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Pharmacology Exam 2 > GI Medications > Flashcards

GI Medications Flashcards

1
Q

What are patient factors that relate to PONV?

A

women
non-smokers
hx motion sickness
hx PONV

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2
Q

What are surgical factors that relate to PONV?

A

length of surgery
laparotomies & laparoscopies
gynecologic
ENT
breast
orthopedic

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3
Q

What are anesthesia factors that relate to PONV?

A

inhalation agents
nitrous oxide
neostigmine
narcotics
etomidate

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4
Q

Where is the vomiting center located?

A

medulla oblongata

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5
Q

How does the vomiting center work?

A

efferent pathways > vagal sympathetic and parasympathetic chains > motor response

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6
Q

Where are signals transmitted from?

A

chemoreceptor trigger zone
vestibular apparatus
thalamus and cerebral cortex
neurons in GI tract

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7
Q

What are the neurotransmitters and corresponding receptors that are involved with PONV?

A

dopamine: dopamine receptors
serotonin: 5HT3 receptors
acetylcholine: muscarinic receptors
histamine: histamine receptors
substance P: neurokinin receptors

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8
Q

What anticholinergics are used to treat PONV?

A

scopolamine
atropine
hyosine

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9
Q

What benzamides are used to treat PONV?

A

metoclopramide

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10
Q

What benzodiazepines are used to treat PONV?

A

midazolam

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11
Q

What butrophenones are used to treat PONV?

A

droperidol
haloperidol

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12
Q

What cannabinoids are used to treat PONV?

A

dronabinol
nabilone

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13
Q

What glucocorticoids are used to treat PONV?

A

dexamethasone

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14
Q

What 5HT3 antagonists are used to treat PONV?

A

ondansetron
dolasetron
granisetron
palonosetron
ramosetron
tropisetron

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15
Q

What neurokinin-1 antagonsists are used to treat PONV?

A

aprepitant
fosprepitant

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16
Q

What phenothiazines are used to treat PONV?

A

promethazine, prochoperazine, chlorpromazine

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17
Q

What is the mechanism of action of Scopolamine?

A

thought to block transmission from vestibular apparatus to medulla

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18
Q

What is the dose of Scopolamine?

A

5 mcg/hr for 72 hours
*best if given 4 hours before stimulus

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19
Q

What is Scopolamine used to treat?

A

motion sickness
PONV from middle ear surgery
N/V from PCA or epidural morphine

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20
Q

What are the side effects of Scopolamine?

A

visual disturbances
*dilated pupils

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21
Q

What is the mechanism of action of Metoclopramide?

A

stimulate the GI tract via CHOLINERGIC mechanism and ANIT-DOPAMINERGIC effect

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22
Q

What patients do we use caution with Metoclopramide?

A

RLS
Parkinson’s
*due to anti-dopamine effects

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23
Q

What is the mechanism of action of Midazolam?

A

thought to decrease the stimulation and release of dopamine in the CRTZ

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24
Q

When should Midazolam be given if using to treat PONV?

A

at the end of the case

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25
Q

What is the mechanism of action of Droperidol?

A

competitive dopamine antagonist

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26
Q

What are the receptor and ligands for Droperidol?

A

receptor: D1
ligands: dopamine & GABA

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27
Q

What is the dose of Droperidol?

A

0.625 mg (initial)
1.25 mg (rescue)

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28
Q

What patients do we use caution with Droperidol?

A

RLS
Parkinson’s
*due to anti-dopamine effects

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29
Q

What is a critical side effect of Droperidol?

A

QT prolongation
*seen in high doses

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30
Q

What is the mechanism of action of Dexamethasone?

A

inhibits prostaglandin release and controls endorphin release

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31
Q

What is the dose of Dexamethasone?

A

4 mg

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32
Q

What patients do we use caution with Dexamethasone?

A

diabetic patients and obese
*due to potential hyperglycemia

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33
Q

What kind of receptor is a 5HT3?

A

ligand-gated ion channel (Na & K)
inotropic
excitatory

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34
Q

What other body functions does serotonin affect?

A

mood, cognition, sleep

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35
Q

What other effects does serotonin have?

A

addiction
aggression
vasoconstriction
increased intestinal motility
learning and memory consolidation

36
Q

What are 5HT3 antagonists used to treat?

A

PONV
N/V due to chemotherapy
*does not work for motion sickness, no 5HT3 receptors in the vestibular apparatus

37
Q

What is the dose of Ondansetron?

A

4 mg

38
Q

What is the onset of Ondansetron?

A

30-60 minutes

39
Q

What are the side effects of Ondansetron?

A

headache
QT prolongation
diarrhea

40
Q

Why does Ondansetron have very few CNS effects?

A

does not cross BBB

41
Q

What is Tropisetron used to treat?

A

symptoms of carcinoid syndrome

42
Q

What is the dose and duration of Granisetron?

A

dose: 0.1 mg
duration: 24 hours

43
Q

What is special about Dolasetron?

A

has an active metabolite

44
Q

What is Substance P?

A

primary neurotransmitter produced by pain/temperature afferent peripheral neurons

45
Q

What is the mechanism of action of Aprepitant?

A

competitive antagonist at NK1 receptors

46
Q

What is Aprepitant used to treat?

A

N/V due to chemotherapy

47
Q

What is a critical side effect of Aprepitant?

A

can inhibit steroidal birth control for 7-10 days

48
Q

What is the mechanism of action of Promethazine?

A

antagonizes H1 (histamine) and M1 (acetylcholine) receptors

49
Q

Where are H1 receptors located?

A

vascular smooth muscle
bronchial smooth muscle
CNS

50
Q

What are some H1 receptor antagonists?

A

Diphenhydramine (Benadryl)
Dimenhydrinate (Dramamine)
Loratadine (Claritin)
Hydroxyzine (Atarax)
Promethazine (Phenergan)

51
Q

Where are H2 receptors located?

A

stomach

52
Q

What are some H2 receptor antagonists?

A

famotidine

53
Q

Where are H3 receptors located?

A

presynaptic nerve terminals
*reduces further histamine release

54
Q

What is the mechanism of action of H1 antagonists?

A

competitively blocks H1 receptors

55
Q

What is the dose of Diphenhydramine?

A

25-50 mg

56
Q

What is the onset and duration of Diphenhydramine?

A

onset: 3 minutes
duration: 1-7 hours

57
Q

What receptors does Dymenhydrinate block?

A

H1 & M1 (vestibular apparatus)
*effective against motion sickness and as a sleep aid

58
Q

What is a critical side effect of Promethazine?

A

orthostatic hypotension
*adrenoceptor blocking action
potentiates anesthetic sedative effects

59
Q

What are H1 receptor antagonists used to treat?

A

allergic reactions
motion sickness
N/V of pregnancy (Promethazine)

60
Q

What patients are at increased risk of aspiration?

A

pregnant women
diabetics
mask induction (no protected airway)
emergency cases

61
Q

What is the mechanism of action of antacids?

A

removes H+ ions
neutralize gastric pH

62
Q

What is the duration of action of antacids?

A

about 30 minutes

63
Q

What are side effects of antacids?

A

increase gastric volume
change the metabolism of other drugs

64
Q

What antacid is used prior to cesarean sections? What is the dose and when is it given?

A

Bicrita
15-30 mL
immediately before induction

65
Q

What are some H2 receptor antagonists?

A

Cimetidine (Tagamet)
Ranitidine (Zantac)
Famotidine (Pepcid)
Nizatidine (Axid)

66
Q

What is the mechanism of action of H2 antagonists?

A

selectively and reversibly block histamine at H2 receptors

67
Q

What are H2 antagonists used to treat?

A

peptic duodenal ulcer
gastric ulcer
erosive esophagitis
hypersecretory conditions

68
Q

What are critical side effects of Cimetidine?

A

*CNS dysfunction in elderly (slurred speech, delirium, confusional states)
*liver toxicity

69
Q

Do H2 antagonists cross the placenta and enter breastmilk?

A

Yes!
*can affect the baby

70
Q

What drugs when given with Cimetidine can lead to toxicity due to a decrease in hepatic blood flow and inhibition of the P450 system?

A
71
Q

What drugs when given with Cimetidine can lead to toxicity due to a decrease in hepatic blood flow and inhibition of the P450 system?

A

Warfarin
Dilantin
Propranolol
Metoprolol
Labetalol
Quinidine
Caffeine
Lidocaine
Theophylline
Alprazolam
Diazepam
Flurazepam
Triazolam
Carbamazepine
Ethanol
Tricyclic antidepressants
Calcium channel blockers

72
Q

What are some proton pump inhibitors?

A

Omeprazole
Pantoprazole
Esomerprazole
Lansoprazole

73
Q

What is the effect of proton pump inhibitors?

A

increase gastric fluid pH
decrease gastric fluid volume

74
Q

What type of drug is Omeprazole?

A

prodrug
*becomes PPI after metabolism

75
Q

What is the onset of Omeprazole and when is it best taken in regards to surgery?

A

couple of days
night before surgery

76
Q

Does Omeprazole cross the BBB?

A

Yes!
Can cause headaches, agitation, confusion

77
Q

What is Omeprazole specifically used to treat?

A

Zollinger-Ellison syndrome

78
Q

What is the mechanism of action of Metoclopramide?

A

cholinergic stimulation & dopamine antagonism

increasing lower esophageal sphincter tone, enhancing peristaltic contractions, accelerating the rate of gastric emptying

79
Q

Does Metoclopramide cross the BBB?

A

Yes!
also affects CRTZ

80
Q

What is the dose of Metoclopramide?

A

10-30 mg

81
Q

What patients do we use caution with Metoclopramide?

A

RLS
Parkinson’s
patients on MAOI or tricyclic antidepressants
GI surgery
patients taking phenothiazines or butrophenones (r/t dopamine)

82
Q

Does Metoclopramide change gastric pH?

A

No!

83
Q

What is Metoclopramide used to treat?

A

diabetic gastroparesis
antiemetic
GERD
enteral feeding assist in chronically ill

84
Q

What are the side effects of Metoclopramide?

A

placental transfer
abdominal cramping
extrapyramidal effects (anti-cholinergic)
prolonged succinylcholine effect (inhibits plasmaesterase synthesis)

85
Q

What are anticholinergic side effects?

A

red as a beet (flushed skin)
dry as a bone (dry eyes, mouth, & skin)
blind as a bat (dilated pupils, blurry vision)
mad as a hatter (confusion, agitation)
hot as a hare (overheating)
full as a flask (urinary retention)

Pharmacology Exam 2 (5 decks)

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