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Pharmacology I > GI Medications > Flashcards

GI Medications Flashcards

1
Q

General pop __% vomiting, __% nausea

N/V % in > risk patients?

N/V may > d/c time by __%

A

30%v, 50%n

70-80%

25%

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2
Q

Pathways that effect N/V:

A
  • Medulla
  • Chemoreceptor “TRIGGER ZONE”
  • Neural path in vestibular system
  • Reflex afferent pathways
  • Midbrain afferents
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3
Q

Chemoreceptor Trigger Zone:

A

Located outside BBB, these meds don’t have to be super lipophilic to act.

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4
Q

The Vomiting Center is in the _______.

A

Medulla

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5
Q

Post Op N/V

Early, Late, Delayed

A

Early: 2-6 hours
Late: 6-24 hours
Delayed: >24 hours

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6
Q

What is “Post-Op N/V?

A

N/V 24 hours or later after surgery (post dc)

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7
Q

> PONV Risk Factors

A
  • Females (#1)
  • PONV Hx (#2)
  • Non-smoker (#3)
  • Age <50
  • General vs Regional (G > PONV than R)
  • Volatile anesthetics and N2O
  • > Duration of procedure (q 30 min > risk -60%)
  • Type of procedure (cholecystectomy, gynecological, laparoscopic)

Risk factors 1:20%, 2:40%, 3:60%, 4:80%

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8
Q

PONV dc > Risk Factors:

A
  • Female
  • < 50 y/o
  • Hx of PONV
  • Opiates in PACU
  • Nausea in PACU
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9
Q

Risk Factors for Children N/V:

A

Procedure > 30 Mins
> 3 y/o
Strabismus (eye) surgery
Hx of or a relative who had Hx PONV

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10
Q

Who needs pretreatment?

A

Anyone who has 3 or more risk factors need pre-Tx for PONV

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11
Q

Anesthesia Considerations

A
  • Propofol
  • Regional “9x lower incidence of PONV to use R rather than G”
  • NSAIDS over Opiates
  • Don’t need to reduce Neostigmine dose any more
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12
Q

7 Pre Tx Options:

A
  • Dexamethasone
  • 5HT3 (Serotonin) antagonists
  • H1 Blocklers (antihistamines)
  • Scopolamine Patch (anticholinergic)
  • NK1 antagonists
  • Droperidol

-Hydration (ensure correct fluid status before incision.

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13
Q

Is Reglan a supported PONV med?

A

No

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14
Q

Rescue Meds

A

5HT3 (serotonin) antagonists
D2 blockers
Reglan
H1 Blocker

(Try a different med with a different mech of action)

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15
Q

What % of pt will experience some sort of PONV?

A

1/3 (especially with > risk patients)

Give dexamethasone (longest duration of action)

Scopolamine patch

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16
Q 
When to give anti NV meds
-setron (serotonin agents)
Dexamethasone
Scopolamine Patch
Aprepitant
A

-setron (serotonin agents): End
Dexamethasone : Before induction
Scopolamine Patch: prior evening
NK receptor antagonist (Aprepitant): 1-3 hours prior

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17
Q

What anti NV med is the best?

A

None. All equally effective

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18
Q

5HT3 Serotonin Antagonists

A

…setron (ondansetron …)

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19
Q

Where are the 5HT3 receptors primarily located?

A

GI tract

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20
Q

5HT3 Antagonists are metabolized by the _____.

A

Liver (CYP450)

Dolasetron needs to be metabolized 1st before it is active (prodrug)

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21
Q 
Half life of 
Ondonsetron
Granisetron
Dolasetron
Palonosetron
A

Ondonsetron: 4 hours
Granisetron: 9-11 hours
Dolasetron: 7-9 hours
Palonosetron: 40 hours

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22
Q

Side effects of 5HT3 Antagonists

A

EKG QT prolongation (Torsads)

Mild constipation/Diarrhea, Nausea, dizziness

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23
Q

Dexamethasone is a ___________.

A

Corticosteroid

Endorphin release
Prostaglandin antagonist

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24
Q

Dexamethasone Side Effects:

A

Impaired wound healing/infection
> glucose
HTN, edema
AMS

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25
Q

1/2 life of Dexamethasone

A

35-54 hours

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26
Q

Dexamethasone onset

A

4-6 hours

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27
Q

Droperidol is a ___________

A

Anti-dopaminergic

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28
Q

Droperidol works on the ____ receptor.

A

D2

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29
Q

Other effects of Droperidol other than being anti-dopaminergic?

A

Mild Antihistamine

Mild antiserotonergic

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30
Q

Chemoreceptor trigger zone relates to what drug?

A

Droperidol

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31
Q

Does > 5 mg of droperidol could cause?

A 
QT prolongation (Torsades) 
(Rare)(like Zofran)
32
Q

Side Effect of Droperidol:

A

Dysphasia
Hypotension
Extra Perametal Symptoms (movements, jerks).

33
Q

Parkinsons is too > or < of dopamine?

A

Decreased

34
Q

Too much of dopamine leads to ________.

A

Euphoria

35
Q

1/2 life of Droperidol?

A

2.3 hours

36
Q

Droperidol is metabolized by the _____

A

Liver (hepatic)

37
Q

Phenothiazines (phenergan and compazine) are …

A

D2 Receptor antagonist

38
Q

Phenothiazines are metabolized …

A

Hepatic (CYP)

39
Q

1/2 life of Phenothiazines

A

4-8 hours

40
Q

Phenothiazines and H1 Antagonists are highly _________.

A

Sedating

41
Q

H1 Antagonists (antihistamine)

A

Dimenhydrinate (Dramamine) (CNVIII)
Histamine (1)
Highly sedating

42
Q

Scopolamine Patch

A

Anticholinergic

Prior to surgery or 4 hours after waking up.

43
Q

Aprepitant (Emend)

A

Neurokinin 1 Receptor Antagonist
(Blocks substance P)
-Brain stem
-Dorsal vagal complex

CYP3A4

Not many side effects

44
Q

1/2 life of Aprepitant (Emend)is…

A

9-13 hours

45
Q

Aprepitant (Emend) is highly _______ _______.

A

Protein bound

46
Q

Metoclopramide (Reglan)

A 
Dopamine antagonist 
(Antagonizes dopamine’s effect on the CTZ and contribute to an antiemetic effect)

> L.E.S. tone
peristaltic contraction
gastric emptying
Does NOT alter gastric H+ ion secretion

47
Q

Metoclopramide (Reglan) ____ metabolism with _______ elimination.

A

Hepatic (CYP with extensive 1st pass effect)

Renal

48
Q

Adjust the dose of Reglan on w pt with….

A

Renal impairment (prolongs 1/2 time)

49
Q

Metoclopramide (Reglan) is excreted in _______ _____.

A

Breast milk

50
Q

Does Metoclopramide (Reglan) readily cross BBB and placental barriers?

A

Yes.

51
Q

Side effects of Metoclopramide (Reglan)

A

Abd cramping
Akathesia (restlessness)
Systolic extrapyramidal reactions

52
Q

Interaction and cautions with Metoclopramide (Reglan):

A

Inhibit effect on plasma cholinesterase
> sedative actions of CNS depressants > extrapyramidal reaction (additive effect)
Avoid with Hx seizure or mechanical gastric outlet obstruction.

53
Q

Metoclopramide (Reglan) helps to < …

A

Aspiration risk.

< gastric volume, not pH change

54
Q

________ ______ can be caused by a fast administration of Metoclopramide (Reglan)

A

Gastric cramping

55
Q

H2 Receptor Antagonist inhibit histamine binding to the receptors on ____ ______ _____.

A

Gastric parietal cells

56
Q

H2 Receptor Antagonist produce _______ and _______ inhibition of H2 receptor mediated secretion of acidic gastric fluid.

A

selective and reversible

57
Q

H2 Receptor Antagonist drugs end in …

A

“tidine”

58
Q

Most potent H2 Receptor Antagonist:

A

Famotidine

59
Q

Least potent H2 Receptor Antagonist:

A

Cimetidine

60
Q

Shortest acting H2 Receptor Antagonist drug:

A

Cimetidine

61
Q

Histamine activated _______ ______ buy binding to H2 receptors on parietal cells.

A

Adenylate cyclase

62
Q

H2 Receptor Antagonist do or don’t have a consistent effect on L.E.S. function or the rate of gastric emptying?

A

Don’t

63
Q

How long to give oral H2 Receptor Antagonist before surgery?

A

1.5 - 2 hours

64
Q

Do H2 Receptor Antagonist reduce gastric volume?

A

No. Just changes the pH

65
Q

H2 Receptor Antagonist Clinical Uses:

A

Allergic prophylaxis

Drug-induced histamine release

66
Q

With only H2 receptor antagonism, effects of drug-induced histamine release may actually be _________.

A

Exaggerated

67
Q

To with only an H1 or H2 antagonist alone is not effective in preventing the _____________ effects of histamine

A

Cardiovascular

68
Q

Side effects of H2 Receptor Antagonist

A
  • Diarrhea, HA, fatigue, skeletal muscle pain.
  • Rare thrombocytopenia (< Platelets)
  • Mental confusion
  • Arrhythmias (rare) Brady, hypotension
69
Q

What H2 Receptor Antagonist inhibits CYP450?

A

Cimetidine
(Lesser extent ranitidine)

This < metabolism for other drugs also leading to toxicity.

70
Q

H2 Receptor Antagonist effect other drugs how?

A

Altered absorption by > gastric pH

Acids helps absorb iron products, mag and calcium products, B12

71
Q

PPIs end in …

A

“prazole”

72
Q

PPis are used to Tx:

A

Mod to severe GERD
Hypersecretory disorders
PUD

73
Q

Onset of PPIs:

A

2-6 hours

74
Q

What is faster onset on action PPIs or H2 Receptor Antagonist?

A

H2 Receptor Antagonist

75
Q

Adverse reactions of PPIs

A

C. Diff
Kidney injury
Dementia
< absorption (Ca, Fe, Mg, B12)

(Confusion, arrhythmias, muscle weakness, fractures)

Pharmacology I (6 decks)

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