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Pharmacology > Exam 3- Antiemetics And Adjuncts > Flashcards

Exam 3- Antiemetics And Adjuncts Flashcards

1
Q

What are the antihistamine receptors?

A

H1 and H2 receptor antagonists

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2
Q

Where do stimulation of H1 receptors occur?

A

In GI tract

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3
Q

What does H1 receptors lead to?

A

Contraction of intestinal smooth muscle

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4
Q

Where does the stimulation of H2 receptors occur?

A

In parietal cells

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5
Q

What does H2 receptors do?

A

Increase gastric acid secretion H+

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6
Q

What are H2 blockers used for (5)

A
  1. Duodenal and gastric ulcers
  2. Zollinger Ellison syndrome
  3. GERD
  4. IV for critical patients to prevent stress ulcers (stress ulcer prophylaxis)
  5. Reduce peri-op risk of aspiration pneumonia
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7
Q

What does H2 blockers effect?

A

pH (acid secretion)

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8
Q

How can H2 be used to reduce aspiration risk? (2)

A
  1. Given at bedtime the night before and 2 hours before procedure
  2. Depends on renal elimination
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9
Q

Are H1 blockers used primarily to prevent aspiration?

A

NO

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10
Q

What are H2 blockers (4)?

A
  1. Ranitidine
  2. Famotidine
  3. Nizatidine
  4. Crimetidine
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11
Q

What is Proton Pump Inhibitor (PPI) and how does it work?

A

Inhibit acid secretion by binding to the K+ H+ pump

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12
Q

What is PPI used for (3)?

A
  1. Duodenal ulcer
  2. GERD
  3. Stress ulcer prophylaxis
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13
Q

What are the 3 PPI?

A
  1. Pantoprazole
  2. Lansoprazole
  3. Omeprazole
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14
Q

What is metoclopramide?

A

Dopamine receptor antagonist -central

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15
Q

When is metoclopramide used for in chronic therapy?

A

Primarily for patients with diabetic gastroparesis

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16
Q

Where does metoclopramide elimination occur?

A

Renal

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17
Q

What do you treat metoclopramide adverse effects with?

A

Anti muscarinic (or diphenhydramine)

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18
Q

Patent related risk factors (3)

A
  • female
  • nonsmoking
  • history of PONV or motion sickness
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19
Q

Anesthetic related risk factors (3)

A
  • inhaled anesthetics
  • nitrous oxide
  • opioids
20
Q

Surgery related risk factors (2)

A
  • duration

- type of surgery

21
Q

Each 30 min of surgery relates to what PONV?

A

Increase risk of 60%

22
Q

5 neurotransmitter receptors:

A
  1. Muscarinic (M1)
  2. Dopamine (D2)
  3. Histamine (H1)
  4. Serotonin (5HT3)
  5. Neurokinin 1 (NK1) - substance P
23
Q

6 pharmacological options

A
  1. Antimuscarinic
  2. Dopamine (D2) receptor antagonist
  3. Antihistamine
  4. 5HT3 receptor antagonist
  5. NK1 receptor antagonist
  6. Corticosteroid
24
Q

Where and what can the nausea and emesis be triggered by?

A

Higher cortical centers communicating with the central pattern generator in the medulla

25
Q

In peri-op the stimulation of what are central stimuli that may cause N&V?

A

Vestibular system

26
Q

2 rescue antiemetic:

A

Use agent of another class

  • prochlorperazine
  • droperidol
27
Q

Where are the 5HT3 receptors:

A

GI tract and CTZ (brain)

28
Q

When are 5HT3 emesis attributable?

A

Vagal stimulation in post-op and chemo

29
Q

When is 5HT3 receptor antagonists useful for?

A

Prevention and treatment of vomiting near end of surgery or rescue therapy in PACU

30
Q

Do 5HT3 receptor antagonists have sedative side effects?

A

NO

31
Q

What kind of metabolism does 5HT3 receptor antagonists have?

A

Liver

32
Q

What is a risk of 5HT3 receptor antagonists?

A

Prolonged QT

33
Q

4 5HT3 receptor antagonists?

A
  1. Ondansetron
  2. Granisetron
  3. Dolasetron
  4. Palonosetron
34
Q

Of the 5HT3 receptor antagonists, which has the longest half life?

A

Palonosetron

35
Q

Other use for dexamethasone?

A

Decrease ICP

36
Q

2 possible risks for dexamethasone?

A
  1. Impaired glucose tolerance

2. Risk of wound infection

37
Q

What is a antimuscarinic?

A

Scopolamine

38
Q

Where do D2 receptor block?

A

CTZ

39
Q

2 common D2 blockers?

A

Butyrophenones

Droperidol

40
Q

Which dopamine blocker is not used in children (4)

A

Droperidol
Perphenazine
Promethazine
Prochlorperazine

41
Q

Box warning for droperidol?

A

QT prolongation risk

Arrhythmia tornadoes de pointe

42
Q

Adverse effect of dopamine receptor blocker?

A

Acute dystonic reaction

43
Q

How do you treat dopamine receptor blockers adverse effects?

A

Antimuscarinic (or diphenhydramine)

44
Q

Where do NK1 antagonist inhibition occur?

A

At both central and peripheral receptors

45
Q

What is a NK1 receptor antagonist?

A

Aprepitant

46
Q

Acupuncture where can help with PONV

A

Median nerve

Pharmacology (14 decks)

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