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Pharm > GI Medications > Flashcards

GI Medications Flashcards

1
Q

What is late PONV defined as?

A

6-24hr post emergence

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2
Q

What are patient risk factors for PONV?

A

female, non-smoker, hx of motion sickness, previous PONV

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3
Q

What are surgical risk factors for PONV?

A

Length of procedure, laparotomies, gynecologic surgery, laparoscopic, ENT, breast, and orthopedic surgeries.

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4
Q

What are anesthesia risk factors for PONV?

A

Inhaled agents, Nitrous Oxide, Neostigmine, Narcotics, Etomidate

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5
Q

Where is the vomiting center located?

A

Medulla Oblongata

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6
Q

What are the 4 areas involved with nausea and vomiting?

A

CTZ, Vestibular apparatus, thalamus/cerebral cortex (CNS), and GI tract

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7
Q

Which neurotransmitters work in the vestibular apparatus and what is the receptor?

A

Acetylcholine (M1 receptor), Histamine (H1 receptor)

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8
Q

Which neurotransmitters work in the CTZ and what is the receptor

A

Dopamine (D? receptors), Serotonin (5HT3), Substance P (NK), Acetylcholine (M1), Histamine (H1)

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9
Q

Which neurotransmitters work in the GI tract and what is the receptor

A

Acetylcholine (M1), Histamine (H1), Serotonin (5HT3), Substance P (NK), and mechanoreceptors

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10
Q

What ending do anticholinergics have and what is an example?

A

“ine”

ex: Scopolamine, Atropine

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11
Q

What ending do benzamides have and what is an example?

A

“ide”

Ex: Metaclopramide

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12
Q

What ending do benzodiazepines have and what is an example?

A

“azolam”

Ex midazolam

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13
Q

What ending do butrophenones have and what is an example?

A

“peridol”

Ex. Haloperidol, Droperidol

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14
Q

What ending do 5HT3 have and what is an example?

A

“tron”

Ex: Ondansetron

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15
Q

What ending do NK1 anatgonists have and what is an example?

A

“itant”

Ex. Aprepitant

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16
Q

What ending do phenothiazines have and what is an example?

A

“azine”

Ex: Promethazine

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17
Q

What is an example of a glucocorticoid?

A

Dexamethasone

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18
Q

What is an example of a Cannabinoid?

A

Dronabinol

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19
Q

What is the following for Scopolamine:

MOA:
Dose:
Uses:
Side Effect(s)

A

MOA: blocks transmission from the vestibular apparatus to the medulla
Dose: 5mcg/hr x 72 hrs (give 4 hrs before for best results)
Uses: motion sickness, middle ear surgery, N/V with PCA or morphine
Side effects: visual disturbances

20
Q

What is the following for metoclopramide:

MOA:
Caution with:

A

MOA: stimulates the GI tract via cholinergic mechanism and anti-dopaminergic effect
Use with caution in pts with Parkinsons and restless leg

21
Q

What is the MOA and use with Midazolam?

A

Decreases the synthesis and release of dopamine within the CTZ. Use at the end of case for nausea

22
Q

What is the following for Droperidol:

Class name:
MOA:
Dose:
Cautions:

A

Class: Butyrophenomes
MOA: Competitive dopamine antagonist. Receptor is D2 and ligands are dopamine and GABA
Dose: 0.625-1.25mg
Cautions: Parkinsons, restless leg syndrome, black box for high dose d/t long QTc

23
Q

What is the following for Dexamethasone:

Class name:
MOA:
Dose:
Cautions:

A

Class: Corticosteroid
Dose: 4mg
Cautions: obese, diabetes (hyperglycemia)

24
Q

What is the dose, onset, and side effects of zofran?

A

dose: 4mg
onset: 30-60 min
s/e: headache, diarrhea, QTc prolongation

25
Q

What is tropisetron used for?

A

To treat carcinoid syndrome

26
Q

What is the dose for Granisetron?

A

0.1mg per 24 hrs

27
Q

What is the name of the 5HT3 antagonist that has an active metabolite?

A

Dolasetron

28
Q

Where is substance P produced?

A

CNS and gut

29
Q

What is a side effect or NK Antagonists?

A

can inhibit steroidal contraceptives for about 7 days

30
Q

What are NK Antagonists commonly used for?

A

Chemo induced NV

31
Q

How do NK Antagonists work?

A

Competitive antagonist at the NK1 receptor and prevents substance P from binding

32
Q

What is the following for Phenothiazines?

MOA:
Receptors:
Use:
Examples:

A

MOA: antagonizes H1 and M1 receptors
Receptors: histamine, acetylcholine
Use: vestibular apparatus
Ex: promethazine

33
Q

What are examples of h1 receptor antagonists?

A

Benadryl, meclizine, phenergan

34
Q

What is the following for benadryl?

Use:
Dose:
Onset:
Duration:

A

Use: prophylaxis and treatment of allergic reactions
Dose: 25-50mg IV
Onset: 3 min
Duration: 1-7 hrs

35
Q

What is the MOA and use of Dramamine (dimenhydrinate)?

A

MOA: H1 and M1 antagonist
Use: motion sickness and sleep aid

36
Q

What are the 4 H2 receptor antagonist drugs?

A

Cimetidine/Tagamet
Ranitidine/Zantac
Famotidine/Pepcid
Nizatidine/Axid

37
Q

Are H2 receptor antagonists selective or nonselective?

A

Selective

38
Q

What side effects are seen with H2 antagonist toxicity?

A

CNS: slurred speech, delirium, confusion in elderly

Liver toxicity

39
Q

Which H2 antagonist is most likely to cause CNS side effects and liver toxicity?

A

Cimetidine

40
Q

T or F: H2 receptor antagonist cross the placenta and are secreted into breastmilk

A

True

41
Q

Is cimetidine a P450 inducer or inhibitor?

A

inhibitor

42
Q

Name 6 drugs cimetidine has an interaction with. What does it cause?

A 
Reduced blood flow and inhibits P450 system. 
Dilantin
Propranolol
metoprolol
labetalol
diazepam
calcium channel blockers
43
Q

What syndrome is Omeprazole good for?

A

Zollinger-Ellison Syndrome

44
Q

What is the following for Reglan:
MOA:
Dose
Cautions:

A

MOA: Cholinergic stimulation and dopamine antagonism. Causes contraction of lower esophageal sphinctor and stomach (prevents reflux), increases gastric and small intestine mobility. Crosses BBB and can be used as an antiemetic.
Dose: 10-30mg IV over 3-5 min
Cautions: Parkinsons, RLS, patients on MAOI’s, tricyclic antidepressants, GI surgery

45
Q

Which GI medication does not change gastric pH?

A

Reglan

46
Q

What are s/e of Reglan?

A

Abdominal cramping if given too fast, Extrapyramidal symptoms (crosses BBB), Prolongs Succ (inhibits plasma cholinesterase)

Pharm (12 decks)

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