Exam 4 - GI Nausea and Vomiting Flashcards
Causes of N/V?
CNS-related, infection, GI disorders, meds, radiation
What and where is the Chemoreceptor Trigger Zone?
Area in the brain which receives signals from brain and GI tract. Stimulates brain’s vomiting center via NTs.
Who gets Chemo-Induced NV (CINV) most often?
Young people and women.
What causes CINV? What is the intensity based on?
Chemo agents, based on potency of chemo agent.
3 risk factors for CINV?
Hx of prior CINV
Hx of motion sickness
Hx of morning sickness
Acute CINV in what time frame?
0-24h after chemo
Delayed CINV in what time frame? Mostly due do?
More than 24h after chemo.
Mostly due to high emetogenic chemo agents
What is Anticipated CINV?
Conditioned response to prior N/V from chemo.
Tx for High Emetic Risk?
- NK-1 Antagonist
- 5-HT3 Antagonist
- Corticosteroid
combo of all three
What percent is high emetic risk? Which two chemo agents cause it most?
Over 90%. Cisplatin and Cyclophodoid.
What percent range in Moderate Emetic Risk? Which agent causes it most?
30-90%. Doxarubicin.
Tx for Moderate Emetic Risk?
- Dopamine-antagonist
- Corticosteroid
combo of the two
What is range for Low Emetic Risk? Which chemo agent often causes?
10-30%. Roxtinamib
Tx for Low Emetic Risk?
Corticosterois
Percent range for Minimal Emetic Risk?
0-10%
Tx for Minimal Emetic Risk?
May or may not need treatment
MOA and indications for Serotonin 5-HT3 Antagonist?
Blocks 5-HT3 receptors centrally and peripherally.
CINV (acute better than delayed), PONV, RINV. Give before chemo!
5HT3 route, SE, and name?
PO or IV.
Constipation, mild HA, possible QT prolongation.
“-setron”
NK-1 Antagonist MOA and indications?
Antagonized NK-1 receptors.
Strongest available! Prevent acute and delayed CINV. Give with 5HTP or steroid.
When to give 5HT3 Antagonist?
Before chemo
Give NK-1 Antagonist with what other meds?
Give with 5HTP or steroid.
NK-1 routes, SE, and name?
PO or IV.
Diarrhea, dizzy, fatigue, CYP3A4, CYP2C9.
“-itant”
NK-1 regimen? Routes during regimen?
3 day regimen.
Day 1=IV
Day 2-3=PO
Dopamine Antagonist MOA and indications?
Dopamine-antagonist.
Delayed CINV w/moderate to low emetogenic chemo.
Dopamine-antagonist SE, name, and potency?
“-azine”
Low potency. An older drug.
Corticosteroid MOA and indications?
MOA unknown.
Acute and delayed CINV. Given with 5HT3 to increase efficacy.
Corticosteroid route, SE, and name?
PO and IV.
Insomnia, jittery, fluid retention, check BGL in DM.
“-one”
Corticosteroids given with what? Why?
Given with 5HT3 Antagonists to improve effectiveness.
Benzo MOA and use?
Anoxiolytic activity.
Anticipatory CINV to allow to sleep through.
Benzo name? Does it have antiemetic properties?
“-zepam”
No antiemetic properties
Cannabinoid MOA and use?
Interacts with cannabinoid receptors. Poorly understood MOA.
Refractory and delayed CINV.
Cannabinoid names?
Dronabinol (Marinol)
Nabilone (Cesamet)
Dronabinol and Nabilone in what class? Use?
Cannabinoid receptors. Refractory and delayed CINV.
Two classes for Motion Sickness?
- Antihistamines
2. Anticholinergics
Antihistamine for Motion Sickness MOA and use?
Blocks H1-receptors. Crosses BBB and sedates.
Prevent or treat motion sickness for short trips!
Which class to use for short trips?
Antihistamines
Antihistamine for Motion Sickness SE?
Weak cholinergic activity. Dry mouth, sedation, constipation, urinary retention, blurry vision
Names of Antihistamines or Motion Sickness?
Dimenhydrate (Dramamine), Meclizine (Antivert)
Anticholinergic use for motion sickness?
Travel sickness. Apply patch behind ear 3h before starting trip. Reapply q3d. Long trips.
Length of trip Anticholinergic patch used for?
Long trips! Apply patch behind ear 3h before trip, reapply q3d.
Anticholinergic SE? Name?
Dry mouth, sedation, constipation, urinary retention, blurry vision
Scopolamine patch.
Which med for Acute CINV, PONV, and RINV?
5HT3 Antagonist. “-setron”
Which med to prevent acute and delayed CINV?
NK-1
“-itant”
Which med for delayed CINV from moderate to low emetogenic chemo?
Dopamine Antagonist
“-azine”
Which med for Anticipatory CINV?
Benzo
“-zepam”
Med class for Scopolamine patch?
Anticholinergic