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Chapter 41: Nausea and Vomiting

DH is a 56-year-old woman diagnosed with stage 2 breast cancer. Her past medical history (PMH) is significant for heavy alcohol use. She is single and has no children. She presents to clinic today to begin treatment with doxorubicin and cyclophosphamide.

Select which antiemetic combination will give her optimal prevention for CINV?

a. Fosaprepitant, dolasetron, and prochlorperazine

b. Fosaprepitant, haloperidol, and promethazine

c. Fosaprepitant, ondansetron, and dexamethasone

d. Fosaprepitant, prochlorperazine, and dexamethasone

Answer c is correct. Fosaprepitant is FDA approved in combination with a corticosteroid (dexamethasone) and 5-HT3 antagonist (ondansetron) for highly emetogenic regimens.

Answer a is incorrect. Fosaprepitant is FDA approved in combination with a corticosteroid and 5-HT3 antagonist for highly emetogenic regimens. This combination lacks the corticosteroid.

Answer b is incorrect. Fosaprepitant is FDA approved in combination with a corticosteroid and 5-HT3 antagonist for highly emetogenic regimens. This combination lacks the corticosteroid and 5-HT3 antagonist.

Answer d is incorrect. Fosaprepitant is FDA approved in combination with a corticosteroid and 5-HT3 antagonist for highly emetogenic regimens. This combination lacks the 5-HT3 antagonist.

DH is a 56-year-old woman diagnosed with stage 2 breast cancer. Her past medical history (PMH) is significant for heavy alcohol use. She is single and has no children. She presents to clinic today to begin treatment with doxorubicin and cyclophosphamide.

You note that DH is appropriately treated for acute CINV, but not delayed CINV. Her prophylactic regimen includes fosaprepitant 150 mg IV prior to chemotherapy. What is the best prophylaxis regimen to prevent delayed CINV?

a. Aprepitant 80 mg po daily × 2 days and dexamethasone 8 mg po bid × 3 days.

b. Ondansetron 8 mg po bid × 3 days and dexamethasone 8 mg po bid × 3 days.

c. No treatment is needed as DH is not at risk for delayed nausea and vomiting.

d. Dexamethasone 8 mg po × 3 days.

Answer d is correct. Only dexamethasone should be continued when fosaprepitant 150 mg IV is used prior to chemotherapy. The recommended dose is 8 mg daily on day 2 and 8 mg bid on days 3 and 4.

Answer a is incorrect. When fosaprepitant 150 mg IV is used prior to chemotherapy, no additional NK-1 receptor antagonist therapy is needed.

Answer b is incorrect. Ondansetron has not been shown to be more effective than dexamethasone alone for delayed nausea ...

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