ch 66 Flashcards
zofran common side effects
headache
diarrhea
dizziness
prolongs QT
zofran is more effective when combined with
dexamethasone
Aprepitant (emend) is approved for
preventing post-op n/v (PONV) and CINV (chemo induced n/v)
has to be given with another antiemetic (glucocorticoid such as dexamethasone) or serotonin antagonist (zofran)
suffix for Substance P/Neurokinin-1 Antagonist
-pitant
aprepitant
rolapitant
netupitant
fosaprepitant
adverse effects of Aprepitant (emend)
combining with zofran and dex - more fatigue and asthenia (muscle weakness), dizziness, diarrhea
and transient elevation of circulation aminotransferases ->could indicate liver injury
Drug interactions for Aprepitant (emend)
inducer of CYP
inhibitors (itraconazole, ritonavir) can raise levels of aprepitant
can also raise levels of chemo cancer drugs
can raise levels of glucocorticoids to prevent CINV
can induce CYP2d6
decrease levels of warfarin, ethinyl estradiol (birth control)
what benzodiazepine is used for antiemetic in CIMV
lorazepam (ativan)
Promethazine (phenergan) side effecct
resp depression
local tissue injury
what 2 Butyrophenones are used as antiemetics
used for
side effects
Haloperidol (haldol)
droperidol
used for postop n/v and emesis caused by cancer therapy
extrapyramidal reactions
sedation
hypotension
droperidol - QT prolongation
what prokinetic agent used for an antiemetic
used in
Metoclopramide (Reglan)
suppress postop nausea/vomiting as well as emesis caused by anticancer drugs, opioids, toxins and radiation
chemotherapy is associated with 3 types of emesis
anticipatory
acute
delayed
emesis that begins within minutes to a few hours after receiving chemotherapy and often resolves within 24 hours
acute emesis
emesis that develops a day or more after drug administration
delayed emesis
when are antiemetics more effective in CINV
more effective prevention than at suppressing
the current regimen of choice for a pt taking highly emetogenic drugs consists of 3 agents
aprepitant
dexamethasone
5HT3 antagonist (ie) ondansetron and palonosetron)
a severe form of n/v of pregnancy (NVP) , characterized by dehydration, ketonuria, hypokalemia, loss of 5% or more of body weight
hyperemesis gravidarum
nondrug measures for managing NVP
eating small portions of food throughout the day
avoid odors, foods and supplements that can trigger NVP (fatty foods, spicy foods, iron tablets)
use of alternative treatments such as acupuncture and ginger
first line therapy for NVP consists of what
2 drug combo
doxylamine plus vit B6 (pyridoxine) - the combo is sold as Diclegis
other drugs for NVP is
prochlorperazine
metoclopramide
zofran
age for Promethazine
2 and older
dronabinol in kids?
yes for n/v
chenodiol in pregnancy
no, contraindicated
what for gi safe in breastfeeding
prochlorperazine and promethazine safe for short term - observe infant for sedation
what to avoid in breastfeeding
metoclopramide
dronabinol
droperidol
gi meds to avoid in older adults
benzodiazepines
scopolamine
metoclopramide
drug for motion sickness
Scopalamine
antihistamines for motion sickness
dimenhydrinate (dramamine)
meclizine (antivert)
cyclizine (cyclivert)
what drug class is the most effective antidiarrheal agents
why
opioids - decrease intestinal motility which allows more time for absorption of fluids and electrolytes
In pt with IBD, opioids may cause
toxic megacolon
what opioid preps are approved for diarrhea
diphenoxylate (lomotil)
imodium (loperamide)
difenoxin
paregoric
opium tincture
when taken orally in antidiarrheal doses, diphenoxylate affects the CNS in what way
no cns effects
Lomotil is Diphenoxylate in combo with what drug
atropine
Lomotil is a schedule
V
Loperamide (imodium) is schedule
not regulated
what infectious diarrhea needs abx
Salmonella
shigella
Campylobacter
Clostridium species
causative organism for travelers diarrhea
E coli
for travelers diarrhea do you need an antibiotic
self limited, run its course in a few days
however if symptoms are esp severe, treat with
fluoroquinolone - ciprofloxacin adults
azithromycin is drug of choice for children and pregnant women
rifaximin may also be used as long as pt is not pregnant or febrile with non-bloody stools
abx for travelers diarrhea in adults
fluoroquinolone such as ciprofloxacin
abx for travelers diarrhea for children and pregnant women
azyithromycin
antidiarrheal for mild symptoms of travelers diarrhea
loperamide but if you slow peristalsis, you will delay export of the offending organism thereby prolonging the infection
how do you avoid getting travelers diarrhea
avoid local drinking water and carefully washing foods
fluoroquinolones for prophylaxis but non generally recommended
can be vaccinated against some pathogens to protect against diarrhea caused by E coli and vibrio cholerae
c. diff is a gram
gram positive anaerobic bacillus
symptoms of c diff
abd discomfort
nausea
fever
diarrhea
toxic megacolon pseudomembranous colitis colon perforation sepsis death
IBS is defined by
Rome IV criteria
for at least 12 weeks in the previous year
abd pain and discomfort that cannot be explained by structural or chemical abnormalities and at least 2 of listed features p. 611
ibs symptom triggers
stress depression dietary factors including caffeine alcohol fried foods high fat foods gas generating veggies such as beans, brocolli, cabbage - too much sorbitol (found in chewing gum and some diet products)
Ibs helpful tips
smaller more frequent meals
increase fluid
increase fiber
what drug classes for IBS
antispasmodics (hyoscyamine and dicyclomine)
bulk forming agents (psyllium and polycarbophil)
antidiarrheals (loperamide)
tricyclic antidepressants (TCAS)
Bismuth subsalicylate has the side effect of
black tongue and stools
harmless
Sulfasalazine does what for UC
reduces inflammation
Alosetron can cause
ischemic colitis (intestinal damage secondary to reduced blood flow)
and complication of constipation have led to hospitalization, blood tx, surgury, death
alosetron is contraindicated in
chronic constipation intestinal obstruction toxic megacolon gi perf adhesions chrohn Uc diverticulitis
