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Related Concept Videos

Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists01:28

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Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy.  SP binds and activates...
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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists01:29

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Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
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Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
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Vomiting is a complex physiological response to expel harmful or irritating substances from the body. It's a defensive mechanism triggered by stimuli like poisons, microbial toxins, cytotoxic drugs, and mechanical abdominal distension. The process is centrally coordinated by the vomiting (or emetic) center located in the medulla of the brainstem. This area, rich in muscarinic M1, histamine H1, neurokinin 1 (NK1), and serotonin 5-HT3 receptors, coordinates the act of vomiting through...
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Cancer therapies are various modes of treatment, such as surgery, radiation therapy, and chemotherapy that are administered to cancer patients.
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Acupoint Application Combined with Acupressure as an Adjunctive Therapy for Chemotherapy-Induced Nausea and Vomiting
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Chemotherapy-Induced Nausea and Vomiting.

Karen M Mustian1, Tom V Darling1, Michelle C Janelsins1

  • 1University of Rochester School of Medicine and Dentistry, James P. Wilmot Cancer Center, Box 704, 601 Elmwood Avenue, Rochester, NY 14642.

US Oncology
|April 25, 2014
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Summary

Chemotherapy-induced nausea and vomiting (CINV) remains a significant challenge, impacting treatment adherence. This overview covers CINV pathophysiology, standard guidelines, and novel targeted therapies.

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Area of Science:

  • Oncology
  • Pharmacology
  • Psychosomatic Medicine

Background:

  • Chemotherapy-induced nausea and vomiting (CINV) is a prevalent and distressing side effect for 70-80% of cancer patients.
  • Fear of CINV can lead to treatment delays, refusal, or discontinuation, significantly impacting patient outcomes.
  • Specific CINV types like anticipatory, delayed, and nausea alone pose persistent challenges despite treatment advances.

Purpose of the Study:

  • To provide a comprehensive overview of the pathophysiology and psychophysiology of chemotherapy-induced nausea and vomiting.
  • To outline current recommended guidelines for the standard management of CINV.
  • To highlight emerging and targeted treatment strategies for improved CINV control.

Main Methods:

  • Literature review and synthesis of existing research on CINV.
  • Analysis of current clinical guidelines for chemotherapy antiemesis.
  • Review of recent studies on novel targeted therapies for CINV.

Main Results:

  • CINV encompasses complex patho-psychophysiological mechanisms.
  • Standard antiemetic guidelines exist but do not fully address all CINV types.
  • Newer targeted treatments show promise in improving CINV management.

Conclusions:

  • Effective management of CINV is crucial for maintaining cancer treatment adherence and improving patient quality of life.
  • A multi-faceted approach addressing pathophysiology, standard care, and targeted therapies is necessary.
  • Ongoing research into novel treatments is vital for overcoming the persistent challenges of CINV.