Chapter 72 – Chemotherapy Side Effects (QE) Sample Questions
1. A patient receiving chemotherapy for lung cancer is currently taking a prophylaxis regimen of Aprepitant, Dexamethasone, and Ondansetron. Despite compliance with this regimen, the patient reports experiencing breakthrough nausea and vomiting 48 hours after chemotherapy. According to CINV management guidelines found in the resources, which of the following agents is appropriate to add to the current regimen for the management of breakthrough symptoms?
- A. Switch Ondansetron to Granisetron
- B. Add Olanzapine
- C. Increase the Dexamethasone dose
- D. Discontinue Aprepitant and start Metoclopramide
Ans:
B
Explanation: For breakthrough nausea/vomiting while on a standard prophylactic regimen (5-HT3 RA + Dexamethasone + NK-1 RA like Aprepitant), the guidelines suggest adding an agent with a different mechanism of action. The resources specifically list Olanzapine as a suitable addition for breakthrough/refractory nausea. Other options mentioned in the charts include Metoclopramide or Prochlorperazine, but Olanzapine is highlighted as a distinct addition if not already used.
"If not used already, add regular doses of... olanzapine").
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