Anti-emetics Flashcards
Anti muscarinics act where and name one.
Uses?
Side effects?
Vestibular nuclei, CTZ and vomiting centre.
Hyoscine hydrobromide
Motion sickness
Bowel obstruction
Sedation (less than anti-histamines)
Memory issues
Anticholinergics side effects
H1 antagonists.
Name 5.
Use and Caution with cyclizine?
Morning sickness of pregnancy?
Side effects?
Cinnirazine use?
Promethazine Cyclizine Cinnirazine Levomepromazine Diphenhydramine
H1 blockage on vestibular nucleus inhibiting signals from the vestibular system to the CTZ.
Motion sickness but not to be used in little old ladies and children
Promethazine
Sedation
Excitation
Anti-muscarinic
Cardiac toxicity - Long QT.
Vestibular disorders.
Name 3 5HT receptor antagonists.
Describe peripheral and central effects?
Side effects?
Ondansetron
Granesitron
Palonosetron
Reduced gut secretions and motility
Acts on CTZ
Constipation Headache Liver enzyme elevation Long QT syndrome Extra pyramidal side effects
Extrapyramidal symptoms.
Give the main symptoms.
Dystonia
Akathisia (restlessness)
Parkinsonism
Tardive dyskinesia (orofacial muscle involuntary muscles)
Name the D2 receptor antagonists that act on visceral afferent in the gut.
MOA metacloperamide/ domperidone.
Why do they cause galactorrhea?
GUT effects of metacloperamide?
Why does domperidone not cause extra-pyramidal side effects? However what is a serious side effect of domperidone?
What situations is metacloperamide good for?
Metacloperamide
Domperidone
Increases ACh at M receptors in the gut.
Increased prolactin release.
Increased gastric contraction tone
Decrease tone of pyloric sphincter
Increased LOS tone.
Because it does not penetrate the BBB
Sudden cardiac death due to long QT.
GORD and ileus
D2 receptors antagonists that act on the CTZ but not on visceral afferent name them.
What other receptors might they block?
Use prochlorperazine?
Use haloperidol? Why?
Other than sedation - 2 other symptoms?
Haloperidol
Prochlorperazine
Chlorpromazine
Levomepromazine ( notice its also an anti histamine)
H1 and M
Pregnancy
Chemotherapy and palliation
Sedative effect
Extra pyramidal
Hypotension
MOA of corticosteroids as anti-emetics?
Name two.
Uses?
Side effects?
What is used last line in chemotherapy nausea/vomiting/ Two side effects?
Act on the CTZ - properties of D2 antagonists.
Methylprednisolone
Dexamethasone
PONV
Chemotherapy
Palliaiton
Insomnia
Appetite
Hyperglycaemia (increased blood sugar)
Nabilone
Dizziness
Drowsiness
Name three NK1R antagonists.
MOA?
USe?
What may make it particularly good in chemotherapy treatment?
2 minor and one major side effects?
Aprepitant
Fosaprepitant
Netupitant
Stop action of substance P at CTZ and in peripheral nerves.
Boost effects of 5HT-3 receptor antagonists
Chemotherapy delayed emesis
Anxiolytics and antidepressant like effects.
Steven Johnson’s syndrome
headache
Diarrhoea and constipation
What is first line in motion sickness?
What may be given instead due to fewer side effects?
Hyoscine hydrobromide
Cinnirazine
What intervention may be considered in gut problems?
What are the two prokinetics?
When to use and when not to use?
Nasogastric tube
Metacloperamide
Domperidone
GORD and ileus
Obstruction and risk of perforation
What is the Pathophysiology behind hyperemesis gravidarum?
What increases the risk of hyperemesis gravidarum?
What might be seen in urine?
Rapid rise in BhCG stimulates the CTZ (4-16 weeks typically)
Multiple pregnancies
Ketones
Tx for bowelobstruction.
Tx hyperemesis gravidarum.
Give a chemotherapy drugwith high emesis risk and one with low emesis risk.
OCDM
Ondansetron +/- Cyclizine then add Dexamethasone +/- metacloperamide
PPMO
Promethazine or Prochlorperazine add Metacloperamide add Ondansetron
High = cisplatin Low = Fluorouracil
Give some RFs for PONV?
Female
Non-smoker
General anaesthetic
Laparoscopic surgery
