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GI pharm > Antiemetics > Flashcards

Antiemetics Flashcards

1
Q

General Approach to Emesis

A
  1. Find etiology: consider acute v. chronic (>1 month)
  2. Consider consequences/complications: Dehydration, hypokalemia, metabolic alkalosis
  3. Target therapy to etiology: Diet, surgery for obstruction/malignancy, symptomatic treatment
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2
Q

causes of Abdominal pain

A

organic cause: Infectious, tumor, obstruction, etc.

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3
Q

causes of Distension/tenderness

A

obstruction

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4
Q

causes of Emesis few hours after food

A

obstruction/gastroparesis

-Obstructions in high region of small bowel

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5
Q

causes of GERD

A

GERD

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6
Q

causes of AM vominting

A

pregnancy

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7
Q

causes of Feculent vomitus

A

obstruction or gastrocolic fistula

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8
Q

causes of Vertigo/nystagmus

A

vestibular

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9
Q

causes of Neurologic symptoms, projectile, positional

A

neurologic origin

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10
Q

causes of parotid enlargement, dental erosion, dorsal hand calluses

A

bulimia

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11
Q

Acute infectious gastroenteritis can be caused by what?

A

Bacterial, viral, and parasitic causes depending on exposure

- Especially common with rotaviruses, enteric adenovirus, and norovirus

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12
Q

are lab tests usually necessary for Acute infectious gastroenteritis

A

no

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13
Q

about one-third of surgical patients have this after receiving general anesthesia

A

Postoperative nausea and/or vomiting

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14
Q

what is Vestibular neuritis?

A

acute labyrinthine disorder characterized by rapid onset of severe vertigo with nausea, vomiting and gait instability

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15
Q

Acute Disorders Associated with N/V

A
  1. Acute infectious gastroenteritis
  2. postoperative nausea and/or vomiting
  3. Vestibular neuritis
  4. Patients receiving chemotherapy
  5. drugs
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16
Q

Chronic Disorders Associated with N/V

A
  1. Nausea and vomiting of pregnancy
  2. Functional nausea and vomiting
  3. Gastroparesis
  4. Gastroesophageal reflux
  5. Gastric outlet obstruction
  6. Eosinophilic gastroenteritis
  7. Cyclic vomiting syndrome
  8. Chronic idiopathic intestinal pseudo-obstruction
  9. Rumination syndrome
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17
Q

risk factors for emesis with pregnancy

A

increased placental mass, family history of hyperemesis gravidarum or a personal history of the disorder in a previous pregnancy, female fetus, and a history of motion sickness or migraine headaches

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18
Q

what is hyperemesis gravidarum

A

extreme end of emesis associated with pregnancy. Patients are debilitated with this.

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19
Q

is emesis after 9 weeks of pregnancy normal?

A

no

onset after the initial nine weeks should direct especially careful evaluation for another cause

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20
Q

what is Cyclic vomiting syndrome?

A

Characterized by repeated episodes of nausea and vomiting that last for hours to days and are separated by symptom-free periods of variable length

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21
Q

what is a A behavioral disorder that is most commonly identified among mentally-disadvantaged children, although it is increasingly recognized among adolescents and adults of normal mental capacity

A

Rumination syndrome

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22
Q

Classes of antiemetics

A
  1. M1 - muscarinic
  2. D2 - dopamine
  3. H1 - histamine
  4. 5-hydroxytryptamine (5-HT)-3 - serotonin
  5. Neurokinin 1 (NK1) receptor
  6. glucocorticoids
  7. cannabinoids
  8. E-mycin
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23
Q

what is the anticholinergic drug used to treat emesis?

A

Scopolamine (Transderm Scōp)

24
Q

how is Scopolamine applied?

A

transdermal patch applied behind ear

25
Q

use for Scopolamine

A

mainly for prophylaxis against motion sickness

26
Q

Scopolamine ADRs

A

same as other anticholinergics

- Also blocks histamine receptors so can cause significant drowsiness

27
Q

Antihistamines drugs to treat emesis (6)

A 
o	Diphenhydramine (Benadryl)
o	Dimenhydrinate (Dramamine)
o	Cyclizine (Marezine)
o	Hydroxyzine
o	Meclizine (Antivert)
o	Promethazine
28
Q

which Antihistamines is especially good for vertigo

A

Meclizine

29
Q

Antihistamine that is commonly used for acute gastroenteritis

A

Promethazine (Phenergan)

30
Q

Antihistamines common ADR

A

Sedation is common ADR

31
Q

Promethazine (Phenergan) involves multiple receptors such as?

A

o Histamine-1
o Dopaminergic in brain (phenothiazine derivative)
o Alpha-adrenergic
o Muscarinic

Because of this, this drug has a ton of DDIs and side effects.

32
Q

Warning/precautions with Promethazine (Phenergan)

A 
o	Altered cardiac conduction
o	Anticholinergic effects
o	CNS depression
o	EPS- Extrapyramidal symptoms
o	Neuroleptic malignant syndrome
o	Orthostatic hypotension
o	Temperature regulation
33
Q

Disease concerns with Promethazine (Phenergan)

A 
o	Bone marrow suppression
o	CV disease
o	Glaucoma
o	Myasthenia gravis
o	PD
o	Respiratory disease
o	Seizures
34
Q

BBW with Promethazine (Phenergan)

A

o Pediatric: respiratory depression can be fatal–Not something you wan’t to use a lot unless severe
o Tissue injury: injection can cause severe injury including gangrene no matter route
- Preferred route for injection is deep IM
- Suppository or tablet won’t cause this, just injection

35
Q

CI with Promethazine (Phenergan)

A

o Children <2 years of age

o Intra-arterial or subcutaneous administration

36
Q

Dopamine Receptor Antagonists drugs

A
  1. Prochlorperazine
  2. Chlorpromazine (Thorazine)
  3. Perphenazine
  4. Droperidol (Inapsine)
  5. Haloperidol (Haldol)
  6. Metoclopramide (Reglan)
37
Q

BBW Metoclopramide (Reglan)

A

irreversible tardive dyskinesia with high dose and/or long-term use

38
Q

Metoclopramide (Reglan) stimulates what receptors at low doses?

A

o D2 at low doses

39
Q

Metoclopramide (Reglan) stimulates what receptors at high doses?

A

o 5-HT3 at higher doses

40
Q

Dopamine Receptor Antagonist that is Mainly used for psychosis and aggression

A

o Haloperidol (Haldol)

41
Q

Dopamine Receptor Antagonist that is commonly used for schizophrenia

A

o Chlorpromazine (Thorazine):

42
Q

Dopamine Receptor Antagonist that is Commonly used in ERs for patients with migraines

A

o Prochlorperazine

43
Q

Dopamine Receptor Antagonist ADRs

A

o Extrapyramidal reactions
o QT prolongation for some
hypotension for some

44
Q

what are some Extrapyramidal symptoms (EPS)

A
  • Dystonia: muscle spasms of head/neck
  • Tardive dyskinesia: repetitive, involuntary movements
  • Akathisia: motor restlessness
  • Pseudoparkinsonism
  • Akinesia: inability to initiate movement
45
Q

Serotonin Receptor Antagonists drugs

A 
First Generation:
o	Ondansetron (Zofran, Zofran ODT, Zuplenz)
o	Granisetron (Granisol, Sancuso)
o	Dolasetron (Anzemet)
Second Generation:
o	Palonosetron (Aloxi)
46
Q

which Serotonin Receptor Antagonists drug has the longest half life?

A

palonosetron

47
Q

Serotonin Receptor Antagonists ADR

A

o ECG interval changes with all FIRST GENERATION
o HA
o Constipation

48
Q

Neurokinin 1 Receptor Antagonists MOA

A

These drugs block the binding of substance p to neurokinin one receptors

49
Q

Neurokinin 1 Receptor Antagonist drugs

A 
o	Aprepitant (Emend) - PO dosage form
o	Fosaprepitant (Emend for Injection) - IV dosage form
o	Netupitant/palonosetron (Akynzeo)
50
Q

what to the Neurokinin 1 Receptor Antagonist drugs end with?

A

“pitant”

51
Q

what are the names of the two drugs in the Cannabinoids class

A
  • Nabilone (Cesamet)

- Dronabinol (Marinol)

52
Q

Cannabinoids ADRs

A

vertigo, xerostomia, hypotension, dysphoria

53
Q

what is another benefit to using Cannabinoids in certain patients?

A

can increase appetite in patients

54
Q

what Cannabinoid drug is used for stimulating appetite AIDS patients?

A
  • Dronabinol
55
Q

Erythromycin has what kind of effects?

A

pro motility

56
Q

Chemotherapy-Induced Emesis (CIE) is categorized into what 3 types?

A

Acute
delayed
Anticipatory

57
Q

what is the mainstay of therapy for Chemotherapy-Induced Emesis (CIE)

A

5-HT3 and NK1 and glucocorticoids are mainstay of therapy

GI pharm (11 decks)

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