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Kol- Pharm 323 Spring > Anti Emetic Anti Diarrheal IBD > Flashcards

Anti Emetic Anti Diarrheal IBD Flashcards

1
Q

7 classes of antiemetic

A
  1. Serotonin Receptor Antagonists
  2. Substance P Neurokinin1 Antagonists
  3. Glucocorticoids
  4. Benzodiazepines
  5. Dopamine Antagonists
  6. Cannabinoids
  7. Anticholinergics/Antihistamines
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2
Q

side effect profile for antiemetics is usually

A

CNS

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3
Q

prototype for Serotonin Receptor Antagonists

A

ondansetron (Zofran)

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4
Q

how does ondansetron (Zofran) fxn

A

Block 5-HT3 Receptors (serotonin receptors) on the vagal neurons and in the CTZ

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5
Q

most effective antiemetic

A

ondansetron (Zofran

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6
Q

side effects of ondansetron (Zofran)

A

headache, diarrhea, dizziness, prolong QT interval (electrolyte abnormalities, bradycardia use caution)

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7
Q

use caution in which patient population with ondansetron (Zofran)

A

electrolyte abnormalities, bradycardia use caution b/c of risk of QT prolongation

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8
Q

indication for using ondansetron (Zofran)

A

chemo, postop, gastroenteritis

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9
Q

route for ondansetron (Zofran)

A

Oral, sublingual, IV

◦ Max dosing in a day

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10
Q

prototype for Substance P Neurokinin1Antagonists

A

aprepitant (Emend)

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11
Q

how does aprepitant (Emend) fxn

A

Blocks neurokin1type receptors (for substance P) in the chemoreceptor trigger zone

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12
Q

indication for using aprepitant (Emend)

A

Preventing postop N/V and Chemo induced n/v

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13
Q

admin of aprepitant (Emend)

A

Single agent or Used in conjunction with other antiemetics

◦ dexamethasone + ondansetron (Zofran)+ aprepitant (Emend)

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14
Q

drug-drug interactions: for aprepitant (Emend)

A

warfarin, oral contraceptive pills (need alternate form)

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15
Q

side effects of aprepitant (Emend)

A

fatigue and asthenia (loss of strength/energy)

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16
Q

aprepitant (Emend) route

A

oral formulation

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17
Q

prototype for Glucocorticoids

A

dexamethasone (Decadron)

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18
Q

how does dexamethasone (Decadron) fxn to help nausea?

A

MAO unknown

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19
Q

indication for using dexamethasone (Decadron) for n/v

A

chemo induced n/v

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20
Q

side effects of dexamethasone (Decadron)

A

No serious SE when used intermittently and short term

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21
Q

prototype for Benzodiazepines for nausea

A

lorazepam (Ativan)

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22
Q

indication for using lorazepam (Ativan) for nausea?

A

Used in chemo induced n/v–> suppression of anticipatory emesis

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23
Q

side effects of lorazepam (Ativan)

A

Sedation, retrograde amnesia

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24
Q

how do dopamine antagonists fxn?

A

Block dopamine2receptors in the chemo receptor trigger zone

25
Q

3 types of dopamine antagonists

A
  1. Phenothiazines
  2. Butyrophenones
  3. Metoclopramide (Reglan)
26
Q

indication for using dopamine agonists

A

postop, chemo, toxins

27
Q

side effects of dopamine antagonist (in general)

A

extrapyramidal symptoms, anticholinergic effects, hypotension, sedation, movement disorders (involuntary movement of face/arms, dystonia)

28
Q

prototype for phenothiazines

A

Promethazine (Phenergan)

29
Q

consideration for Promethazine (Phenergan)

A

risk of tissue injury due to IV extravasation

-can form precipitate w/ other drugs in tubing

30
Q

side effects of Promethazine (Phenergan)

A

respiratory depression (not under age of 2)

31
Q

indication for using metoclopramide (Reglan)

A

postoperative, CINV, radiation, toxins, opioids, GERD, gastroparesis

32
Q

how does metoclopramide (Reglan) fxn

A

Blocks dopamine and serotonin in the chemo trigger zone

–>Antiemetic + Motility agent (prokinetic)

33
Q

long term vs high dose side effects of metoclopramide (Reglan)

A
  • High dose: sedation, diarrhea

* Long term: tardive dyskinesia –> irreversible eventually

34
Q

prototype for cannabinoids

A

dronabinol (Marinol)

35
Q

indication for using dronabinol (Marinol)

A

Used for Chemo induced n/v, stimulate appetite in AIDS

36
Q

side effects of dronabinol (Marinol)

A

temporal disintegration, dissociation, dysphoria

37
Q

which of our antiemetics is a schedule III

A

dronabinol (Marinol)

38
Q

consideration for dronabinol (Marinol) - use caution with….

A

other CNS drugs

39
Q

prototype for Anticholinergics/ Antihistamines

A

hydroxyzine (Vistaril)

40
Q

indication for using hydroxyzine (Vistaril)

A

Used for motion sickness and Chemo induces n/v

41
Q

how does hydroxyzine (Vistaril) fxn?

A

block histamine and muscarinic receptors from the inner ear

42
Q

side effects of hydroxyzine (Vistaril)

A

sedation and anticholinergic SE

43
Q

Anti-diarrheal agents (2)

A

OPIOIDS:

  • diphenoxylate plus atropine (Lomotil) (V)
  • loperamide (Imodium)
44
Q

most effective anti-diarrhea agents

A

diphenoxylate plus atropine (Lomotil) (V) and loperamide (Imodium)

45
Q

side effects of diphenoxylate plus atropine (Lomotil) (high doses)

A

high doses: morphine like euphoria with Lomotil

46
Q

weird side effects of bismuth subsalicylate (Pepto-Bismol)

A

turn tongue and stool black

47
Q

5 classes of drugs for IBD (crohn’s, uc)

A
  1. 5-aminosalicylates
  2. glucocorticoids
  3. immunosuppressants
  4. targeted therapy
  5. antibiotics
48
Q

prototype for 5-Aminosalicylates

A

Sulfasalazine

49
Q

how does Sulfasalazine fxn?

A

Inhibit prostaglandins –> decrease inflammation for IBD

50
Q

admin considerations for Sulfasalazine- when give in relation to food?

A

Give after meals to dec. GI distress

**check for sulfa allergy

51
Q

side effects of Sulfasalazine

A

nausea, fever, rash and arthralgia.

52
Q

admin for glucocorticoids for IBD- routes? dosing for acute?

A

IV or oral
• Acute=high dose
◦ Tapered over 2-3 months
•Rectal enemas with steroids

53
Q

how do we give immunosuppressive drugs for IBD? (give them w/ something else)

A

Given in combination with steroids

54
Q

side effects of

Immunosuppressive Drugs for IBD

A

suppressed immune system, anemia, thrombocytopenia, RF, hepatotocity

55
Q

prototype for targeted therapy for IBD

A

Monoclonal antibodies : infliximab (Remicade)

56
Q

how does infliximab (Remicade) fxn?

A

inhibit TNF

57
Q

side effects of infliximab (Remicade)

A

infections and infusion reactions

58
Q

Antibiotics for Crohn’s

A

• Metronidazole (Flagyl) AND Ciprofloxacin (Cipro)

**nopt for UC

Kol- Pharm 323 Spring (41 decks)

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