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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

Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists

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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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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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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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In patients with renal impairment, drugs undergo significant changes in their pharmacokinetics, which require dosage adjustments to ensure safe and effective therapy.
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Conventional Chemotherapy Nephrotoxicity.

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  • 1Division of Renal Medicine, Brigham and Women's Hospital, Boston, MA.

Advances in Chronic Kidney Disease
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Conventional chemotherapy can harm kidneys, causing acute kidney injury and chronic kidney disease (CKD). This review details chemotherapy-induced kidney complications, risk factors, and mitigation strategies for better cancer patient outcomes.

Keywords:
Acute kidney injuryCancerChemotherapyCisplatinElectrolyte disturbanceHyponatremia

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Area of Science:

  • Nephrology
  • Oncology
  • Pharmacology

Background:

  • Conventional chemotherapy is a primary treatment for many cancers.
  • Chemotherapy-induced kidney complications are common and can impact patient prognosis.
  • Adverse kidney effects range from acute kidney injury to chronic kidney disease and electrolyte imbalances.

Purpose of the Study:

  • To review kidney complications associated with conventional chemotherapy agents.
  • To identify risk factors and outline strategies for mitigating kidney damage.
  • To provide drug-specific recommendations for managing chemotherapy-induced kidney adverse effects.

Main Methods:

  • Systematic review of literature on chemotherapy-induced nephrotoxicity.
  • Analysis of incidence, risk factors, and management strategies for kidney complications.
  • Focus on frequently used agents like platinum-based drugs, cyclophosphamide, gemcitabine, ifosfamide, methotrexate, and pemetrexed.

Main Results:

  • Chemotherapy can cause acute kidney injury through various mechanisms (tubular injury, nephritis, glomerular disease, thrombotic microangiopathy).
  • Long-term consequences include reduced kidney function and chronic kidney disease (CKD).
  • Electrolyte disturbances are also noted adverse effects.

Conclusions:

  • Understanding and managing chemotherapy-related kidney complications is crucial for patient survival and treatment options.
  • Risk mitigation strategies and dose modifications, though limited by data, are essential.
  • Drug-specific management plans are necessary for addressing these adverse effects.