NAPLEX Question of the Week: Oncology Supportive Care

Supportive care is an important component of managing chemotherapy. Are you up for our question of the week?

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Which of the following statements are true when it comes to Chemotherapy-Induced Nausea and Vomiting (CINV) treatment? Select all that apply. 
A. Highly emetogenic chemotherapy regimens should be prevented with a 5-HT3/dopamine antagonist (e.g. Zyprexa) + Neurokinin-1 receptor antagonist (e.g. aprepitant)
B. Dexamethasone's side effect profile consists of sedation, immunosuppression, and psychosis
C. Olanzapine's dosage forms include tablets and oral disintegrating tablets 
D. Granisetron may prolong QTc in certain patient populations 
E.  Fosaprepitant works by inhibiting binding of substance P and should be given as a one time dose of 150 mg in adults. 
Answers D and E are correct.
When deciding what CINV regiment is most appropriate for a patient, we must first know the emetogenic category of their specific chemotherapy regiment. Chemotherapy drugs are classified into one of four groups: high, moderate, low, or minimal emetogenic potential. Answer A is incorrect because, when managing CINV for a high emetogenic regimen, you must use either triplet or quadruplet therapy. Triple therapy consist of a corticosteroid (dexamethasone: Decadron), a 5-HT3 antagonist (ondansetron: Zofran), and a Neurokinin-1 (NK1) receptor antagonist (aprepitant: Cinvanti) or a serotonin/dopamine antagonist (olanzapine: Zyprexa). Quadruple therapy consist of all four classes. Dexamethasone depresses the hypothalamic-pituitary-adrenal axis (HPA) leading to immunosuppression and has the additional side effects of insomnia and psychosis but not sedation thus answer B is incorrect. Although olanzapine is available as tablets and as orally disintegrating tablets (ODT), it is also available as an injection making answer C incorrect. Answer D is correct because 5-HT3 antagonists can cause QTc prolongation, hence they should be monitored closely in patients with cardiac conduction problems or risk factors for arrhythmias. NK1 receptor antagonist (fosaprepitant: Emend) block the binding of substance P to the NK1 receptor in the CNS and prevent emesis. It is a 150 mg IV infusion give on day one of chemotherapy making answer E correct. 
NAPLEX Competencies Covered:
2.1 Pharmacology, mechanism of action, or therapeutic class
3.4 – Drug dosing or dosing adjustments; duration of therapy
3.5 Drug route of administration, dosage forms, or delivery systems
3.6 Drug contraindications, allergies, or precautions
3.7 Adverse drug effects, toxicology, or overdose
3.11 Evidence-based practice

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.