Chemotherapy induced nausea and vomiting--prevention and treatment.
ABSTRACT Chemotherapy induced nausea and vomiting are among the most feared consequences of cancer treatment. Recent developments in drug treatment make the goal of no nausea or vomiting during chemotherapy realistic.
In this article we review the pathogenesis and management of chemotherapy induced nausea and vomiting.
Regimens to prevent chemotherapy induced nausea and vomiting are guided by the emetogenic potential of the chemotherapeutic agents used. Combined prophylactic therapy targets different pathways, improving the efficacy of prevention and treatment of chemotherapy induced nausea and vomiting. General practitioners have an important role in patients undergoing chemotherapy by reinforcing the importance of prophylactic treatment and administering rescue treatment for patients with breakthrough or prolonged nausea and vomiting postchemotherapy.
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ABSTRACT: Gene directed enzyme prodrug therapy (GDEPT) of cancer aims to improve the selectivity of chemotherapy by gene transfer, thus enabling target cells to convert nontoxic prodrugs to cytotoxic drugs. A zone of cell kill around gene-modified cells due to transfer of toxic metabolites, known as the bystander effect, leads to tumour regression. Here we discuss the implications of either striving for a strong bystander effect to overcome poor gene transfer, or avoiding the bystander effect to reduce potential systemic effects, with the aid of three successful GDEPT systems. This review concentrates on bystander effects and drug development with regard to these enzyme prodrug combinations, namely herpes simplex virus thymidine kinase (HSV-TK) with ganciclovir (GCV), cytosine deaminase (CD) from bacteria or yeast with 5-fluorocytodine (5-FC), and bacterial nitroreductase (NfsB) with 5-(azaridin-1-yl)-2,4-dinitrobenzamide (CB1954), and their respective derivatives.Molecules 11/2009; 14(11):4517-45. DOI:10.3390/molecules14114517 · 2.10 Impact Factor
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ABSTRACT: Physicians frequently prescribe 'stat' orders that need to be actioned immediately or within a limited time frame. This process can be time consuming and expensive. Stat medications are reserved for the highest priority orders and life-threatening situations that need to be dealt with immediately or within a limited time frame. The goals of this study were to evaluate whether stat medications in a teaching hospital were ordered appropriately and to assess the rationale for the stat order. The study was carried out between July and August 2009 in Masih Daneshvari Hospital. All newly admitted patients' charts were reviewed and the records of all inpatients who received at least one stat order were included in the study. Detailed analyses were undertaken to examine the stat use of agents and the rationale for their prescription. Several different guidelines were used to evaluate the rationale for the prescriptions. Charts for 175 patients were reviewed. Of these, 109 (62.3%) patients received a total of 220 stat orders. The mean number of stat orders on each chart of patients who received stat orders was 2.0. Stat orders were divided into two categories: 146 (66.4%) that were administered only once and 74 (33.6%) that were reordered. The internal medicine ward accounted for the most stat medications (35%). The major reasons for stat medication orders were: prophylaxis or management of emesis (22.3%), control of dyspnoea (15.9%), preoperative medications (8.2%) and treatment of exacerbations of chronic obstructive pulmonary disease (7.2%). Hydrocortisone (14.1%), dexamethasone (11.3%), granisetron (9.5%), ceftriaxone (8.6%) and morphine (6.8%) accounted for the most common stat orders. Analysis showed that 133 of the total 220 stat orders (60.5%) were prescribed appropriately; the rationale for 19 orders (8.6%) could not be evaluated. This study showed that most stat orders at Masih Daneshvari Hospital during the study period were prescribed appropriately. Further investigations are recommended to evaluate the outcomes of unnecessary stat orders with respect to adverse drug events.Clinical Drug Investigation 01/2011; 31(4):231-5. DOI:10.2165/11540000-000000000-00000 · 1.70 Impact Factor