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Pharm Test 6 > 33 Drugs used to treat nausea and vomiting > Flashcards

33 Drugs used to treat nausea and vomiting Flashcards

1
Q

Regurgitation

A

gastric or esophageal contents rise to the pharynx because of greater pressure (gas bubbles, tight clothing, body position)

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2
Q

Postoperative nausea and vomiting (PONV)

A

pt-related, anesthesia-related, and surgery-related. Potential for PONV increases with the number of risk factors present in a particular pt. Increased risk for tearing sutures, excess pressure on organs, and increase in cranial pressure

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3
Q

hyperemesis gravidarum

A

electrolytes and fluids become imbalanced; recurring emesis during pregnancy can lead to this- harmful to mother and baby; elderly and very young at risk

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4
Q

psychogenic vomiting

A
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5
Q

chemotherapy-induced nausea and vomiting (CINV)

A
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6
Q

anticipatory nausea and vomiting

A
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7
Q

emetogenicity

A
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8
Q

delayed emesis

A
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9
Q

radiation-induced nausea and vomiting (RINV)

A
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10
Q

Vomiting can be either…

A

self-induced/ voluntary (bulimia) or involuntary with a wide variety of reasons

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11
Q

Etiology

A

chemo-induced, anesthetics, disease process, organ damage, harmful substances

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12
Q

Ongoing emesis can lead to

A

alkalosis due to loss of acid from vomiting

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13
Q

prolonged diarrhea likely to lead to

A

acidosis due to excessive loss of bicarbonate ions in feces. (bicarb ions made by pancreas and secreted into the lumen of the small intestine to neutralize stomach acid)

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14
Q

Control centers for N/V (2); location

A

Chemoreceptor trigger zone and the Vomiting center; brainstem

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15
Q

Two systems receive afferent information from

A

vestibular system of inner ear, GI tract and cerebral cortex

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16
Q

When (inner ear, gi tract, cerebral cortex) systems become activated they release 5 main neurotransmitters that bring about n/v

A

dopamine, serotonin, histamine, acetylcholine, substance p

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17
Q

Medications used to treat n/v used to block what

A

used to block the elevated 5 neurotransmitters; dopamine, serotonin, histamine, acetylcholine, substance p

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18
Q

Anticholinergics block; examples

A

effects of acetylcholine; scoplamine (Transderm-Scop; patch used for motion sickness), trimethobenzamide (Tigan)

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19
Q

Seratonin antagonist SHT-3 antagonists block what neurotransmitter and where

A

ondansetron (Zofran), granisetron (Kytril), palonosetron (Aloxi) (gen. names end in setron); block serotonin receptors in the gastrointestinal mucosa, vomiting center (VC) and chemoreceptor zone (CTZ) in medulla oblongota

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20
Q

indications for SHT-3 antagonists; even more effective when administered with

A

cancer treatment, radiation therapy, PONV; dexamethasone and aprepitant (Emend)

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21
Q

Unlabeled uses for ondansetron

A

bulimia, alcoholism, hyperemisis gravidarum

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22
Q

Seratonin antagonist SHT-3 antagonists; block what neurotransmitter and where

A

ondansetron (Zofran), granisetron (Kytril), palonosetron (Aloxi) (gen. names end in setron); block serotonin receptors in the gastrointestinal mucosa, vomiting center (VC), and chemoreceptor zone (CTZ) in medulla oblongata

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23
Q

Antihistamines

A

diphenhydramine (Benadryl), dimehydrinate (Dramanine), meclizine (Antivert)

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24
Q

Antihistamines use related to n/v

A

motion sickness

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25
Other properties antihistamines have; to block what
anticholinergic properties; to block acetylcholine
26
Substance P
aprepitant (Emend)
27
Many NK-1 receptors located in CTZ and VC- aprepitant is selective to the NK-1 receptor and block this; use
substance-P; cancer treatment, PONV
28
Antidopaminergic
prochlorperazine (Compazine), promethazine (Phenergan), chorpromazine (Thorazine)
29
Antidopaminergic uses; dosage form; Other properties antidopaminergic have
n/v, psychiatric disorders, intractable hiccups; suppositories; anticholinergic properties
30
Metoclopramide; which property promotes gastric emptying into the duodenum; use
antidopaminergic, antiemetic, anticholinergic, prokinetic; prokinetic promotes gastric emptying into the duodenum;use for reflux/regurgitation
31
long term use of metoclopramide can lead to
tardive dyskinesia
32
dronabinol (Marinol) receptor agonist
CB-1 receptor in the brainstem and GI tract
33
dronabinol (Marinol) additional use
appetite stimulant in cancer and aids pts
34
OTC; active ingredients
Emetrol and Nausea relief; dextrose/fructose w/ phosphoric acid
35
how otc medications work
delay gastric emptying by reducing smooth muscle contraction in the GI tract
36
Sites of action: Inner ear- antiemetic
antihistamines, anticholinergics, prokinetics, antidopaminergics
37
Sites of action: GI tract- antiemetic
SHT-3 antagonists, prokinetics, dextrose/fructose w/ phosphoric acid
38
Sites of action: CTZ- antiemetic
SHT-3 antagonists, prokinetics, antidopaminergics, NK-1 antagonists
39
Sites of action: VC- antiemetic
NK-1 antagonists, SHT-3 antagonists
40
Sites of action: Cerebral cortex- antiemetic
CB-1 agonist
41
Important funtion of CTZ
sample blood and spinal fluid for potentially toxic substances and when detected to initiate the vomiting reflux.
42
Can CTZ initiate vomiting independently
no, only by stimulating the VC
43
Prior to vomiting these symptoms of pallor, sweating, and tachycardia cause additional discomfort associated with vomiting
autonomic symptoms
44
N/V in preg: V is more common in (5)
primigravidas, younger women, nonsmokers, African Americans, obese women
45
CINV
chemotherapy-induced nausea and vomiting
46
CINV: conditioned response triggered by the sight or smell of the clinic or hospital or by the knowledge that treatment is imminent
anticipatory nausea and vomiting
47
CINV: onset of anticipatory n/v is usually
2-4 hrs before treatment and most severe at time of chemo administration
48
CINV: delayed emesis starts when
more than 24 after treatment, lasts up to a few days
49
Control of v is important for:
relieving the obvious distress associated with it, preventing aspiration of gastric contents into lungs, dehydration, and electrolyte imbalance
50
Primary treatment of n/v should be directed where; because this is not always possible, treatment with what measures is appropriate
at underlying cause; nondrug and drug
51
PONV drugs
dopamine antagonists, anticholinergic agents, serotonin antagonists, and histamine-2 antagonists
52
PONV therapy may include these options
-hydration -supplemental O2 -a benzodiazepine for anxiolysis -a combination of antiemetics that work by different mechanisms -IV anesthesia induction agents -analgesia with an NSAID rather than an opioid
53
IV anesthesia induction agents
propofol remifentanil
54
N/V in preg: why would ondansetron and metoclopramide be prescribed
to treat hyperemesis gravidarum w/o teratogenic effects
55
Seratonin antagonists: ex; used to prevent __
ondansetron, granisetron, palonosetron; prevent CINV
56
Anticholinergic agents: uses; how to determine which drug to use
-scopolamine and antihistamines (diphenhydramine, dimenhydrinate, meclizine), and promethazine; used to treat motion sickness. -antihistamines used in preg for n/v; -depends on both the period for which antinausea protection is needed and the adverse effects
57
Which anticholinergic agent is used for short periods of motion; which is used for longer periods
scopolamine; antihistamine
58
Corticosteroids use
efficacy and lack of adverse effect due to only a few doses being administered
59
Benzodiazepines (am's) (3)
lorazepam, midazolam, diazepam
60
Benzodiazepines are effective in the frequency of n/v but also in this
the anxiety associated with chemotherapy
61
This serotonin antagonist is given 30 min - 1 hr before chemo and routinely for the next 3-4 days
ondansetron
62
Drugs that increase toxic effects of cannabinoids; what to monitor for
antihistamines, alcohol, analgesics, benzodiazepines, phenobarbital, antidepressants, muscle relaxants, and sedative-hypnotics; monitor for excessive sedation and reduce the dosage of the other sedative agents

Pharm Test 6 (4 decks)

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