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Pharmacology > Antiemetics, Laxatives and Anti-motility > Flashcards

Antiemetics, Laxatives and Anti-motility Flashcards

1
Q

Cyclizine acts on which receptors and is indicated in what forms of nausea?

A
  • acts on H1 and muscarinic receptors

- motion sickness, vertigo, surgery, cerebellar and brain disease induced nausea

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2
Q

2 CI for cyclizine use

NB: one is due to cyclizine is an antimuscarinic and there are antagonised by prokinetic cholinergic meds

A

CI: CONCURRENT METOCLOPRAMIDE / DOMPERIDONE USE
CI: TACHYARRYTHMIAS

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3
Q

Cyclizine, 2 SEs

NB: avoid in hepatic encephalopathy (-> drowsy) and BPH (risk of retention)

A
  • drowsiness
  • dry mouth
  • tremor, flushing, tachycardia
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4
Q

Metoclopramide acts on D2 and 5H4 receptors, what type of action does it have? And when is this antiemetic indicated(give 2)?

A
  • a prokinetic and inhibits sensing in the CTZ
  • for N&V due to reduced gut motility
  • e.g. post-abdo radiotherapy, chemo, distension/delayed gastric emptying, surgery, partial bowel obstruction
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5
Q

When is Metoclopramide contraindicated? Give 2CI:

A 
CI: CONCURRENT CYCLIZINE USE
CI: PARKINSON'S DISEASE
CI: EXTRA-PYRAMIDAL SYMPTOMS
CI: TOTAL BOWEL OBSTRUCTION and PERFORATION
CI: LONG QT
CI: EPILEPSY
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6
Q

Give 2 SEs of the prokinetic metoclopramide:

A
  • colic
  • extrapyramidal SEs
  • long QT
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7
Q

Haloperidol is a 1st generation, typical antipsychotic that acts on which receptor? Helping nausea of what origin/cause?

A
  • D2 receptors

- chemoreceptor triggered nausea

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8
Q

The gen 1 Haloperidol acts on -D2 receptors and helps -chemoreceptor triggered nausea, hence suggest 3 indications for it’s use:

A
  • electrolyte disturbance (–>nausea)
  • uraemia (“”)
  • hormones (“”)
  • opioid induced nausea
  • chemo induced
  • anaesthesia related “”
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9
Q

Give 2 CI for use of Haloperidol as an anti-emetic:

A

CI: PARKINSON’S DISEASE
CI: LONG QT
CI: EPILEPS

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10
Q

Based on the following, give 3 SEs from use of Haloperidol as an anti-emetic:
CI: PARKINSON’S DISEASE
CI: LONG QT
CI: EPILEPSY

A

SE: sedation, extrapyramidal SES, lower seizure threshold, prolonged QT

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11
Q

Levomepromazine is a broad spectrum antiemetic (acts on D2, H1, M,5TH2/3R…) , suggest 2 CIs and 2SEs

A

CI: PARKINSON’S DISEASE
CI: LONG QT
CI: EPILEPSY
SE: sedation, extrapyramidal SEs, lower seizure threshold, prolonged QT

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12
Q

Ondansetron acts on what receptor and works best for what kind of nausea? give 1 CI:

A

-5HT3
-Chemo related
CI: CONSTIPATION
CI: LONG QT

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13
Q

Suggest 4 medications or classes that may cause/contribute to constipation:

A
  • opioids
  • diuretics
  • antimuscarinics e.g. TCAs
  • ondansetron
  • ocreotide
  • ferrous sulphate
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14
Q

What classes of laxatives require pt to drink a lot of water? give an example of this class

A

-osmotic laxatives e.g. laxido/Movicol

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15
Q

How do stimulant laxatives work? Give 2 e.gs of this class. And 1 SE

A
  • stimulate peristalsis
  • transformed by bacteria in colon to active derivatives
  • SE: can cause cramps
  • e.g. Senna, Bisacodyl
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16
Q

Docusate reduces surface tension of stool, so improves water penetration, what class is it? 1 SE

A
  • Surfactant laxative (stool softener)

- SE: cramps, diarrhoea

17
Q

Osmotic Laxatives are not absorbed by the gut, how do they act, give 1 e.g, a non-constipation related use and a SE

A
  • they retain water in the gut by osmosis
  • the stool is softer and extra vol stimulates peristalsis
  • lactulose, macrogol
  • use: liver failure (reduces NH3)
  • -SE: abdo distention, cramps, flatulence, nausea
18
Q

What rouge class of laxatives are used for laxative refractory opioid induced constipation (mainly in pall. care)

A

-peripheral opioid antagonists e.g. methylnaltrexone (SC) or naloxagol (oral)

19
Q

Bran powder and Ispaghula are examples of what class of laxative?
give 1 risk if not with enough water
and 2 SEs

A
  • Bulk forming laxatives
  • risk of obstruction
  • SE: bloating and flatulence
20
Q

PR intervention is used to treat what type of constipation?

  • what are the main 2 modes of intervention
  • what action can they have?
A
  • for faecal impaction
  • suppository e.g. glycerin/bisacodyl or enema e.g. phosphate
  • can be softener/stimulant/(lubricant)
21
Q

Name a medication that is used to symptomatically treat diarrhoea (e.g. in context of IBS/gastroenteritis), what class of drugs is used, that act how?

A
  • loperamide
  • codeine phosphate (+provides analgesia at same time)
  • these are opiods
  • agonist of mu receptors in gut, slows transit, increases anal tone
22
Q

The opioid Loperamide doesn’t penetrate the CNS, it is an agonist of mu receptors in the gut, name 2 SEs based on it’s MOA in treating diarrhoea

A

-GI effects of constipation, abdominal cramping and flatulence

23
Q

Loperamide is an antimotility opioid drug used to treat diarrhoea, when should it’s use be avoided? Suggest 2
Clue: inhibition of peristalsis increases risks of complications in these cases

A
  • in acute ulcerative colitis (increased risk of megacolon/perforation)
  • in c. diff colitis
  • in dysentery (bloody diarrhoea) may signify bacterial infection e.g. E.coli
24
Q

Loperamide is an antimotility opioid drug used to treat diarrhoea, why is it avoided:
-in dysentery (bloody diarrhoea) which may signify bacterial infection
What is the risk? And which bacterial infection is this most likely to occur in?

A
  • Certain strands of E.coli (O157:H7) can cause Haemolytic Uremic Syndrome (HUS)
  • Antimotility drugs increases the risk of HUS
25
Q

Why would you hesitate to prescribe an antimotility drug (e.g. Loperamide) in a pt that develops diarrhoea while in hospital (pt may be frustrated they can’t get a medication they would be able to buy from chemist at home)

A
  • because of the risks of inhibiting peristalsis in c.diff colitis context
  • first wait until aetiology clearer (e.g. w PCR/c.diff toxin test)
26
Q

Suggest 2 SEs of the anti-motility agent loperamide.

NB: this opiod angonist has no penetrance into CNS, acts only in gut

A
  • constipation
  • abdominal cramping
  • flatulence
27
Q

What are the 2 situations Loperamide anti-diarrhoeal use should be avoided due to the inhibition of peristalsis increasing risks of complications?

A
  • in acute UC (increased risk of megacolon and perforation)

- in C. diff colitis

Pharmacology (14 decks)

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