Emetogenicity

Cisplatin administration requires adequate hydration and forced diuresis to prevent kidney damage. Cisplatin is intensely emetogenic and its use requires adequate antiemetic prophylaxis. Myelosuppression is less evident than with other alkylating agents. 

The area postrema is a circumventricular brain region positioned on the dorsal surface of the medulla on the floor of the fourth ventricle. The blood-brain barrier and the cerebrospinal fluid-brain barrier are absent in this region and consequently many substances that do not pass across capillaries in other regions of the brain can do so in the area postrema. The chemoreceptor trigger zone (CTZ), located in the lateral area postrema is sensitive to blood-borne emetogens. Nerves from the CTZ connect with the vomiting centre. 

NTS) in the medulla. The area postrema lacks a blood-brain barrier and is accessible to emetogens in the bloodstream. Neurons pass from the CTZ to the NTS and the vomiting centre. 

Emetogenic drugs may be of value in treating cases of acute poisoning but usually nausea and vomiting induced by a drag are unwanted effects occurring in addition to its therapeutic action. 

Data from DiPiro CV, Taylor AT. Nausea and vomiting. In DiPiro JT, Talbert RL, Yee GC, et a I., (eds.) Pharmacotherapy A Pathophysiologic Approach. 6th ed. New York McGraw-Hill 2005 665-676, and Hesketh PJ, Kris MG, Grunberg SM, et al. Proposal for classifying the acute emetogenicity of cancer chemotherapy. J Clin Oncol 1 997 1 5 1 03-1 09. 

Develop a plan for preventing and treating nausea and vomiting in patients receiving emetogenic chemotherapy. 

Hypersensitivity reactions (fever, hypotension, rash, dyspnea in 25%), much lower risk with polyethylene gycol form low emetogenic potential pancreatitis decreased synthesis of proteins, clotting factors CNS lethargy... 

Myelosuppression alopecia moderate emetogen worse with high dose (greater than 1 g/m2) or IT administration diarrhea mucositis flu-like syndrome with fever and arthralgias rash often followed by desquamation on palms and soles... 

Myelosuppression (dose-related) mucositis (worse with continuous infusion) moderate emetogenic potential alopecia vesicant severe extravasation injury cardiac toxicities acute—not related to cumulative dose arrhythmias, pericarditis chronic— cumulative injury to myocardium (total dose greater than 550 mg/m2 lower total cumulative doses cause damage to myocardium in children (e.g., 350 mg/m2)... 

Moderate emetogenic potential take with meals and a full glass of water edema periorbital edema is characteristic pleural effusions, ascites, or pulmonary edema also occur rash diarrhea neutropenia, thrombocytopenia (sometimes difficult to distinguish from CML-induced cytopenias) increased liver function tests... 

Peripheral neuropathy primary dose-limiting toxicity motor sensory, autonomic, and cranial nerves may all be affected (paresthesias, ileus, urinary retention, facial palsies) may be irreversible mild emetogen SIADH vesicant extravasation injury... 

---