Gemcitabine

Ixabepilone

Methotrexate greater ihan SO nrtg/nrr and less than 250 rng/rn1, .Mitomycin Nflotlnib Paciitaxei Pemetrexed Topotecan Vorinostat

.Most other agents pathophysiology

The pathophysiology of nausea and vomiting is described in Chapter 20. Specific to CINV, the key receptors include serotonin (5-HT3) receptors (located in the chemore-ceptor trigger zone, emetic center of the medulla, and in the GI tract) and neurokinin-1

(NK1) receptors (located in the emetic center of the medulla). Serotonin plays an important role in the genesis of acute vomiting, as some cancer drug therapies can stimulate a release of serotonin from enterochromaffin cells in the GI tract. Serotonin then activates the emetic response by binding to 5HT3 receptors in the emetic center. This short-lived release of serotonin likely explains why serotonin antagonists are more beneficial for preventing acute versus delayed vomiting.5 Other sites that are targeted by antiemetics include dopamine, muscarinic (acetylcholine), histamine, and cannabin-oid receptors.

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