Which class would you not anticipate to be part of premedication for a moderately emetogenic regimen?

• A. Steroids
• B. 5HT3 antagonists
• C. Neurokinin 1 antagonists
• D. Prokinetic agents

Answer: (D)

Moderate emetogenic chemotherapy is typically managed with antiemetics that act on the main pathways involved in vomiting: a corticosteroid to reduce overall emetic signaling, and a serotonin 5-HT3 receptor antagonist to block the serotonin-driven acute phase. For patients at higher risk, an NK1 receptor antagonist is added to provide protection against both acute and delayed nausea and vomiting. Prokinetic agents, like metoclopramide, focus on stimulating gastric emptying and have a modest antiemetic effect primarily through dopamine antagonism; however, they are not part of the standard prophylactic trio for moderate emetogenic risk. They’re more commonly used as rescue therapy or for GI motility issues, and they carry risks such as extrapyramidal symptoms with short-term or long-term use. Therefore, prokinetic agents would not be anticipated as routine premedication for a moderately emetogenic regimen.