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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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Refractory pruritus from malignant cholestasis: management.

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Summary

This case report details a patient with malignant cholestasis experiencing severe pruritus resistant to standard treatments. Addressing multifactorial causes and exploring diverse therapies is crucial for managing this challenging symptom in cancer patients.

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Area of Science:

  • Oncology
  • Hepatology
  • Palliative Care

Background:

  • Malignancy-associated pruritus, particularly with cholestasis, presents a significant challenge in cancer care.
  • Conventional treatments like ursodeoxycholic acid, chlorpheniramine, and cholestyramine may be insufficient for severe cases.

Observation:

  • A patient in a tertiary-care cancer hospital experienced pruritus refractory to standard therapies.
  • The multifactorial nature of malignancy-associated pruritus was considered in this case.
  • Resource limitations in the setting impacted optimal symptom palliation.

Findings:

  • Correctable factors contributing to pruritus were identified and addressed.
  • Treatment strategies focused on addressing potential underlying etiologies.
  • Various pharmacotherapies and non-pharmacological measures were considered for symptom relief.

Implications:

  • Highlights the need for a comprehensive, multifactorial approach to managing refractory pruritus in cancer patients.
  • Underscores the challenges posed by resource limitations in palliative care settings.
  • Suggests the potential for novel therapeutic strategies and further research into malignancy-associated pruritus.