预防化疗引起恶心呕吐之药物介绍-北药No1.PDF

預防化療引起噁心嘔吐之 藥物介紹 林口長庚醫院 鄭吉元 藥師 Outline Introduction Pathophysiology Risk factors -- emetogenicity (致吐性) of chemotherapy Guideline: ASCO, NCCN, ESMO, MASCC Pharmacological treatment Complementary therapy Special situations -- consecutive day of chemotherapy -- poor emesis control Patient education Summary 疲勞、嘔心噁吐 、落髮 是病人最在意的化療副作用  疲勞 (80.6%) 。 噁心嘔吐 (70.5%) 。 落髮 (60.4%) 。 78% 的化療病患曾有噁心嘔吐的情況 以女性及 50 歲以下機率較高 癌症病患經過化療後，有 77.7%的病患都發生噁心嘔吐的狀況。 男性嘔吐機率： 69.5% 50 歲以下嘔吐機率：88% 女性嘔吐機率：83 % 50 歲以上嘔吐機率：76 % 女性發生嘔吐較男性高 50 歲以下嘔吐機率高 Causes of Nausea and Vomiting in Cancer Patients • Gastrointestinal obstruction • Drugs - Opioids - Chemotherapy • Biochemical - Hypercalcemia - Uremia • Raised intracranial pressure due to CNS metastasis • Pain • Surgery • Radiotherapy of abdominopelvic sites Three distinct types of CINV Acute emesis: 24 hours after chemotherapy Delayed emesis: 24 hours after chemotherapy (長達 2-5 天的嘔吐) Anticipatory emesis: vomiting before chemotherapy CINV: chemotherapy-induced nausea/vomiting 8 Delayed emesis • Delayed emesis occurs most frequently after cisplatin but can also occur following other agents, including carboplatin, cyclophosphamide, anthracyclines, and oxaliplatin. Pathophysiology AP: area postrema NTS: nucleus tractus solitarius AP/NTS: chemoreceptor trigger zone N Engl J Med 2008;358:2482 Neurotransmitter receptor sites Five neurotransmitter receptor sites are of primary importance in the vomiting reflex: •