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PCOL2 > Antiemesis > Flashcards

Antiemesis Flashcards

1
Q

Four drugs that can bring about emesis.

A

Chemo
Opioids
Digoxin
GA

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2
Q

The Vomiting Centre receives its input from which three places?

A
  1. The chemoreceptor trigger zone (CTZ)
  2. Cerebral Cortex
  3. Inner ear.
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3
Q

Three things can make us wanna puke. Toxins, motion sickness and interestingly, things that subjectively disgust us.
What three places feed into the vomiting centre?

A
  1. The CTZ
  2. The inner ear
  3. The cerebral cortex
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4
Q

What four receptors can be targets for antagonist therapy in anti-emesis?

A

H1
5HT3
DA
mAChR

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5
Q

Why is there no universal antiemesis drug?

A

Because none would target all of the relevant receptors.

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6
Q

Is antiemetic therapy tyically useful once emesis has set in?

A

No, they’re characteristically only really reliable for prophylaxis of nausea and emesis.

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7
Q

CINV is?

A

CHEMOTHERAPY-induced nausea and vomiting.

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8
Q

NVP is?

A

Nausea and Vomiting in PREGNANCY

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9
Q

What antipsychotics (anti-DA) are used in anti-emesis?
Horse pushing a pram making noise with his horseshoes.
I’m all for drowning Perez Hilton in chlorine.
This dom perignon champagne is overated. I’m still gonna drink every last drop.

A

Prochlorperazine
Metoclopramide
Domperidone
Droperidol.

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10
Q

Where does antiemetic DA-block occur?

A

CTZ only.

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11
Q

Where does antiemetic DA-block occur?

A

CTZ only.

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12
Q

It’s usually phenothiazine antipsychotics that are used for antiemesis. What side effect do they normally have apart form the usual muscle stuff?

A

Sedation.

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13
Q

What does peripheral D2 antagonism do to help antiemesis?

A

Lowers oesophageal sphinctre tone

Increases gastric emptying

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14
Q

Domperidone - cons?

A

Weak (has to be taken in combination)

Rare EPS

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15
Q

Where does the anticholinergic block act to prevent vomiting?
WHere is it thereby useful?

A

Vestibular nuclei

Motion sickness

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16
Q

What is the name of the anticholinergic antiemetic?

Being chased by a hyena would be good to stop vomiting.

A

Hyoscine (aka scopolamine).

17
Q

Hyoscine (aka scopolamine) also acts non-specifically on some H1 receptors. What side effect does this cause?

A

Sedation.

18
Q

Where do we find emetic mAChR adn H1 receptors in teh CNS?

A

vestibular nuclei

solitary tract’s nucleus

19
Q

What are the best antiemetics for CINV?

A

5HT3 blockers.

20
Q

What are the antihistamines? Antihistamines are used for morning and motion sickness.
I’m sitting here pregnant and nauseous wishing all men would die so I can just get back to my meth habit like I was smoking at prom where he knocked me up.

A

Dimenhydropinate

Promethazine.

21
Q

What are the antihistamines?

A

Dimenhydroptinate

Promethazine

22
Q

Could I use dimenhydroptinate or promethazine to drive to sussex if I took it half and hour before?

A

Yes - 4-6 hours duration.

But you shouldn’t because it causes sedation and impairs performance.

23
Q

Because the glowing ball of specialness in an annoying mother is so fucking precious, what can we give to the annoying woman to shut her up?

A

Ginger or VitB6 (aka pyridoxine)

24
Q

What is the only antihistamine we can give to a pregnant woman?

A

doxylamine

25
Q

You’d really need muscles to pull a scollop off a rock or fight a hyena. What’s the only anticholinergic mentioned in this lecture?

A

hyoscine/scolopamine

26
Q

If someone’s getting REALLY hardcore chemo, what’s the big-gun combination of four antiemetics?

A

Aprepitant + glucocorticoid + 5HT antagonist + dexamethasone?

27
Q

For antiemesis, what’s the glucocorticoid you need to remember?
Hopefully you have enough dex to get you in the zone for this stupid glucocorticodi.

A

Dexamethasone.

28
Q

Antiemetic glucocorticoid?

A

Dexamethasone.

29
Q

Why are DA antagonists ineffective for motion sickess?

A

Because the vestibular nucleus has no DA receptors. Those are only in the CTZ (where they hang out with seratonin receptors).

30
Q

What does aprepitant do?

The think I like about camping is peeing outside.

A

Blocks substance P, NK receptors in the CTZ.

31
Q

Why is aprepitant unlikely to have similar side effects to the other drugs?

A

No affinity for any of their receptors.

PCOL2 (24 decks)

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