This CE activity is jointly provided by ProCE, Inc. and Hospital Pharmacy. ProCE, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. ACPE Universal Activity Number 0221-9999-15-043-H01-P has been assigned to this knowledge-based home-study CE activity (initial release date 04-01-2015). This CE activity is approved for 1.5 contact hours (0.15 CEUs) in states that recognize ACPE providers. This CE activity is provided at no cost to participants. Completion of the evaluation and the post-test with a score of 70% or higher are required to receive CE credit. No partial credit will be given.

Faculty: Dennis J. Cada, PharmD, FASHP, FASCP (Editor), Founder and Contributing Editor, The Formulary; James Leonard, Drug Information Intern, College of Pharmacy, Washington State University; and Danial E. Baker, PharmD, FASHP, FASCP, Director, Drug Information Center, and Professor of Pharmacy Practice, College of Pharmacy, Washington State University. The authors indicate no relationships that could be perceived as a conflict of interest. This activity is self-funded by Hospital Pharmacy.

Release Date: April 1, 2015

Expiration Date: April 1, 2017

Continuing Education for this activity is processed through the ProCE online CE Center. To receive CE credit, please go to: 

• www.ProCE.com/HPJFDR
• Click to access the activity page to enroll and complete the Post-Test and Evaluation

For questions related to registering for and obtaining CE credit, contact ProCE at 630-540-2848 or Info@ProCE.com.

1. The US Food and Drug Administration (FDA)–approved indication for netupitant/palonosetron is for the prevention of:
   1. Nausea and vomiting after irradiation.
   2. Acute and delayed chemotherapy-induced nausea and vomiting.
   3. Hyperemesis gravidarum.
   4. Postoperative nausea and vomiting.
      
      
2. Netupitant/palonosetron produces its antiemetic effects by inhibition of:
   1. Dopamine receptors.
   2. Neurokinin-1 receptors only.
   3. 5-HT3 receptors only.
   4. Both neurokinin-1 receptors and 5-HT3 receptors.
      
      
3. In which of the following dosage form is netupitant/palonosetron available?
   1. Capsules.
   2. Tablets
   3. Orally dissolving tablets
   4. Injectable
      
      
4. Which of the following is a contraindication to the use of netupitant/palonosetron?
   1. There are no contraindications to therapy with netupitant/palonosetron.
   2. Concomitant apomorphine
   3. Administration with pimozide
   4. History of serotonin syndrome
      
      
5. Netupitant/palonosetron is in which Pregnancy Category?
   1. A
   2. B
   3. C
   4. X
      
      

Case History

K.N. is a 52-year-old female patient with controlled hypertension, hyperlipidemia, depression, and newly diagnosed HER2-negative breast cancer. Her current medications include daily lisinopril, simvastatin, fluoxetine, and as-needed lorazepam. Her physician plans to begin chemotherapy with cyclophosphamide and doxorubicin. Her renal and hepatic function are both normal. Prior to chemotherapy, the following laboratory results were obtained: white blood cell count 37, red blood cell count 4.2, hemoglobin 13.8, hematocrit 38.4%, and platelets 300. Her physician thinks she may benefit from netupitant/palonosetron prior to chemotherapy.

6. K.N. should receive which of the following medications adjunctively with netupitant/palonosetron?
   1. Metoclopramide
   2. Prochlorperazine
   3. Dexamethasone
   4. Lorazepam
      
      
7. What is the recommended dose of netupitant/palonosetron for K.N.?
   1. 8 mg/ 8 mg
   2. 24 mg/0.25 mg
   3. 125 mg/12 mg
   4. 300 mg/0.5 mg
      
      
8. K.N. should receive the netupitant/palonosetron dose:
   1. 1 hour prior to chemotherapy.
   2. 30 minutes prior to chemotherapy.
   3. 1 day before and repeated 30 minutes prior to chemotherapy.
   4. Concomitantly at the time of chemotherapy administration.
      
      
9. What is the total netupitant/palonosetron and dexamethasone dosing duration for K.N.?
   1. 1 day for netupitant/palonosetron and 2 days for dexamethasone
   2. 1 day for netupitant/palonosetron and 4 days for dexamethasone
   3. 2 days for netupitant/palonosetron and 2 days for dexamethasone
   4. 3 days for netupitant/palonosetron and 4 days for dexamethasone
      
      
10. Which of K.N.’s medications may interact with netupitant/palonosetron due to an enzyme-mediated pathway?
    1. Fluoxetine
    2. .56 tablets
    3. Lisinopril
    4. Cyclophosphamide
    5. None of the above
       
       
11. Which of the K.N.’s medications may interact with netupitant/palonosetron due to a synergistic mechanism?
    1. Fluoxetine
    2. Lisinopril
    3. Simvastatin
    4. None of the above
       
       
12. What baseline and periodic monitoring would you recommend for K.N.’s netupitant/palonosetron therapy?
    1. Blood pressure
    2. Cholesterol panel
    3. Sedation
    4. Nausea and vomiting
       
       
13. The most common side effects associated with netupitant/palonosetron prior to chemotherapy include:
    1. Nausea, headache, and diarrhea.
    2. Dyspepsia, fatigue, and constipation.
    3. Headache, nausea, and constipation.
    4. Dyspepsia, abnormal liver function tests, and fatigue
       
       
14. Netupitant/palonosetron is supplied in a package containing:
    1. 1 capsule.
    2. 4 capsules
    3. 30 capsules.
    4. 90 capsules.
       
       
15. K.N. is taking the recommended dose of netupitant/palonosetron and has been experiencing severe constipation. Her physician wants to reduce her dose and has asked you for the recommended dose reduction for adverse events. Which of the following is recommended?
    1. Reduce the dose of dexamethasone.
    2. Open the capsule and take 200 mg netupitant (2 tablets) and 0.5 mg palonosetron.
    3. Open the capsule and take 100 mg netupitant (1 tablet) and 0.5 mg palonosetron.
    4. No dosage reductions are recommended; she may need to change therapy.