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Several treatment methods are available to help prevent CINV. Pharmaceutical treatment is generally separated into two types: prophylactic (preventative) treatment, given before the dose of chemotherapy agents, and rescue treatment, given to treat breakthrough nausea and vomiting.
Cancer and nausea are associated in about fifty percent of people affected by cancer. [1] This may be as a result of the cancer itself, or as an effect of the treatment such as chemotherapy, radiation therapy, or other medication such as opiates used for pain relief. About 70–80% of people undergoing chemotherapy experience nausea or vomiting.
As most chemotherapy drugs kill cancer cells in this manner, defective apoptosis allows survival of these cells, making them resistant. Many chemotherapy drugs also cause DNA damage, which can be repaired by enzymes in the cell that carry out DNA repair. Upregulation of these genes can overcome the DNA damage and prevent the induction of apoptosis.
Chemotherapy is a major cause of emesis, and often can cause severe and frequent emetic responses. This is because chemotherapy agents circulating in the blood activate the CTZ in such a way as to cause emesis. [13] Patients receiving chemotherapy are often prescribed antiemetic medications.
5-HT 3 antagonists are most effective in the prevention and treatment of chemotherapy-induced nausea and vomiting (CINV), especially that caused by highly emetogenic drugs such as cisplatin; when used for this purpose, they may be given alone or, more frequently, with a glucocorticoid, usually dexamethasone.
It was the first in a series of drugs that gave doctors a better way to control nausea and vomiting, said Dr. Alexi Wright, a Dana-Farber Cancer Institute oncologist who teaches at Harvard. Wright and other cancer specialists call ondansetron a cornerstone treatment because of its relative safety, effectiveness and limited side effects.
The discovery of neurokinin 1 (NK 1) receptor antagonists was a turning point in the prevention of nausea and vomiting associated with cancer chemotherapy. [4] An example of a drug in this class is aprepitant. Chemotherapy-induced emesis appears to consist of acute and delayed phases.
An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer. They may be used for severe cases of gastroenteritis, especially if the patient is dehydrated. [1] [2]
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