Anti-emetic Flashcards
1
Q
ANTICHOLINERGIC
Examples Mechanism of Action Uses S/E Contraindications Considerations
A
- Scopalamine (Patch)
- It works by antagonizing the M1 muscarinic receptor [vestibular system]
- It is predominantly used to treat motion sickness or prophylactically in the perioperative setting.
- Side effects are typically mild but include dry mouth, vision changes, or drowsiness.
- Known hypersensitivity, narrow-angle glaucoma
- Consider –> 4 hours before or night before; caution in elderly
2
Q
ANTIHISTAMINE (1st/2nd Gen)
Examples Mechanism of Action Uses S/E Contraindications Considerations
A
- 1st gen [worse side effects]
- -> diphenhydramine, dimenhydrinate, doxylamine, meclizine
- -2nd gen [lack CNS depressant - not effective]
- -> Cetirizine and Fexofenadine
- antagonize H1 and muscarinic cholinergic receptors [vestibular]
- prevent and treat n/v due to motion sickness, vertigo, or migraine
- Sedation
- Known hypersensitivity
3
Q
DOPAMINE ANTAGONIST
–>Three Main Groups
Examples Mechanism of Action Uses S/E Contraindications Considerations -- avoid in children under 2 or <9kg \+ other considerations
A
- Phenothiazines
- ->promethazine, prochlorperazine, chlorpromazine
- –>antagonize D2 receptor in CTZ
- —> motion sickness/vertigo, gastritis, NVP, PONV, CINV
- —>sedation, orthohypotension, **EPS [dystonia, tardive dyskinesia, akathisia)
- –> dilute IV – especially intraarterially
- Butyrophenones
- ->Droperidol and Haloperidol
- –> Central acting (CTZ ?)
- —> PONV, some CINV
- –> *Black box warning for QT prolongation and torsades
- –> 12-lead EKG
- Prokinetics
- -> Metoclopramide
- –> d2 receptor antagonist in CTZ and peripherally GI
- —> PONV, CINV, gastroparesis, GERD
- —> crosses BBB** –> EPS, somnolence
- –>**young children and elderly avoid
4
Q
CORTICOSTEROIDS
Examples Mechanism of Action Uses S/E Contraindication
A
dexamethasone & methylprednisone
- release of serotonin & decrease inflammation
- combination therapy; PONV, CINV
- – GI upset, anxiety, insomnia, hyperglycemia
- Hypersensitivity, systemic fungal infections.
5
Q
Cannabinoids
Examples
Mechanism of Action
Uses
S/E
A
Nabilone and dronabinol
- unknown / central acting
- CINV
- drowsiness, euphoria, vision change
6
Q
Benzodiazepines
Examples Uses S/E Contraindications Considerations
A
Lorazepam (ADJUNCT antiemetic)
- CINV
- Sedation and amnesia, respiratory depression
- dont use with alcohol
7
Q
Serotonin Antagonists
Examples Mechanism of Action Uses S/E Contraindications Considerations
A
Dolasetron, Granisetron, Ondansetron, Palonsetron
- 5-HT antagonist is GI tract and CTZ
- CINV and PONV
- headache, somnolence, diarrhea, constipation, *QT changes
- Palonsetron = 40 hour half-life (acute and delayed CINV)
- -> granisetron degrades by light (patch)
8
Q
NK-1 Receptor Antagonist
Examples Mechanism of Action Uses S/E Contraindications Considerations
A
- Aprepitant (fosaprepitant IV), rolapitant, netupitant
- preventing the release of substance-P, which is an inducer of vomiting
- acute and delayed CINV (**with -setron and corticosteroid); PONV
- fatigue hiccups, h/a
9
Q
Olanzapine
Examples Mechanism of Action Uses S/E Contraindications Considerations
A
- Olanzapine (anti-psych)
- dopamine and serotonin receptors
- combo therapy for severe CINV
- sedation on day 2 on s/e
10
Q
CHEMO - INDUCED Nausea and Vomiting
- Acute/delayed/anticipatory
- Risk Factors for CINV & anticipatory
- Emogenic Potential
- – minimal, Low, moderate, High examples and treatment
A
- -Acute - within 24 hours
- -delayed - more than 48 hours
- anticipatory - prior to chemo when n/v happened in past
- CINV Risk Factors- poor emetic control with prior tx, female, low chronic alcohol intake, younger age
- Anticipatory Risk Factors- Poor prior control of tx and hx of motion sickness or NVP
- minimal- no tx
-Low --> Day 1 (acute) - Dexamethasone OR 5HT3 Antagonist
-Moderate –> lower cyclophoshamide, isosfamide, carboplatin
Day 1 (acute) - 5-HT3 antagonist PLUS dexamethasone
–> Day 2-4 (Delayed) – dexameth day 2-3
- high --> cisplatin and high dose cyclophosphamide + AC Day 1 (Acute) - NK1 Receptor antagonist + 5HT3 antagonist + dexamethasone + olanzapine
11
Q
PONV
risk factors
Pre vs Post treatment
Treatment method (Combination) and breakthrough
A
- 1 patient factors (female sex, nonsmoking, history of PONV) and 2) anesthesia factors (opioids and gases) and 3) Surgical factors (duration and type)
-PRE – aprepitant, palonosetron, dexamethasone
-POST- droperidol, 5-ht3 Receptor antagonist
Scopalamine (evening prior or 2 hours prior)
- use combo of method (zofran plus dexameth)
- use separate class med if one class fails
- – if no class used, low dose 5HT3
12
Q
NVP
Consideration
Lines of tx
hyperemesis gravidarum and tx
A
- 1) teratogenic potential of therapy 2) severity of n/v
- Pyridoxine (b6) 10-25mg 4x daily alone or w/ antihistamine = first line
- Zofran second line
-treat gravidarum with methylprednisolone AFTER 10 WEEKS (oral cleft)
