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Pharmocolgy > Anti-emetics > Flashcards

Anti-emetics Flashcards

1
Q

What are the steps in emesis ?

A
  1. nausea, salivation and sweating
  2. retrograde peristalsis
  3. deep inspiration
  4. closure of glottis
  5. adbo muscles contract
  6. LOS relaxes
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2
Q

what make the chemical trigger zone activate ?

A

Sensory afferents via midbrain
direct triggers
vestibular nuclei
visceral afferents from gut

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3
Q

what drugs act on the vestibular nuclei ?

A

Muscarinic receptor antagonists

H1 receptor antagonists

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4
Q

Name 1 Muscarinic antagonist / anti-spasmodic drug

A

hyoscine hydrobromide

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5
Q

how does hyoscine hydrobromide work ?

what are its uses/benefits ?

A

competitive blockade of M ACh receptors (nonspecific) in vestibular nuclei and CTZ

People who cant take tablets
motion sickness
bowel obstruction

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6
Q

what are the side effects of hydroscine hydrobromide ?

A

sedation
memory problems
glaucoma
dry mouth and constipation

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7
Q

How do H1 receptor antagonists work ?

A

acts on vestibular nuclei by inhibiting Histaminergic signals from vestibular system to the CTZ in medulla

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8
Q

name 3 H1 receptor antagonists

A 
Cyclizine - not suitable for elderly or children 
Levomepromazine 
Clinnirazine 
promethazine 
diphenhydramine
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9
Q

what are side effects of clinnirazine ?

A

H1 antagonist
Sedation , excitation , Antimuscarinic (dry mouth, constipation, urinary retention)
cardiac toxicity

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10
Q

what agents act on visceral afferents in the gut ?

A

5HT3 receptor antagonists

D2 Receptor antagonists

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11
Q

where is serotonin produce in the gut ?
what is it stimulated by ?
what is the effect of serotonin on the Gut ?

A 
enterochromaffin cells 
parasympathetics
SM contraction = increases motility 
Increases gut secretions 
regulates appetite
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12
Q

What are the main functions of 5ht3 Receptor antagonists ?

A

centrally- inhibits the CTZ

Peripheral - reduces GI motility / secretions

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13
Q

name 2 5HT3 antagonists

A

Ondansetron , Granesitron and palonosetron

1st line treatment

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14
Q

what are the side effects of Ondansetron ?

A

uncommon

Constipation , headache , elevated LFTs, long QT syndrome , dystonia , parkinsonism

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15
Q

name a D2 receptor antagonist specific to viscreal afferent of the guts

A

Metacloperamide

domperidone

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16
Q

how does Metaclopramide work ?

A

increase ACh at M receptors in Gut =
promotes gastric emptying by:
Increasing tone at LOS and amplitude of gastric contractions
decrease tone of pylorus = increased peristalsis

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17
Q

what are D2 antagonists used for ?

A

GORD , ileus

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18
Q

what are the side effects of metaclopramide ?

A

Galactorrhoea via prolactin release

Dystonia , parkinsonism

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19
Q

what is domperidone alternative use ?

what is its main side effect?

A

improving lactation for mothers

sudden cardiac death

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20
Q

what drugs act on the CTZ ?

A 
5HT3 receptor antagonists
H1 antagonists
Muscarinic antagonists
D2 . antagonists
Corticosteroids 
cannabinoids
NK1 antagonists
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21
Q

name 2 anti psychotics/ d2 antagonists

A

Haloperidol
Levomepromazine
chlorpromazine
Prochlorperazine

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22
Q

what D2 antagonists is used in pregnancy ?

A

prochlorperazine

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23
Q

what is haloperiodol used for ?

A

chemotherapy and palliative care

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24
Q

name 2 corticosteroids

A

Dexamethasone , methylprednisolone

25
Q

what are corticosteroids good for ?

A

periop nausea and vomiting
chemotherapy
palliation

26
Q

what are side effects of methylprednisolone ?

A

Insomnia, increase appetite and blood sugar

27
Q

Name 1 cannabinoid

A

Nabilone

28
Q

what are side effects of nabilone?

A

dizziness / drowsiness

29
Q

how do NK1 receptor antagonists work ?

A

prevent action of substance P at CTZ and in peripheral nerves
boosts effects of 5HT3 antagonists =
Anxiolytic and antipressent properties

30
Q

name 2 NK1 antagonists

A

aprepitant
fosaprepitant
netupitant

31
Q

what are the side effects of NK1 antagonists ?

A

Headaches , diarrhoea , constipation and stevens-johnson

32
Q

name 2 prokinetics

A

domperidone

metaclopramide

33
Q

what drugs to use for motion sickness ?

A

1st line Hyoscine hydrobromide (drowsiness)

Cinnirazine - fewer sides effects (vestibular )

34
Q

what procedure can you use instead of drugs for antiemetics ?

A

Nasogastric tube

35
Q

when shouldn’t you use Domperidone ?

A

prokinetic -

risk of obstruction or perforation

36
Q

what are the 4 medications of anti-emetic GI patholgies and their MOAs?

A 
Odndanserton - 5HT3 antagonist
Cyclizine - H1 antagonist
then add
Dexamethasone - Corticosteroid 
Metacloperamide- D2 antagonist
37
Q

What causes hyperemesis gravidrum ?
what complications can occur ?
what puts you at more risk ?

A

rapid rise in bHCG in the CTZ
Dehyrdation , weight loss, electrolyte imbalance and urinary ketones
multiple pregnancies

38
Q

Name the 4 drugs you use for hyperemesis Gravidum ?

A

Promethazine (h1) or prochlorperazine (D2)
Add
Metaclopramide (D2)
Ondanserton

39
Q

what drugs do you use for low risk chemo?

A

Dexamethasone

40
Q

what drugs do you use for moderate risk chemo?

A

Dexamethasone

Ondanserton

41
Q

what drugs do you use for high risk chemo?

A

Dexamethasone
Ondanserton
Aprepitant

42
Q

what can put you in risk of emesis in terms of anaesthetics and surgery ?

A 
use of general 
Volatile/ NO gases
post op opoids 
duration of surgery 
Laparoscopic
43
Q

what is general rule for anti-emetic post op care in terms of low, moderate and high risk ?

A 
Low = wait and see
moderate = 1 or 2 antiemetics 
high = 2 or more antiemetics
44
Q

what should you do if prophylactic anti emetic care does not work ?

A

use a different class of anti emetic

45
Q

how can you describe diarrhoea? what can you use ?

A

Consistency , frequency
compare to normal bowel habitat
Bristol stool chart

46
Q

how do opioid agonists help with diarrhoea ?

A

decreases tone of Longitudinal and circular Smooth muscle
reduce peristalsis but increase segmental contraction = more time
supresses gastrocolic reflex

47
Q

Name 2 opioids and which one is specific to the myenteric plexus ?

A

Loperamide - gut specific
Codeine
morphine

48
Q

What are the side effects of Opioids ?

A

paralytic ileus
nausea and vomiting
sedation and addiction

49
Q

what should you avoid when you have diarrhoea ?

A

Caffeine , sorbitol , fatty/ spicy foods and fizzy drinks

re instate a balanced intestinal flora

50
Q

What should you do if you are constipated ?

A

Drink more water
increase fibre intake
regular excercise
toilet routine and positioning

51
Q

name 2 osmotic laxatives

A

Lactulose, Macrogol

52
Q

how does Lactulose work ?

A

draws fluids in

53
Q

how does macrogols work ?

A

retain the fluid they came in with

54
Q

name 2 stimulant laxative s

A

Docusate sodium, Senna, Sodium picosulfate

55
Q

how does Docusate sodium work?

A

stimulant and stool softener

56
Q

how does glycerin work ?

A

causes rectal irritation and lubrication

57
Q

Name the bulk forming laxatives

A

Ispaghula husk, Methylcellulose

58
Q

how do stool softeners work and name 2

A

Decrease surface tension of stool
increase penetration of fluid into stool
Arachis oil, Glycerol suppository

Pharmocolgy (22 decks)

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