Antiemetic Drugs + Supplements

Question 1

Anticholinergic examples, MOA/use/route, side effects

Answer 1

-Ex: scopolamine
-MOA: blocks Ach in inner ear, dry out GI secretions
-ROUTE/USE: patch often used for motion sickness
-SFX: dry you out–blurred vision, dry mouth, urinary hesitancy, drowsiness. Used CAUTION w/ older adults

Question 2

Antihistamine examples, MOA, side effects

Answer 2

ex: diphen, meclinzine, dimenhydrinate (dramamine)
-MOA: blocks H1 receptors in vestibular/reticular formations
-R/U: oral–motion sickness
-SFX: dizziness, drowsiness, dry mouth, constipation–use w/ caution in older adults

Question 3

Antidopaminergics examples, MOA, route/use, SFX

Answer 3

-prochlorperazine (Compazine), promethazine, droperidol
-MOA: block dopamine receptors in the CTZ
-R/U: oral/suppository/IV, general N/V
-SFX: drying, sedative, constipation. Can cause NMS

Question 4

What is NMS, and what antiemetic class(/es) can cause it?

Answer 4

-Neuroleptic Malignant Syndrome: life threatening fever, altered mental status, rigidity, autonomic function loss
-Antidopaminergics, prokinetics

Question 5

What antidopaminergic can cause agranulocytosis (low neutrophil count)? What would that put the pt at risk for?

Answer 5

-Prochlorperazine
-Infection

Question 6

Prokinetic (metoclopramide) examples, MOA, route/use, SFX

Answer 6

-metoclopramide
-MOA: block dopamine in CTZ and stimulates Ach receptors in GI
-R/U: more commonly used for motility issues like GERD
-SFX: drying and drowsy, long term use = tardive dyskniesia (on BEERS), NMS

Question 7

Signs and symptoms of TD (tardive dyskinesia)

Answer 7

-stooped posture, forward tilted trunk
-rigidity
-flexed elbows/wrists
-reduce arm swinging
-trembling in extremities

Question 8

Serotonin blockers examples, MOA, route/use, SFX

Answer 8

-“trons”: ondansetron (Zofran), dolasetron, granisetron, palonosetron
-MOA: block serotonin receptors in GI, CTZ
-R/U: tabs, SL tabs, IV… for chemo/post-op N/V
-SFX: headache, diarrhea, RARELY: serotonin syndrome, Torsades de Pointes

Question 9

Describe serotonin syndrome and Torsades de Pointes–what classes of drugs can cause these?

Answer 9

-Serotonin syndrome: polypharmacy of serotonin blockers
-TDP: widening QT interval
-Serotonin blockers can cause these

Question 10

Neurokinin Receptor Antagonists

Answer 10

-

Question 11

Tetrahydrocannabinoids example, MOA, R/U, SFX

Answer 11

-dronabinol
-MOA: inhibitory effects on reticular formation, thalamus, cerebral cortex
-R/U: chemotherapy, cancer, AIDs, stimulates appetite
SFX: mood changes, drowsy/dizzy, dry mouth

Question 12

Water soluble vitamins vs fat-soluble vitamins

Answer 12

-Water soluble: excess peed out. Vitamins B/C
-Fat soluble: D,A,K,E. Stored in liver, adipose tissue

Question 13

Vitamin B1 use

Answer 13

THIAMINE
-needed for carb metabolism
-deficiency –> wernicke’s encephalopathy (effects short term memory)

Question 14

Vitamin B2

Answer 14

RIBOFLAVIN
-necessary for RBC function
-deficiency caused by poor nutrition
-found in: dairy, flours, green leafy veg, nuts, meat…

Question 15

Vitamin B3

Answer 15

NIACIN
-coenzyme for metabolizing lipids
-deficiency caused by alcohol abuse, nutritional/absorption deficiency

Question 16

Vitamin B6

Answer 16

PYRIDOXINE
-necessary for amino acid/carb/lipid metabolism
-deficiency from poor nutrition, isoniazide–causes anemia, neurological issues

Question 17

Vit B9

Answer 17

FOLIC ACID
-necessary for fetal dev (spina bifida), RBCs

Question 18

Vit B12

Answer 18

-needed for RBC and DNA development
-helps brain and nerve cell development

Question 19

Vitamin C

Answer 19

ASCORBIC ACID
-collagen formation/tissue repair, antioxidant
-deficiency –> scurvy, and bleeding gums, gingivitis, wound healing
-no evidence for helping/preventing colds

Question 20

Vit D2/D3

Answer 20

-fat soluble
-helps w/ bones, teeth

Question 21

Vitamin A

Answer 21

Retinol
-growth of bones, teeth
-from beta-carotenes (green/yellow plants)

Question 22

Vitamin K

Answer 22

-clotting
-Given to newborns to prevent dangerous bleeding (into brain)

Question 23

Vitamin E

Answer 23

-antioxidant
-protects body from free radicals
-can be low in preemies–supplemented here

Question 24

Important minerals–why?

Answer 24

-Calcium (bones, cardiac–in milk, cereal, juice)
-Magnesium (nerve, muscle contraction–in green leafy veg, meat, nuts)
-Phosphorus (bones/teeth, DNA synthesis–milk, eggs)
-Zinc (tissue growth–red meat, liver, milk)

Question 25

What can you not take w/ Calcium?

Answer 25

Tetracycline (hypercalcemia)

Question 26

What can cause Mg deficiency?

Answer 26

-alcohol abuse
-don’t supplement w/ impaired kidneys