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Central Nervous System Drugs
Published in Sarah Armstrong, Barry Clifton, Lionel Davis, Primary FRCA in a Box, 2019
Sarah Armstrong, Barry Clifton, Lionel Davis
Antiemetics are those drugs used to prevent nausea and vomitingMost drugs act centrally on the vomiting centre (VC) and chemoreceptor trigger zone (CTZ) but some (e.g. metoclopramide) have peripheral actions on the gastrointestinal tractAntiemetic drugs include dopamine antagonists, anticholinergics, antihistamines, 5-HT3 antagonists, NK1 antagonists and miscellaneous drugs
Laparoscopic antireflux surgery
Published in Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson, Operative Thoracic Surgery, 2017
Sarah K. Thompson, Glyn G. Jamieson
Aggressive anti-emesis is administered postoperatively to prevent vomiting. We use an intravenous 5-HT3 antagonist (e.g., ondansetron) at regular time periods over 48 hours. Other anti-emetics are charted, including droperidol 0.5 mg, metoclopramide 10-20 mg, and cyclizine 50 mg. Patients are given regular IV paracetamol, and low dose opioid (e.g., fentanyl) if needed. Clear fluids are allowed the same day, with a contrast swallow performed on postoperative day 1. If the wrap is subdiaphragmatic and no leak is identified (see Figure 38.9), free fluids are commenced, with an upgrade to a minced/pureed diet that evening. A soft diet is commenced the following day, either as an outpatient or prior to discharge.
Principles of Systemic Cancer Therapy
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
Christina Thirlwell, John Bridgewater, Judith Cave
In vitro evidence suggests that for some drugs such as cisplatin, there is a clear relationship between dose of chemotherapy and proportion of cells killed (16, 47). In potentially curable tumors, there has been a great deal of interest in escalating treatment doses to improve survival, but, as mentioned above, dose is commonly limited by bone marrow suppression. Supportive care has improved significantly in recent years, and since the 1970s, it has been possible to perform peripheral blood stem cell rescue (48, 49). This is a procedure whereby the patient’s stem cells are collected from the peripheral blood and stored so that they can be returned after a high dose of chemotherapy, thus shortening the duration of neutropenia. The introduction of 5-HT3 antagonists has enabled nausea to be controlled more effectively (enabling the majority of chemotherapy regimens to be given as outpatient), and for some drugs the use of colony-stimulating factors alone is enough to significantly increase the tolerated dose (50).
A pharmacological overview of aprepitant for the prevention of postoperative nausea and vomiting
Published in Expert Review of Clinical Pharmacology, 2023
Andrew Padilla, Ashraf S Habib
A recent network meta-analysis included data from 585 studies and 97,516 patients. The primary outcome of this analysis was postoperative vomiting. In this review, there was high certainty evidence for the clinical efficacy of aprepitant in reducing post-operative vomiting, alongside with other four antiemetics (ramosetron, granisetron, dexamethasone and ondansetron). When ranking the antivomiting efficacy compared with placebo, fosaprepitant ranked first and aprepitant third, while another NK1 antagonist (casopitant) ranked second. Of note, casopitant is not currently approved or available for the management of PONV. The review identified that combination of drugs was generally more effective than monotherapy in the prevention of vomiting. The review also suggested that, in comparison to combinations of dexamethasone-ondansetron, dexamethasone-granisetron, and droperidol-ondansetron, aprepitant alone had comparable efficacy for reducing post-operative vomiting. There was no apparent dose response for the antivomiting efficacy of aprepitant. However, the review identified aprepitant’s anti-nausea effects as modest with uncertainty. Other agents in the D2 antagonist and 5-HT3 antagonist class demonstrated better anti-nausea efficacy compared with the NK1 antagonists [12].
Ondansetron versus ondansetron with dexamethasone to prevent intrathecal-morphine pruritus for caesarean patients: randomised double-blind trial
Published in Journal of Obstetrics and Gynaecology, 2021
Thaer Ankouni, Saleh Kanawati, Rania El Khatib, Janah El Hassan, Saad Eddine Itani, Omar Rajab, Zoher Naja
The use of neuraxial opioids in the obstetric population provides effective long-lasting postoperative analgesia but have adverse side effects that include nausea, vomiting, and pruritus (Charuluxananan et al. 2000; Siddik-Sayyed et al. 2007; Yurashevich and Habib 2019). The incidence of pruritus in caesarean section patients has been reported to be between 36% and 60% (Weigl et al. 2017; Thay et al. 2018). The exact mechanism of opioid-induced pruritus is unclear but it could be due to an interaction between oestrogen, opioid receptors and central serotonin receptors (Waxler et al. 2005; Bonnet et al. 2008). It has been suggested that the interaction between opioids and 5-hydroxytryptamine subtype 3 (5HT3) receptors could have a role in causing neuraxial opioid-induced pruritus. 5-HT3 receptors are numerous in the spinal tract of the trigeminal nerve in the medulla and in the dorsal horn of the spinal cord. Therefore, 5-HT3 antagonists such as ondansetron have been identified as possible antipruritic agents (Koju et al. 2015; Kumar and Singh 2013).
Selinexor (KTP-330) - a selective inhibitor of nuclear export (SINE): anti-tumor activity in diffuse large B-cell lymphoma (DLBCL)
Published in Expert Opinion on Investigational Drugs, 2020
Sharon Ben-Barouch, John Kuruvilla
A total of 50 serious AEs (SAEs) were reported, with at least 11 being potentially drug-related and occurring at doses between 30 to 70 mg/m2. All patients with grade 3 SAEs recovered with supportive care or drug interruption. Twelve of the 79 patients underwent dose reductions due to toxicity and 15 withdrew consent because of AEs. An analysis of patients stratified into those receiving >40mg/m2 or less, found that the higher dose group more frequently had significant weight loss and shorter time on therapy. Given this difference in tolerability, the RP2D was determined to be 35mg/m2. In patients who continued on selinexor, cumulative toxicity was not observed with repeated dosing and with longer drug exposure, symptoms on treatment tended to moderate in the 18% of patients that received treatment for at least 6 months. Typical supportive care for anorexia and nausea included pre-medication with 5-HT3 antagonists, D2 antagonists, and/or olanzapine. Dexamethasone at 4 to 8 mg with each dose of selinexor provided further nausea control, improve appetite, and reduce fatigue, and megestrol acetate was also potentially used to ameliorate anorexia and weight loss in rare patients.