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GI II Exam I AP > Drugs - Treatment of NVDC (Kinder) > Flashcards

Drugs - Treatment of NVDC (Kinder) Flashcards

1
Q

ondansetron

A

Zofran

5-HT3 antagonist

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2
Q

Metoclopromide

A

Reglan

Substitued Benzamide
D2 receptor antagonist

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3
Q

Prochloperazine (Compazine)

A

Penothiazines

D2 receptor Antagonist

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4
Q

Diphenhydramine (Benadryl)

A

Antihistamine

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5
Q

Promethazine (Phenergen)

A

Antihistamine

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6
Q

Dronabinol

A

Cannabinoids

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7
Q

MOA of Serotonin 5 HT3 receptor antagonists

A

ondansetron is prototype

blocks central 5HT3 receptors (vomiting center and CTZ) and peripheral receptors (GI tract -viscera)

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8
Q

Therapeutice use of ondansetron

A

***Acute CINV
(chemo induced n/v)

(little or no efficacy in delayed CINV)

PONV and post-radiation NV

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9
Q

when do you dose adjust ondansetron

A

hepatic insufficiency

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10
Q

ADR’s of ondansetron

A

well tolerated; headache, dizziness, constipation

QT prolongation

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11
Q

MOA of D2 receptor antagonists (metoclopramide)

A

inhibits D2-like (D2, D3, D4) dopamine receptors in the CTZ and solitary tract nucleus

Additional actions: 5-HT3 antagonism & prokinetic (nausea and vomiting peripherally)

prokinetic- results in peristalsis

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12
Q

therpeutic use of metoclopramide

A

CINV

diabetic gastroparesis

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13
Q

ADR’s of metoclopramide

A

Crosses BBB; extrapyramidal symptoms

-restless, dystonia (immature muscle contractions), parkinsonian symptoms

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14
Q

MOA of prochlorperazine

D2 receptor antagonist

A

inhibits D2-like (D2, D3, D4) dopamine receptors in the CTZ and solitary tract nucleus

Additional actions: antihistaminic and anticholinergic

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15
Q

therapeutic use of D2 receptor antagonist prochlorperazine

A

“General purpose” antiemetics

Motion sickness

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16
Q

what are the ADR’s of prochlorperazine

A

Hypotension, sedation, extrapyramidal symptoms
(don’t use post-operatively b/c you don’t want to make them more sedated)

hyperprolactinemia

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17
Q

MOA of diphenhydramine and promethazine

A

histamine, H1 receptor antagonists

Additional actions: anticholinergic and some antidopaminergic

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18
Q

Therapeutic use of diphenhydramine and promethazine

A

Motion sickness
PONV (post-op)
Vertigo

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19
Q

what are the ADR’s of antihistamines

A

dizziness,
sedation
dry mouth
urinary retention

*anticholinergic effects

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20
Q

MOA of scopalamine

A

MOA: muscarinic cholinergic receptor antagonist

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21
Q

therapeutic use of Scopalamine

A

motion sickness

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22
Q

ADR’s of scopalamine

A

better tolerated as a patch (behind ear)

often used for fisherman, people on boats

don’t use PO

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23
Q

MOA of cannabinoids (dronabinol)

and therapeutic use

A

stimulation of central CB1 receptors

therapeutic use:

  • appetite stimulant
  • antiemetic
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24
Q

what are the drug drug interactions of cannabinoids (dronabinol)

A

DDIs: potentiate effects of other psychoactive agents

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25
Q

what are the ADR’s of cannabinoids (dronabinol)

A

euphoria, dysphoria, sedation, hallucinations

autonomic- tachy, orthostatic hypotensino

26
Q

NK1 receptor antagonists (aprepitant, fosaprepitant)

MOA

A

inhibits binding of substance P

acute phase of CINV is believed to be mediated by 5HT and substance P

while delayed CINV primarily due to substance P

27
Q

therapeutic use of NK1 receptor antagonists

A

acute and delayed CINV

28
Q

what drug do NK1 receptor antagonist decreased effectiveness

A

warfarin— can lead to clotting

29
Q

what are therapeutic uses of corticosteroids in N/V

A

dexamethasone

increases the efficacy of 5-HT2 antagonists for acute and dealayed CINV

PONV

30
Q

treatment combination for acute CINV

A

5HT3 receptor antagonist + NK1 receptor antagonist + glucocorticoid

31
Q

what is the treatment for anticapatory n/v

A

benzodiazepine -> sedative properties reduce anxiety

32
Q

what are the drugs used in PONV

A

5-HT3 receptor antagonist + dexamethasone

dimenhydrinate (if sedation desired)

prochlorperazine- less sedation

metaclopramide if above don’t work

33
Q

what drugs are used for motion sickness

A

dimenhydrinate

promethazine

scopalamine

34
Q

gastroparesis treatment

A

metoclopramide (D2 receptor antagonist)

35
Q

pyridoxine use

A

pregnancy N/V

36
Q

Loperamide

A

opioid

anti-diarrheal

37
Q

bismuth subsalicylate

A

mucosal protective agent

anti-diarrheal

38
Q

what are the osmotic laxatives

A

saline laxatives

polyethylene glycol

39
Q

MOA of loperamide

A

stimulates μ-opioid receptors; increase transit time, increase fecal water absorption, decrease motility

non-prescription opioid

does not cross BBB (no CNS side effects)

no analgesic properties

no potential for addiction

40
Q

Therapeutic use of Opioid agonists (Loperamide)

A

Nonspecific treatment of diarrhea
Traveler’s diarrhea
Adjunct in chronic diarrhea

41
Q

ADR”s of loperamide

A

well tolerated

CNS effects at high doses (so use atropine added to discourage abuse)

CI in C. diff and active IBD due to risk of toxic megacolon

42
Q

Psyllium

MOA

A

bulk forming laxative

indigestible, hydrophilic colloids which absorb water. Bulky emollient gel distends colon promoting peristalsis.

used for long term prevention

43
Q

ADR’s of psyllium

A

bloating and flatulence

44
Q

stool surfactant (softeners)

Docusate**

MOA:

A

allows water and lipids to penetrate stool which softens it

Ineffective for treatment but useful for prevention

helpful to prevent straining – > MI, after rectal surgery, etc.

45
Q

MOA of osmotic laxatives

saline (mag citrate)
polyethylene glycol (sugar)
A

soluble, non-absorbable, increase stool liquidity due to increase in fecal fluid

46
Q

when do you not use anti-diarrheal agents

A

bloody diarrhea

high fever

systemic toxicity

47
Q

Senna (Stimulant Laxative)

MOA

A

MOA: direct stimulation of enteric nervous system

48
Q

therapeutic use of Stimulant laxatives

A

Not 1st line, recommended for intermittent use

Administer in lowest effective dose for shortest period of time

Long-term in neurologically impaired, bed-bound in long-term care facilities ***

Severe constipation with non-modifiable risk factors

49
Q

Metoclopramide (Prokinetic)

MOA and therapeutic use

A

central and peripheral dopamine (D2) receptor antagonist; a serotonin (5-HT4) agonist; a serotonin (5-HT3) antagonist (at high doses); and a cholinesterase inhibitor

↑ motility of upper GI tract & ↑ gastric emptying;

antiemetic

Treats gastroparesis and GERD

50
Q

lactulose used for what

A

hepatic encephalopathy

51
Q

what is used for bowel prep for colonoscopy

A

polyethylene glycol

mag citrate

52
Q

Softens stool is 1-3 days

A

Bulk forming laxatives

Stool softeners

Osmotic laxatives

  • lactulose
  • polyethylene glycol
53
Q

softening of semi-fluid stool in 6-12 hrs

A

Senna

Mag sulfate

54
Q

watery evacuation in 1-6 hrs

A

mag citrate

polyethylene glycol

55
Q

MOA of Methylnatltrexone

A

selective inhibition of mu (opioid) receptors

does not cross BBB

inhibits peripheral receptors without affecting analgesia

therapeutic use
-opioid induced constipation in pt’s receiving palliative care for advanced illness

CI: GI obstruction

56
Q

in pt’s with chronic renal disease and HTN problems , what drug do you want to avoid

A

sodium phosphate oral solution (osmotic laxative)

57
Q

serotonin

A

binding in the periphery of 5HT3–> N/V

58
Q

what is first line treatment for constipation prevention

A

bulk forming laxatives

docusates (Stool softeners)

59
Q

what are sorbitol, lactulose, and magnesium hydroxide

A

osmotic laxatives

60
Q

how long does it take for osmotic active agents to cause bowel evacuation

A

1-3 hrs

61
Q

sodium phosphate

type of drug

ADR’s

A

osmotic laxative

frequently causes hyperphosphatemia, hypocalcemia, hypernatremia, and hypokalemia

can lead to cardiac arrythmias or acute renal failure

don’t use in frail or elderly, renal insufficiency , cardiac disease, or those unable to maintain adequate hydration

62
Q

in comparison to sorbitol and lactulose what does polyethylene glycol not do

A

does not produce significant cramps or flatus

also designed so no significant intravascular fluid or electrolyte shifts occur

GI II Exam I AP (8 decks)

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