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Pharm 101 > Ch. 52- Antiemetic and Antinausea Drugs > Flashcards

Ch. 52- Antiemetic and Antinausea Drugs Flashcards

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1
Q

What is nausea?

A

Unpleasant feeling preceding vomiting

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2
Q

What is the vomiting center?

A

An area in the brain that is responsible for initiating the physiologic events that lead to nausea and vomiting.

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3
Q

Where do the neurotransmitter signals that are sent to the vomiting center come from?

A

The chemoreceptor trigger zone (CTZ)

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4
Q

What is the CTZ?

A

Chemoreceptor trigger zone. An area in the brain involved in the induction of nausea and vomiting.

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5
Q

What is ACh’s site in the vomiting pathway?

A

VC in brain; vestibular and labyrinthine pathways in inner ear

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6
Q

What is Dopamine (D2)’s site in the vomiting pathway?

A

GI tract and CTZ in brain

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7
Q

What is Histamine (H1)’s site in the vomiting pathway?

A

VC in the brain; vestibular and labyrinthine pathways in inner ear

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8
Q

What are prostaglandins’ site in the vomiting pathway?

A

GI tract

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9
Q

What is Serotonin (5-HT3)’s site in the vomiting pathway?

A

GI tract; CTZ and VC in the brain

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10
Q

What is Substance P (Neurokinin 1)’s site in the vomiting pathway?

A

Brainstem

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11
Q

What are antiemetic drugs?

A

Drugs that are used to relieve nausea and vomiting

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12
Q

What is the mechanism of action for anticholinergic drugs?

A

Bind to and block ACh in the vestibular nuclei (inner ear labyrinth)
Block transmission of nauseating stimuli to the chemoreceptor trigger zone (CTZ)

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13
Q

What are the indications of anticholinergics?

A

Motion sickness, secretion reduction before surgery, nausea and vomiting

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14
Q

What is the main example of an anticholinergic antiemetic drug?

A

Scopolamine

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15
Q

What is scopolamine used to treat?

A

Postoperative nausea and vomiting, treatment and prevention of the nausea and vomiting associated with motion sickness

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16
Q

In what form is scopolamine available?

A

Oral, injectable, transdermal, and even ocular forms. Most common is transdermal patch

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17
Q

When traveling, when should you put on the scopolamine patch?

A

At least 4 hours before travel

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18
Q

Where and how often do you apply a scopolamine patch?

A

Hairless area behind the ear, every three days

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19
Q

What do antihistamines do?

A

Inhibit ACh by binding to H1 receptors.

Prevent cholinergic stimulation in vestibular and reticular areas, similarly to anticholinergics.

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20
Q

When what two systems stimulated does nausea and vomiting occur?

A

Vestibular and reticular systems

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21
Q

What are the three biggest examples of antihistamines?

A
  • Dimenhydrinate (Dramamine)
  • Diphenhydramine (Benadryl)
  • Meclizine (Antivert)
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22
Q

What are the indications of antihistamines?

A

Motion sickness, non productive cough, sedation, rhinitis, allergy symptoms, nausea and vomiting

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23
Q

What is meclizine (antivert) commonly used to treat?

A

Vertigo, dizziness, nausea and vomiting associated with motion sickness.

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24
Q

What are the contraindications of meclizine (antivert)?

A

Shock and lactation

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25
Q

What form is meclizine (antivert) available in?

A

Oral only

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26
Q

How long before travel should you give an antihistamine?

A

1 hour

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27
Q

What is the mechanism of action for antihistamines?

A

Block H1 receptors, thereby preventing ACh from binding to the receptors in the vestibular nuclei

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28
Q

What are the adverse effects of antihistamines on the EENT?

A

Blurred vision, dilated pupils, dry mouth

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29
Q

What are the adverse effects of antihistamines on the CNS?

A

Dizziness, drowsiness, confusion

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30
Q

What are the adverse effects of antihistamines on the GI?

A

Urinary retention

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31
Q

What are the adverse effects of anticholinergics on the CNS?

A

Dizziness, drowsiness, disorientation

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32
Q

What are the adverse effects of anticholinergics on the cardiovascular system?

A

Tachycardia

33
Q

What are the adverse effects of anticholinergics on the EENT?

A

Blurred vision, dilated pupils, dry mouth

34
Q

What are the adverse effects of anticholinergics on the GI?

A

Difficult urination, constipation

35
Q

What are the adverse effects of anticholinergics on the integumentary?

A

Rash, erythema

36
Q

What is the mechanism of action of antidopaminergic drugs?

A

Block dopamine receptors in the CTZ

37
Q

What are the indications of antidopaminergic drugs?

A

Used for psychotic disorders, intractable hiccups, nausea and vomiting

38
Q

What are antidopaminergic drugs known for?

A

Their antipsychotic effects

39
Q

What are the three main examples of antidopaminergic drugs?

A
  • prochlorperazine (Compazine)
  • promethazine (phenergan)
  • Dropiderol (Inapsine)
40
Q

Where is prochlorperazine used frequently?

A

Hospital setting, in injectable form

41
Q

What is prochlorperazine contraindicated with?

A

Pts n a coma, those with seizures, encephalopathy, bone marrow suppression, hypersensitivity to phenothiazines

42
Q

What is promethazine commonly used for?

A

An antiemetic.

43
Q

What must you be especially careful with when giving promethazine (Phenergan)?

A

If given in IV (not preferred), must avoid intraarterial injection. Severe tissue damage (and amputation) could result.

44
Q

What happens if burning or pain is felt when giving promethazine?

A

Therapy must be discontinued immediately

45
Q

What is the most common adverse effect of promethazine (Phenergan)?

A

Sedation

46
Q

What are the adverse effects of antidopaminergics in the cardiovascular system?

A

Orthostatic hypotension, tachycardia

47
Q

What are the adverse effects of antidopaminergics in the CNS?

A

Extrapyramidal symptoms, tardive dyskinesia, headache

48
Q

EENT adverse effects of antidopaminergics?

A

Blurred vision, dry eyes

49
Q

GU adverse effects of antidopaminergics?

A

Urinary retention

50
Q

GI adverse effects of antidopaminergics?

A

Dry mouth, n/v, anorexia, constipation

51
Q

What is the mechanism of action for prokinetic drugs?

A

Block dopamine in the CTZ
Cause CTZ to be desensitized to impulses that it receives from the GI tract
Stimulates peristalsis in the GI tract

52
Q

What are the indications of prokinetics?

A

GERD, delayed gastric emptying, n/v, gastroesophageal reflux

53
Q

What is the main example of a prokinetic?

A

Metoclopramide

54
Q

What is metoclopramide used for?

A

The treatment of delayed gastric emptying and gastroesophageal reflux and also as an antiemetic

55
Q

What is metoclopramide contraindicated for?

A

Pts with seizure disorder, pheochromoctyoma, breast cancer, GI obstruction.

56
Q

What is the FDA posting on metoclopramide?

A

Potential for developing irreversible tardive dyskinesia with long term use of this drug

57
Q

What is the mechanism of action of serotonin blockers?

A

Block serotonin receptors in the GI tract, CTZ, and VC

58
Q

What are the indications of serotonin blockers?

A

n/v associated with chemotherapy, postoperative n/v

59
Q

What people are serotonin blockers used for?

A

Those receiving chemotherapy or those who are postoperative

60
Q

What are the four most common types of serotonin blockers? Hint: Dog pee, Azk A

A

Dolstetron (anzemet)
Ondansetron (Zofran)
granisetron (kytril)
Palonosetron (aloxi)

61
Q

Why is ondansetron significant?

A

Major breakthrough in treating chemotherapy-induced n/v, and also postoperative n/v. First of the class to become available as a generic formulation, significantly increasing its use.

62
Q

What is the concern of using ondasetron in the first trimester of pregnancy?

A

Has been known to cause a cleft palate

63
Q

What is the mechanism of action of THC (tetrahydrocannabinoids)?

A

Alter body’s mood and perception of surroundings
Major psychoactive substance in marijuana
Inhibitory effects on reticular formation, thalamus, cerebral cortex

64
Q

What are the indications of THC (tetrahydrocannabinoids)?

A

N/V associated with chemotherapy, anorexia associated with weight loss in patients with AIDS and cancer. May stimulate appetite

65
Q

What is the best example of a THC (tetrahydrocannabinoid) drug?

A

Dronabinol

66
Q

True or False: Dronabinol is used as a second-line drug after treatment with other antiemetics has failed.

A

True

67
Q

What are the CNS adverse effects of tetrahydrocannabinoids?

A

Drowsiness, dizziness, anxiety, confusion, euphoria

68
Q

What are the EENT adverse effects of tetrahydrocannabinoids?

A

Visual disturbances

69
Q

What are the GI adverse effects of tetrahydrocannabinoids?

A

Dry mouth

70
Q

What are the CNS adverse effects of serotonin blockers

A

Headache

71
Q

GI adverse effects of serotonin blockers?

A

Diarrhea

72
Q

Other adverse effects of serotonin blockers?

A

Rash, bronchospasm, prolonged QT interval

73
Q

CNS adverse effects of prokinetics?

A

Sedation, fatigue, restlessness, headache, dystonia

74
Q

Cardiovascular adverse effects of prokinetics?

A

Hypotension, supraventricular tachycardia

75
Q

GI adverse effects of prokinetics?

A

Dry mouth, n/v, diarrhea

76
Q

What is the herbal product ginger used for?

A

n/v caused by chemotherapy, morning sickness, and motion sickness.

77
Q

Adverse effects of ginger?

A

Anorexia, n/v, skin reactions

78
Q

Drug interactions with ginger?

A
  • May increase absorption of oral meds
  • increase bleeding risk with anticoagulants
  • not recommended for use during pregnancy
79
Q

How long before chemotherapy begins should you give an antiemetic?

A

30-60 minutes

Pharm 101 (6 decks)

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