Anti Emetic Anti Diarrheal IBD Flashcards
7 classes of antiemetic
- Serotonin Receptor Antagonists
- Substance P Neurokinin1 Antagonists
- Glucocorticoids
- Benzodiazepines
- Dopamine Antagonists
- Cannabinoids
- Anticholinergics/Antihistamines
side effect profile for antiemetics is usually
CNS
prototype for Serotonin Receptor Antagonists
ondansetron (Zofran)
how does ondansetron (Zofran) fxn
Block 5-HT3 Receptors (serotonin receptors) on the vagal neurons and in the CTZ
most effective antiemetic
ondansetron (Zofran
side effects of ondansetron (Zofran)
headache, diarrhea, dizziness, prolong QT interval (electrolyte abnormalities, bradycardia use caution)
use caution in which patient population with ondansetron (Zofran)
electrolyte abnormalities, bradycardia use caution b/c of risk of QT prolongation
indication for using ondansetron (Zofran)
chemo, postop, gastroenteritis
route for ondansetron (Zofran)
Oral, sublingual, IV
◦ Max dosing in a day
prototype for Substance P Neurokinin1Antagonists
aprepitant (Emend)
how does aprepitant (Emend) fxn
Blocks neurokin1type receptors (for substance P) in the chemoreceptor trigger zone
indication for using aprepitant (Emend)
Preventing postop N/V and Chemo induced n/v
admin of aprepitant (Emend)
Single agent or Used in conjunction with other antiemetics
◦ dexamethasone + ondansetron (Zofran)+ aprepitant (Emend)
drug-drug interactions: for aprepitant (Emend)
warfarin, oral contraceptive pills (need alternate form)
side effects of aprepitant (Emend)
fatigue and asthenia (loss of strength/energy)
aprepitant (Emend) route
oral formulation
prototype for Glucocorticoids
dexamethasone (Decadron)
how does dexamethasone (Decadron) fxn to help nausea?
MAO unknown
indication for using dexamethasone (Decadron) for n/v
chemo induced n/v
side effects of dexamethasone (Decadron)
No serious SE when used intermittently and short term
prototype for Benzodiazepines for nausea
lorazepam (Ativan)
indication for using lorazepam (Ativan) for nausea?
Used in chemo induced n/v–> suppression of anticipatory emesis
side effects of lorazepam (Ativan)
Sedation, retrograde amnesia
how do dopamine antagonists fxn?
Block dopamine2receptors in the chemo receptor trigger zone
3 types of dopamine antagonists
- Phenothiazines
- Butyrophenones
- Metoclopramide (Reglan)
indication for using dopamine agonists
postop, chemo, toxins
side effects of dopamine antagonist (in general)
extrapyramidal symptoms, anticholinergic effects, hypotension, sedation, movement disorders (involuntary movement of face/arms, dystonia)
prototype for phenothiazines
Promethazine (Phenergan)
consideration for Promethazine (Phenergan)
risk of tissue injury due to IV extravasation
-can form precipitate w/ other drugs in tubing
side effects of Promethazine (Phenergan)
respiratory depression (not under age of 2)
indication for using metoclopramide (Reglan)
postoperative, CINV, radiation, toxins, opioids, GERD, gastroparesis
how does metoclopramide (Reglan) fxn
Blocks dopamine and serotonin in the chemo trigger zone
–>Antiemetic + Motility agent (prokinetic)
long term vs high dose side effects of metoclopramide (Reglan)
- High dose: sedation, diarrhea
* Long term: tardive dyskinesia –> irreversible eventually
prototype for cannabinoids
dronabinol (Marinol)
indication for using dronabinol (Marinol)
Used for Chemo induced n/v, stimulate appetite in AIDS
side effects of dronabinol (Marinol)
temporal disintegration, dissociation, dysphoria
which of our antiemetics is a schedule III
dronabinol (Marinol)
consideration for dronabinol (Marinol) - use caution with….
other CNS drugs
prototype for Anticholinergics/ Antihistamines
hydroxyzine (Vistaril)
indication for using hydroxyzine (Vistaril)
Used for motion sickness and Chemo induces n/v
how does hydroxyzine (Vistaril) fxn?
block histamine and muscarinic receptors from the inner ear
side effects of hydroxyzine (Vistaril)
sedation and anticholinergic SE
Anti-diarrheal agents (2)
OPIOIDS:
- diphenoxylate plus atropine (Lomotil) (V)
- loperamide (Imodium)
most effective anti-diarrhea agents
diphenoxylate plus atropine (Lomotil) (V) and loperamide (Imodium)
side effects of diphenoxylate plus atropine (Lomotil) (high doses)
high doses: morphine like euphoria with Lomotil
weird side effects of bismuth subsalicylate (Pepto-Bismol)
turn tongue and stool black
5 classes of drugs for IBD (crohn’s, uc)
- 5-aminosalicylates
- glucocorticoids
- immunosuppressants
- targeted therapy
- antibiotics
prototype for 5-Aminosalicylates
Sulfasalazine
how does Sulfasalazine fxn?
Inhibit prostaglandins –> decrease inflammation for IBD
admin considerations for Sulfasalazine- when give in relation to food?
Give after meals to dec. GI distress
**check for sulfa allergy
side effects of Sulfasalazine
nausea, fever, rash and arthralgia.
admin for glucocorticoids for IBD- routes? dosing for acute?
IV or oral
• Acute=high dose
◦ Tapered over 2-3 months
•Rectal enemas with steroids
how do we give immunosuppressive drugs for IBD? (give them w/ something else)
Given in combination with steroids
side effects of
Immunosuppressive Drugs for IBD
suppressed immune system, anemia, thrombocytopenia, RF, hepatotocity
prototype for targeted therapy for IBD
Monoclonal antibodies : infliximab (Remicade)
how does infliximab (Remicade) fxn?
inhibit TNF
side effects of infliximab (Remicade)
infections and infusion reactions
Antibiotics for Crohn’s
• Metronidazole (Flagyl) AND Ciprofloxacin (Cipro)
**nopt for UC