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PHARMACOLOGY > 22-Drugs for Nausea and Vomitting > Flashcards

22-Drugs for Nausea and Vomitting Flashcards

1
Q

Vomiting is….

A

Forceful expulsion of stomach contents and the contents of the proximal small intestine

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2
Q

True or False:

Vomiting is a symptom NOT a disease

A

True

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3
Q

What are some consequences of vomiting?

A
  • Potassium deficiency
  • Sodium depletion
  • Alkalosis
  • Malnutrition
  • Esophageal and gastric injury
  • purpura
  • aspiration pneumonia
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4
Q

the three steps in the act of vomiting

A
  1. Nausea
  2. Retching (‘Dry Heaves’
  3. Vomiting
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5
Q

What is projectile vomiting and who can do it?

A

normally for children as they have little food in their stomach and can push it out with greater force

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6
Q

What are the two things that are NOT vomiting?

A

Regurgitation = Return of previously swallowed food or secretions into the mouth (involuntary)

Rumination = Repetitive, effortless regurgitation of recently ingested food into the mouth followed by re-chewing and re-swallowing (voluntary, purposeful)

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7
Q

Why is nausea called a “psychic” experience?

A

it is very personal, hard to explain + describe

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8
Q

Physiologically, nausea is associated with… (3)

A

Decreased gastric motility

Increased small intestinal tone

Reverse proximal small intestinal peristalsis

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9
Q

what are the 5 highly coordinated series of events in vomiting?

A
  1. A deep breath,
  2. The glottis closes and the larynx is raised to open the upper esophageal sphincter
  3. The soft palate is elevated to close off the posterior nares

4, The diaphragm is contracted sharply downward

  1. Downward movement of the diaphragm, contraction of the muscles of the abdominal walls
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10
Q

what are the three area in the brainstem that control vomiting

A

Vomiting Centres (VC)

Nucleus tractus solitarius (NTS)

Chemoreceptor Trigger Zones (CTZ)

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11
Q

why do we think that vomiting has a neurological control?

A

it is a complex, stereotypical set of activities

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12
Q

why is the location of the CTZ important? where is it?

A

it is located very close to the fourth ventricle where the blood brain barrier is at it’s thinnest

there is the greatest opportunity here for the CTZ to pick up bad stimuli

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13
Q

where are the bilateral vomiting centers found and what do they do?

A

found in the reticular formation of the medulla

their activation by electric stimulation induces vomiting

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14
Q

where does the vomiting centers (VC) receive signals from

A

the chemoreceptor trigger zone & Nucleus Tractus Solitarius

Visceral afferents from the GI tract

Visceral afferents from outside the GI tract

Afferents from extramedullary centers in the brain

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15
Q

What are… Visceral afferents from GI Tract

A

Vagus or sympathetic nerves

GI distention (very potent),

mucosal irritation

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16
Q

What are… Visceral afferents from outside GI Tract

A

Bile ducts, peritoneum, heart and a variety of other organs

17
Q

What are… Afferents from extramedullary centers in the brain

A

Psychic stimuli (odors, fear)

Vestibular disturbances (motion sickness)

Cerebral trauma

18
Q

What are the chemoreceoptor Trigger Zones? (CTZ) where are they located?

A

they are bilateral centers in the brainstem

they detect chemical abdominal for the VC and sends them excitatory signals

19
Q

True or false:

Like the VC, the CTZ can cause vomiting rom electrical stimulation

A

False

Only emetic drugs can cause vomiting in the CTZ

20
Q

how does chemotherapy induce nausea and vomiting?

A
  1. Chemotherapeutic drugs directly stimulate the CTZ
  2. they stimulate GI cells to release serotonin which activates 5-HT receptors in the CTZ, vagal afferents in the git and the nucleus tractus solitarius
21
Q

why can the cerebral cortex be our friend or enemy?

A

We can teach ourselves not to vomit until we get to a washroom

But it can create a Pavlov like response to the chemotherapy

22
Q

what is Anticipatory nausea and vomiting

A

Occurs before or during therapy in individuals who have had severe symptoms with previous therapy

Triggered by specific odors, tastes, or objects that a patient associates with treatment

23
Q

what is Acute nausea and vomiting

A
  • occurs within 24 hours after cancer treatment
24
Q

what is Delayed (late onset) nausea and vomiting

A

Occurs more than 24 hours after cancer treatment and may continue for several days

25
Q

Anticholinergics drugs effects and what they are good for treating.

A

Muscarinic receptor antagonist in the NTS and CTZ

Reduces feelings of nausea and vomiting

Good for motion sickness, not chemo

26
Q

Antihistamines drugs action and what they treat.

A

H1 receptors in the NTS and CTZ

Soothes feelings of upset stomach and nausea

27
Q

Cannabinoids drugs action and what they treat

A

CB1 receptor in the cortex and VC

Not as good as preventing these feeling but they maintain hunger

Better able to tolerate feelings of nausea and vomiting

28
Q

Serotonin antagonists actions

A

5HT3 receptors in the CTZ and NTS

29
Q

What population is the Serotonin antagonists drug Palonosetron used on vs the drug Ondansetron?

A

Palonosetron= safe for people with heart issues

Ondansetron = for people with NO heart issues

30
Q

action of Dopamine antagonists drugs

A

D2 receptors in the CTZ and NTS

31
Q

what Dopamine antagonist “keeps the gut moving in the right direction?”

A

metoclopramide

32
Q

Mechanism of action of Glucocorticoids (4)

A

Anti-inflammatory & analgesic effects

Inhibition of serotonergic tone (5HT release & receptor density)

Reversal of chemotherapy induced HPA hypofunction

Direct central action within the NTS

33
Q

what drug are Glucocorticoids commonly combined with?

A

5HT antagonists and NK1antagonists

34
Q

Neurokinin receptor antagonists drug action

A

Block the binding of Substance P at the NK1 receptor

Aprepitant & Rolapitant; highly selective for NK1 receptor

Commonly co-prescribed with 5HT receptor antagonists and glucocorticoids, generally well tolerated

35
Q

True or false: Glucocorticoid dose should be reduced if co-administered as an antiemetic drug

A

True

36
Q

when is antiemetic therapy called for?

A

Not for chronic use

Normally for people who are, for example, prone to intense vomiting before giving speeches

can also be helpful for PTSD

37
Q

What are the 5 steps in the treatment approach for nausea + vomiting?

A
  1. Assess likely cause
  2. Assess consequences
  3. Treat consequences
  4. Confirm the cause
  5. Treat the cause
38
Q

t/f: antiemetic drugs are safe to use during pregnancy

A

true

PHARMACOLOGY (27 decks)

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