents pharmacology /certified fixed orthodontic courses by...
Chemotherapeutic agents  pharmacology /certified fixed orthodontic courses by...Chemotherapeutic agents  pharmacology /certified fixed orthodontic courses by...
Chemotherapeutic agents pharmacology /certified fixed orthodontic courses by...
 

Similar a chemotherapy induced Nausea &vomiting

Anti emetics 1.ppt
Anti emetics 1.pptAnti emetics 1.ppt
Anti emetics 1.pptssuser7b172e
 
2- Antiemetic.ppt
2- Antiemetic.ppt2- Antiemetic.ppt
2- Antiemetic.pptHananHagar
 
Antiemetics Pharmacology Presentation.ppt
Antiemetics Pharmacology Presentation.pptAntiemetics Pharmacology Presentation.ppt
Antiemetics Pharmacology Presentation.pptAyush Roy
 
Antiemetics and prokinetics classification with mechansim
Antiemetics and prokinetics classification with mechansim Antiemetics and prokinetics classification with mechansim
Antiemetics and prokinetics classification with mechansim SONALPANDE5
 
Emetcs and antiemetics
Emetcs and antiemeticsEmetcs and antiemetics
Emetcs and antiemeticsChintan Doshi
 
Emetics and anti emetics
Emetics and anti emeticsEmetics and anti emetics
Emetics and anti emeticsSanthaLakshmi12
 
Physiology of nausea and vomiting , vomiting in
Physiology of nausea and vomiting , vomiting inPhysiology of nausea and vomiting , vomiting in
Physiology of nausea and vomiting , vomiting inShirish Acharya
 
Antiemetics, Pharmacology by Baqir Naqvi.pptx
Antiemetics, Pharmacology  by Baqir Naqvi.pptxAntiemetics, Pharmacology  by Baqir Naqvi.pptx
Antiemetics, Pharmacology by Baqir Naqvi.pptxDr. Baqir Raza Naqvi
 
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptxCHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptxDr Monica P
 
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptxCHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptxDr Monica P
 

Similar a chemotherapy induced Nausea &vomiting (20)

Anti emetics 1.ppt
Anti emetics 1.pptAnti emetics 1.ppt
Anti emetics 1.ppt
 
Antiemetics, emetics
Antiemetics, emeticsAntiemetics, emetics
Antiemetics, emetics
 
2- Antiemetic.ppt
2- Antiemetic.ppt2- Antiemetic.ppt
2- Antiemetic.ppt
 
Antiemetics Pharmacology Presentation.ppt
Antiemetics Pharmacology Presentation.pptAntiemetics Pharmacology Presentation.ppt
Antiemetics Pharmacology Presentation.ppt
 
Antiemetics and prokinetics classification with mechansim
Antiemetics and prokinetics classification with mechansim Antiemetics and prokinetics classification with mechansim
Antiemetics and prokinetics classification with mechansim
 
Anti emetics
Anti emeticsAnti emetics
Anti emetics
 
Nausea & Vomiting
Nausea & VomitingNausea & Vomiting
Nausea & Vomiting
 
Antiemetic drugs
Antiemetic drugs Antiemetic drugs
Antiemetic drugs
 
Antiemetics
AntiemeticsAntiemetics
Antiemetics
 
Emetcs and antiemetics
Emetcs and antiemeticsEmetcs and antiemetics
Emetcs and antiemetics
 
pain_pi.ppt
pain_pi.pptpain_pi.ppt
pain_pi.ppt
 
Emetics and anti emetics
Emetics and anti emeticsEmetics and anti emetics
Emetics and anti emetics
 
Nausea and vomiting
Nausea and vomiting Nausea and vomiting
Nausea and vomiting
 
Anaphylactic
AnaphylacticAnaphylactic
Anaphylactic
 
Antiemetics
AntiemeticsAntiemetics
Antiemetics
 
Physiology of nausea and vomiting , vomiting in
Physiology of nausea and vomiting , vomiting inPhysiology of nausea and vomiting , vomiting in
Physiology of nausea and vomiting , vomiting in
 
Antiemetics, Pharmacology by Baqir Naqvi.pptx
Antiemetics, Pharmacology  by Baqir Naqvi.pptxAntiemetics, Pharmacology  by Baqir Naqvi.pptx
Antiemetics, Pharmacology by Baqir Naqvi.pptx
 
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptxCHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
 
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptxCHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
CHEMOTHERAPY-INDUCED NAUSEA AND VOMITING.pptx
 
Emetics & antiemetics
Emetics & antiemeticsEmetics & antiemetics
Emetics & antiemetics
 

Último

High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptPradnya Wadekar
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationMedicoseAcademics
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.kishan singh tomar
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project reportNARMADAPETROLEUMGAS
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsMedicoseAcademics
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.whalesdesign
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptPradnya Wadekar
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectiondrhanifmohdali
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaSujoy Dasgupta
 

Último (20)

High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Unit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.pptUnit I herbs as raw materials, biodynamic agriculture.ppt
Unit I herbs as raw materials, biodynamic agriculture.ppt
 
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxationPhysiology of Smooth Muscles -Mechanics of contraction and relaxation
Physiology of Smooth Muscles -Mechanics of contraction and relaxation
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...American College of physicians ACP high value care recommendations in rheumat...
American College of physicians ACP high value care recommendations in rheumat...
 
Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.Different drug regularity bodies in different countries.
Different drug regularity bodies in different countries.
 
blood bank management system project report
blood bank management system project reportblood bank management system project report
blood bank management system project report
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
AUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functionsAUTONOMIC NERVOUS SYSTEM organization and functions
AUTONOMIC NERVOUS SYSTEM organization and functions
 
MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.MedMatch: Your Health, Our Mission. Pitch deck.
MedMatch: Your Health, Our Mission. Pitch deck.
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
ayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologypptayurvedic formulations herbal drug technologyppt
ayurvedic formulations herbal drug technologyppt
 
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
How to master Steroid (glucocorticoids) prescription, different scenarios, ca...
 
AORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissectionAORTIC DISSECTION and management of aortic dissection
AORTIC DISSECTION and management of aortic dissection
 
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy DasguptaMale Infertility Panel Discussion by Dr Sujoy Dasgupta
Male Infertility Panel Discussion by Dr Sujoy Dasgupta
 

chemotherapy induced Nausea &vomiting

  • 2. 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 Autonomic symptoms Retching Contraction Vomiting Contraction + forced expel of Gicontent
  • 3. Pathophysiology Nausea & vomiting are complex interaction from different systems Central vomiting center (medulla) CTZ (5-HT3 ,D2,NK1 Gastrointestin al(visceral afferents(5- HT3,D2,NK1 Cerebral cortex (sensory) Vestibular system (H!, muscarinic )
  • 4. •Types & causes :  GI or intraperitoneal  Cardiac  Neurologic  Therapy induced  Endocrine/metabolic  Others ( CINV , PONV , NVP , motionskiness )
  • 5. •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. PharmacologicalNon pharmacological
  • 6. •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)
  • 7. •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
  • 8. •Pharmacological Anti emetic classes : • cyclazine • DiphenhydramineAntihistaminic • Phenothiazine(chloropromazine) • Butyrophenone(haloperidol) • Benzamides(metaclopromide , domperdione ) antidopaminergic • Granisetron • ondansetron • Palonosetrone Serotonin antagonists Neurokinin 1 antagonist •Aprepitant •Fosaprepitant
  • 9. •Cont,.: • DexamethasoneCorticosteroides • Aloprozolam • Lorazepam Benzodiazipens • nabilone • Dronabinol Cannabinoids
  • 10. 1 • Types of CINV 2 • Risk stratification 3 • How to manage (guidelines ) CINV
  • 11. •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
  • 12. •Risk stratification : Patient related risk factors Emetogenicity of chemotherapy agents Radiation exposure
  • 13. •Patients related risk :  Patient’s age (younger or those younger than 50 years  Female sex  HX of motion skiness or NVP  Poor control of N&V in pervious chemo cycles  HX of chornic alcoholism (+ve risk ↓incidence)
  • 15. 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 )

Notas del editor

  1. Phase III trials of netupitant and rolapitant are ongoing - See more at: http://www.cancernetwork.com/cancer-management/management-nausea-and-vomiting/page/0/2#sthash.Vurz3Xtv.dpuf