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Anti-emetics Flashcards

1
Q

What are the four etiologies of N/V?

A
  1. Vestibular
  2. GI
  3. CTZ/VC
  4. CNS -etiology of vomiting from psyche disorders, AV, and cancer therapy
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2
Q

Where are the CTZ and VC located in the brain?

A

brainstem

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3
Q

Which receptors are located in the GI?

A

5-HT3 serotonin receptors

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4
Q

Which receptors are located in the ear/vestibular system?

A

H1 receptor/ Histamine

M1 receptor/Muscarinic

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5
Q

Which receptors are located in the CTZ zone? (4)

A

dopamine D2 receptors
NK-1 receptors
opioid receptors
5-HT3

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6
Q

What is simple N/V?

A

self limiting N/V that requires symptomatic therapy

patient complains of queasiness or discomfort

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7
Q

What is Complex N/V?

A

N/V that results in patient deterioration, fluid/electrolyte imbalances
patient complains of weight loss, fever, abdominal pain

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8
Q

Which labs should you monitor with a patient who suffers from N/V?

A

CMP- look at electrolytes

Upper/lower GI evaluation

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9
Q

What are the clinical uses of antacids?

A

simple N/V

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10
Q

ADE of antacids?

A
  • Mg products cause diarrhea
  • Al and calcium products cause constipation
  • Sodium bicarbonate causes metabolic alkalosis
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11
Q

Ondansetron, Granisetron, Dolasetron (1st generation), and Palonosetron (2nd generation) are what class of drug?

A

5-HT3 antagonist

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12
Q

MOA of 5-HT3 antagonist?

A

block peripheral 5-HT3 receptors from intestinal vagal and spinal afferent nerves into the CTZ

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13
Q

What are clinical uses of 5-HT3 antagonist?

A

PONV
chemotherapy induced N/V
post radiation N/V

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14
Q

What is unique to Palonosetron?

A
  • greater affinity to 5-HT3 receptor
  • most potent
  • half life around 40 hrs while 1st gen 5-HT3 have 1/2 life of 4-9 hrs
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15
Q

PK of 5-HT3 antagonist?

A
  • extensive hepatic metabolism
  • no need for dose reduction in those who have renal issues
  • dose reduction with odansetron for those with hepatic issues
  • slow colonic transit time
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16
Q

T/F 5-HT3 receptor antagonist have little effect on preventing delayed N/V ( i.e. 24 hrs after chemotherapy) when used alone

A

TRUE

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17
Q

T/F 5-HT3 are most effective if given 30 min (IV) before chemo administration

A

TRUE

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18
Q

Which drugs can be combined with 5-HT3 antagonist to enhance efficacy?

A

Corticosteroid/Dexamethasone
Olanzapine
NK1 receptor antagonist

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19
Q

What are most common ADE of 5-HT3 antagonist?

A

HA
constipation
QT prolongation with 1st generation drugs

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20
Q

Which of the 5-HT3 antagonist causes the greatest QT prolongation?

A

Dolasetron

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21
Q

What should you monitor with 5-HT3 antagonists?

A

hypomag, hypokalemia, bradyarrhythmia

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22
Q

Aprepitant and Fosaprepitant, Rolapitant are what drug class?

A

NK-1 receptor antagonist

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23
Q

What is clinical use of NK-1 receptor antagonist?

A

relief from delayed emesis from cancer tx or drugs that cause vomiting

24
Q

What combo therapy with NK-1 receptor antagonist can prevent N/V and tx delayed n/V?

A

Netupitant and palonosetron

Fosnetupitant and palonosetron

25
What are ADE of NK-1 receptor antagonist?
hiccups HA diarrhea/constipation
26
What are drug inetraction withNK-1 receptor antagonist?
reduce dose of corticosteroids - because netupitant is modertae inhibitor of CYP3A4 - rolapitant cannot be used with thioridazine because it inhibis CYP2D6
27
Dimenhydrinate (dramamine) and Diphenydramine/benadryl, meclizine, scopalamine, hydroxyzine, trimethobenzamide are what drug class?
Antihistamine-Anti-cholinergic agents
28
What are ADE of Antihistamine-Anti-cholinergic agents ?
confusion, drowsiness, blurred vision, dry mouth, urinary retention -elderly at risk for BPH, narrow angle glaucoma, asn asthma
29
What is clinical use of Antihistamine-Anti-cholinergic agents ?
motion sickness
30
What is route of scopalamine?hydroxizine?meclizine?trimethobenzamide?
transdermal IM, capsule, Tablet capsule
31
Prochlorperazine, promethazine are what drug class?
anti-dopaminergic
32
T/F anti-dopaminergic drugs have anti-cholingergic affects
TRUE
33
What are clinical uses of anti-dopaminergic drugs
- simple N/V - break through CIN/V - psyche issues - incurrable hiccups
34
What are ADE of prochlorperazine and promethazine?
- sedation - torticollois - tardive dyskenisia - prolonged QT
35
T/F Promethazine is used over prochlorperazine in ER because the ADE are a bit less
TRUE
36
Haloperidol and Droperidol are what drug class? what is route of administration?
D2 blocker-Butyrophenones Halo: IV, IM, tablet, liquid Droperidol: IM, IV
37
What are ADE of droperidiol and haloperidol?
Droperidol: TDP, QT porlonged, Haloperidol: sedation, constipation, hypotension, dose dependent QT prolongation
38
What should you monitor for droperidiol and haloperidol?
droperidol: 12 lead EKG done before giving med and cardiac maonitoring after Halo: ensure no other additive sedation effects with other drugs
39
What is clinical use of Haloperidol?
N/V palliative care acute psychosis
40
What drug class are Lorazepam and Alprazolam?
Benzos
41
What is clinical use of benzos?
reduce anxiety and anticipatory N/V, CINV, PONV | Lorazepam can be given night before or morning of chemotherapy induction
42
What are ADE of benzos?
- memory impairment | - sedation
43
What is the clinical use of dexamethasone?route?
- enhance efficacy of 5-HT3 receptor antagonist for stopping N/V - IV, tablet
44
what is ADE of dexamethasone?
- cant register satiety - agitation - GI symptoms - insomnia
45
What is dronabinol and nabilone?
purified synthetic delta 9 tetrahydrocannabinol
46
What is clinical use of dronabinol and nabilone?
moderate antiemetic | CINV
47
What are ADE of dronabinol, nabilone?
somnolence, euphoria, and dry mouth | nabilone: vertigo, somnolence,
48
What is metoclopramide?
anti-dopaminergic and anti-cholinergic | tablet
49
T/F Metoclopramide is useful as prokinetic and helps in diabetic gastroparesis
TRUE
50
What is olanzapine?
second gen anti-psychotic that blocks 5-HT and DA2 to tx acute an delayed N/V and breakthrough CINV -tablet
51
What are ADE of metcolopramide?olanzapine?
- tardive dyskinesia,asthenia, HA | olanzapine: sedation
52
What is first line anti-emetic tx in pregnancy?
Pyridoxine with or wihtout doxylamine
53
What is second line?
anti-histamine or Dopamine antagonist
54
What should you replace if pregnant patient shows signs of dehydration?
IV fluid with thiamine
55
T/F Corticosteroids are reserved for refractory cases of N/V or hyperemesis gravidarum
TRUE

Pharmacology (47 decks)

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