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Anesthesia Pharm > Antiemetics > Flashcards

Antiemetics Flashcards

1
Q

Where is the vomiting center?

A

Nucleus of the Tractus Solitarius

Reticular Formation of the Medulla Oblongata

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2
Q

Where is the CRTZ?

A

Chemoreceptor Trigger Zone is on the floor of the fourth ventricle, which is OUTSIDE THE BLOOD BRAIN BARRIER

This means a substance doesn’t have to cross the BBB to activate the CRTZ

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3
Q

Who is at highest risk of PONV?

A

Women

Nonsmokers

Hx of Motion Sickness

Hx of PONV

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4
Q

Why are women more likely to have PONV?

A

It has to be related to the effects of progesterone or estrogen, because the extent of PONV varies with the menstrual cycle and decreases after menopause

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5
Q

How does the incidence of PONV change with age in adults?

A

Decreases per decade in adults

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6
Q

How does the incidence of PONV change with age in children?

A

increases with age

very low incidence in children < 3

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7
Q

What anesthesia-related drugs have been linked to PONV?

A

inhalation anesthetics

Nitrous Oxide

Neostigmine

Opioids

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8
Q

What is serotonin’s role in N/V?

A

Serotonin is released from the enterochromaffin cells of the SI when there is a caustic or irritating substance

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9
Q

What kind of N/V are 5-HT3 receptor antagonists NOT useful against?

A

N/V caused by vestibular stimulation

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10
Q

What drugs are 5-HT3 antagonists?

A

all of the “-setron” drugs

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11
Q

What are the most common side effects from Ondansetron treatment??

A

Headache and diarrhea

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12
Q

Does acetylcholine trigger or inhibit the CRTZ?

A

Triggers it. Anticholinergics reduce N/V

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13
Q

Which cholinergic receptors activate the CRTZ?

A

Muscarinic receptors in the VESTIBULAR SYSTEM

This is why scopolamine is helpful for motion sickness but ondansetron isnt

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14
Q

Why are scopolamine patches so much more desirable than IV or PO doses?

A

IV or PO administration requires much larger doses, which leads to more side effects (sedation, cycloplegia, dry mouth)

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15
Q

Why is scopolamine helpful in patients on a morphine PCA or morphine PCEA?

A

morphine stimulates the vestibular apparatus

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16
Q

Why do morphine and synthetic opioids cause N/V?

A

They increase vestibular sensitivity to motion

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17
Q

If a patient with a scopolamine patch has one blown pupil, what should you suspect?

A

They’ve probably touched the patch and then touched their eye

Contamination of the eye will cause anisocoria, and it will go away with time

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18
Q

What is Central Anticholinergic Syndrome?

A

Blockade of muscarinic cholinergic receptors and competitive inhibition of the effects of Ach in the CNS cause restlessness and hallucinations all the way to somnolence and unconsciousness

19
Q

Which anticholinergics cause Central Anticholinergic Syndrome?

A

Scopolamine and Atropine

Glycopyrrolate doesn’t cross the BBB

20
Q

Which drug is used to treat Central Anticholinergic Syndrome?

A

Physostigmine

This is the only anticholinesterase that crosses the BBB

21
Q

What does anticholinergic overdose look like?

A

Dry and flushed skin

Dry mouth

Difficulty swallowing and talking

blurry vision

Photophobia

22
Q

Who is susceptible to atropine fever?

A

Little kids

23
Q

What is barrier pressure and how is it effected by anticholinergics?

A

The difference between gastric pressure and LES pressure

Decreased by anticholinergics, increasing the risk of aspiration

24
Q

Antagonism of which receptors results in decreased N/V?

A

5-HT3

Histamine

Dopamine

Neurokinin-1

Muscarinic

25
Q

Which histamine receptor is responsible for N/V?

A

H1

26
Q

Which antihistamines are effective in treating N/V?

A

Nonspecific H1 receptor blockers:

Diphenhydramine, Promethazine, Dramamine

27
Q

What are the most common side effects from antihistamines?

A

Anticholinergic effects: dry mouth and somnolence

28
Q

Why is Dimenhydrinate (Dramamine) so helpful in treatment motion sickness?

A

inhibition of the vestibular nuclei 2/2 decreased RAS input

29
Q

Which dopamine receptor subtype is found in the CRTZ?

A

D2

30
Q

How does Metoclopramide reduce N/V?

A
  1. Antidopaminergic
  2. Stimulates the GI tract via cholinergic mechanisms
31
Q

Which patients should not receive Metoclopramide?

A

Patients with Parkinson, RLS, or other movement disorder related to dopamine depletion

32
Q

Why do droperidol and Haldol reduce N/V?

A

They antagonize the D2 receptor

33
Q

What receptors do Haldol and Droperidol block?

A
  1. Dopamine
  2. Norepinephrine
  3. Ach
  4. Histamine
34
Q

Name two Neurokinin-1 antagonists

A

Aprepitant and Fosaprepitant

35
Q

How does aprepitant reduce N/V?

A

Antagonizes Neurokinin-1 receptor, whose ligand is Substance P

36
Q

Why does versed decreased N/V?

A

may decrease synthesis and release of dopamine in the CRTZ

37
Q

What cases of N/V are cannabinoids useful in treating?

A

CINV, but not PONV

38
Q

How does stomach pH influence gastric motility?

A

Neutralizing gastric pH increases gastric motility by increasing gastrin release

It also increases LES tone, but not via gastrin

39
Q

What electrolyte derangements can be caused by calcium containing antacids?

A

Hypercalcemia

Hypophosphatemia

40
Q

What are the side effects of aluminum-containing antacids?

A

Hypomagnesemia

Hypophosphatemia

Anemia

Constipation

41
Q

Why is bicitra the preferred oral antacid?

A

It is less likely to cause a foreign body reaction if aspirated

AND

more complete and rapid action

42
Q

Acid rebound is a side effect unique to which antacids?

A

Calcium containing antacids

43
Q

What is milk-alkali syndrome?

A

Hypercalcemia

Increased BUN and Cr

Systemic Alkalosis

Most commonly associated with ingestion of large amounts of CaCO3 and > 1 L milk every day

Anesthesia Pharm (12 decks)

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