4B. Vomiting Center

Question 1

• +++ > stimulates vomiting center; — > brake and slow down vomiting center
  
  • Drugs with____ receptor blockers are the best for motion sickness
  • Drug induced vomiting or nausea that’s hormonally related > ____ blockers; some SE antagonists were used for drug-induced nausea vomiting for pre-surgery and between and after chemo treatments; now starting to see used for bad morning sickness
  • Astronatus is a ____-induced phenomenon, given musc chol antagonist and something induced ____ like drug

Answer 1

musc chol
SE/DA
motion
NE

Question 2

Motion Sickness

• Want \_\_\_\_ (muscarinic receptor antagonist)
– \_\_\_\_ (Benadryl®)
– \_\_\_\_ (Dramamine®) 
– \_\_\_\_ (Bonine®)
– \_\_\_\_ (Transderm Scop®)

• Better to prevent than treat
• 1-3 are \_\_\_\_
	○ Most of the efficacy is due to ability in blocking \_\_\_\_ receptors (some from histamine effect, but not much)
• Scopoamine
	○ Pure ant \_\_\_\_
	○ \_\_\_\_ formatulion
		§ Reason put behind ear > skin thickness is \_\_\_\_ among people

Answer 2

anticholinergic
diphenydramine
dimenhydriamte
meclizine
scopalamine
antihistamines
musc chol
muscarininc
consistent

Question 3

Drug-induced nausea/vomitting

• Dopamine-2 receptor blockade
– ____ (Phenergan®)
– ____ (Compazine®)
– ____ (Tigan®)

• Serotonin 5HT3 receptor blockade
– ____ (Zofran®)
– Dolasetron (Anzemet®)

• Serotonin and dopamine-2 receptor blockade
– ____ (Reglan®)

• Opioids are a major inducer
• [???] used to be combined with chlorohydrate > controversy is that it's \_\_\_\_ in a test tube (property of alcohols even bud light)
• Available in \_\_\_\_ forms > cannot give a pill if vomiting; so give it rectally
	○ Take the lining of the sepositary off; there is a first-pass effect
• Serotonin blockers
	○ Common in cancer \_\_\_\_ and radiation treatment
	○ Now used in women with bad \_\_\_\_
• Metoclopramide
	○ \_\_\_\_
	○ But also blocks SE and DA receptors > can be used for \_\_\_\_-induced nausea and vomiting
	○ Can develop extrapyramidal effects > effect that resembles \_\_\_\_ > must be on drug for long time
		§ Tardic dyskinesia > symptoms \_\_\_\_ go away

Answer 3

promethazine
prochlorperazine
trimethobenzamide

ondansetron
metoclopramide

mutagenic
chemo
morning sickness
GERD
drug
parkinson's
don't

Question 4

Percentage of Patients with Vomiting Over First 24 Hours

• Norco > \_\_\_\_ and \_\_\_\_ > dose after dental surgery > one days worth 21% of people vomited
	○ Took and combined with \_\_\_\_ > CL-108 > reduced nausea/vomit for 50%
• CL-108 has \_\_\_\_
	○ Shouldn't be first line because of it
	○ Post surgical and third molar pain > two \_\_\_\_ is doing much better bc dental post-surgical is driven by inflammation

Answer 4

acetominophen
hydrocodone

promethazine
opiods
advil

Question 5

Ondansetron

• Taken before the \_\_\_\_ and the radiation, and then taken for a while afterwards

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Answer 5

chemo