Risk factors and antiemetic management of chemotherapy-induced nausea and vomiting.

PURPOSE/OBJECTIVES: To review the emetic potential of chemotherapeutic agents and the specific factors that may help to identify patients who are most vulnerable to nausea and vomiting following chemotherapy. To review the classes of antiemetic drugs that effectively control nausea and vomiting associated with chemotherapeutic regimens. DATA SOURCES: Journal articles, abstracts, and clinical experience. DATA SYNTHESIS: The trend toward outpatient care requires aggressive antiemetic therapy from the outset, with clear recognition of the risk factors for chemotherapy-induced nausea and vomiting. The basic categories of antiemetics include 5-hydroxytryptamine, (5-HT3)-receptor antagonists, phenothiazines, butyrophenones, substituted benzamides, and cannabinoids. Additional agents often used in combination with these antiemetics include corticosteroids and benzodiazepines. CONCLUSIONS: The 5-HT3-receptor antagonists offer enhanced control of emesis while causing few side effects. For highly emetogenic chemotherapy regimens, the combination of 5-HT3-receptor antagonists and dexamethasone appears superior to other single agents or combinations in preventing nausea and vomiting. IMPLICATIONS FOR NURSING PRACTICE: Nursing care involves educating patients about self-care initiatives for effective management of chemotherapeutic side effects, including compliance with prescribed antiemetic regimens to prevent nausea and vomiting.