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spring 2020 - pharmacology 1 > GI Meds + Intro to Vasopressors - Final Wrapup > Flashcards

GI Meds + Intro to Vasopressors - Final Wrapup Flashcards

1
Q

What are the Nausea & Vomiting Pathways?

A

Medulla

Chemoreceptor Trigger Zone

Vestibular Neural Pathway

Reflex & Midbrain Afferent Pathway

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2
Q

What is considered Early PONV?

A

2-6 Hrs

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3
Q

What is considered Late PONV?

A

6 - 24 Hrs

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4
Q

What is Considered Delayed PONV?

A

> 24 Hrs.

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5
Q

What is the population most at risk for PONV?

A

Non Smoking Female who is younger than 50 years old w/ a PONV hx.

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6
Q

How do risk factors relate to incidence of PONV?

A

Each risk factor = 20%

No risk factors = 10%

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7
Q

Which drugs can cause PONV?

A

Anesthetic Gas, N2O, and Opioids

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8
Q

What are the PONV risk factors for Kids?

A

> 3 years old

Strabismus Surgery

Surgery > 30 Min

Family Hx

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9
Q

What are some Anesthesia Considerations to reduce PONV?

A

Use Propofol

Regional Anesthesia

NSAIDs over Opiates

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10
Q

Should Neostigmine be reduced due to it’s PONV side effect?

A

No, Not Recommended

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11
Q

What do you do if PONV pretreatment does not work?

A

Try medication w/ different MOA

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12
Q

Which meds are recommended for Post Discharge N/V?

A

Dexamethasone

Scopolamine Patch

&

Rescue Meds
(Zofran, Phenergan)

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13
Q

Which meds are more effective when given BEFORE Induction?

A

Dexamethasone

Scopolamine Patch

Aprepitant

Amisulpride (Barhemsys)

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14
Q

Out of Zofran, Droperidol, and Dexamethasone, which drug is most effective for PONV?

A

All Equally Effective

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15
Q

Which drugs are classified as 5HT3 Antagonists?

A

5HT3 = Serotonin

Drugs that end in -setron

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16
Q

How are 5HT3 metabolized?

A

CYP450

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17
Q

What is the Half Life of Ondansetron?

A

4 Hrs

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18
Q

What is the Half Life of Granisetron?

A

9 - 11 Hrs

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19
Q

What is the Half Life of Dolasetron?

A

Prodrug

7 - 9 Hrs

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20
Q

What is the Half Life of Palonosetron?

A

40 Hrs

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21
Q

What are the Side Effects of 5HT3 Antagonists?

A

Generally Mild

QTc Prolongation

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22
Q

How might Dexamethasone work?

A
  • Glutocorticoid Receptors in brain reduce emetic activity
  • ↓Prostaglandin Synthesis to reduce GI contraction
  • ↓Serotonin Activity
  • ↓Anti-Inflammatory & Pain Effects
  • ↑ Endorphins
  • Augments other Antiemetics
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23
Q

What are the Side Effects of Dexamethasone?

A
  • Low Risk for Single Dose
  • Long Term use:
    • Impaired wound healing
    • ↑Glucose
    • HTN
    • AMS
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24
Q

Which D2 Antagonist is classified as Butyrophenone?

A

Droperidol

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25
Q

What effects does Droperidol have?

A

Anti-Emetic

Anti-Histamine

Anti-Serotonergic

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26
Q

Why is Droperidol normally given Post-Operatively vs Pre-Operatively?

A

Onset: 5-10 min

Peaks @ 1 Hr.

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27
Q

What are the Side Effects of D2 Blockers?

A

Dysphoria

Hypotension

Extrapyramidal Symptoms

Sedation

QT Prolongation

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28
Q

What is Droperidol’s Black Box Warning?

A

QT Prolongation & Sudden Cardiac Death

Rare

Must have ECG Monitoring for 3 hours

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29
Q

Which drugs are classified as D2 Phenothiazines?

A

Promethazine & Prochlorperazine

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30
Q

How do Phenothiazines compare to Butyrophenone D2 blockers?

A

More Highly Sedating & Highly Antihistaminergic

Also Available in Tabs, Gels, Suppository, Liquid

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31
Q

Which D2 Blocker was recently approved for only PONV?

A

Amisulpride (Barhemsys)

IV Only

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32
Q

How does Reglan work?

A

D2 Antagonist tht acts on CTZ for its Antiemetic Effects, mainly used for Gastric Emptying

  • Increases Lower Esophageal Sphincter Tone
  • Enhances Peristaltic Contractions & Gastric Emptying
  • Does NOT alter Hydrogen Ion Secretion
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33
Q

How is Reglan Eliminated?

A

Liver & Kidneys

Crosses BBB & Placenta

Also Excreted in Breast Milk

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34
Q

What are Side Effects of Reglan?

A

Abdominal Cramps

Akathesia

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35
Q

What are some consideratios w/ using Reglan in terms of Drug Interactions?

A

Inhibits Plasma Cholinesterase

Increase CNS Depressant Effects

Increase EPS effects of other Drugs

Avoid w/ Hx of Seizure & Gastric Obstruciton

36
Q

What drugs are H1 Antgonist?

A

Diphenhydramine (Benadryl)

Dimehydrinate (Dramamine)

Scopalamine

37
Q

Which drug is a Neurokinin 1 Antagonist in the Brainstem & Vagal Complex?

A

Aprepitant (Emend) - PONV

Rolapitant - Chemo Induced NV

Netupitant - Chemo Induced NV

38
Q

How is Aprepitant Elimintated?

A

Liver

Highly Protein Bound

Half Life: 9-13 hrs

39
Q

What are the side effects of Aprepitant?

A

Neuropathy

Anemia

UTI

Neutropenia

40
Q

How does Aprepitant effect Birth Control?

A

Reduce Effectiveness up to 4 Weeks

41
Q

How can Aprepitant cause Bleeding?

A

Increases INR for 7-10 days w/ Warfarin

42
Q

What is Dronabinol (Marinol) used for?

A

Chemo-Induced NV > PONV

No effect on Pain or Opiate Reduction

43
Q

Which drugs are H2 Antagonists?

A

Cimetidine (Tagamet)

Ranitidine (Zantac)

Famotidine (Pepcid)

Nizatidine (Axid)

44
Q

How do H2 Blockers work?

A

H2 Blockers competitively inhibits Histamine from binding to H2 receptor, preventing activation of adenylate cyclase

Only changes pH, not amt. of gut content

45
Q

Which H2 Antagonists is the most potent? Which is the Least Potent?

A

Most Potent: Famotidine

Least Potent: Cimetidine (Shortest Acting)

46
Q

How do H2 Blockers relate to Acid Pneumonitis?

A

May actually increase Pneumonitis

47
Q

What are the Side Effects of H2 Blockers?

A

Thrombocytopenia

Diarrhea, Headache, Fatigue

Confusion

Dysrhythmias

48
Q

What are Drug Interactions to consider when using Cimetidine or Ranitidine?

A

CYP-450 Inhibitor

Slows breakdown of Diazepam, Propanolol, Mepridine, Lidocain

49
Q

What can happen w/ the pH increase from H2 Blockers?

A

Decreased Absorption of Ketoconazole, Iron, and Calcium Carbonate

50
Q

What drugs are Proton Pump Inbibitors?

A

Drugs ending in -prazole

51
Q

What are PPIs used for?

A

GERD

Hypersecretory Disorders

PUD

52
Q

How do H2 Blockers compare to PPIs?

A

H2 Blockers work faster, but does not last as long as PPIs

53
Q

What are the Side Effects of PPIs?

A

C Diff

Kidney Injury

Dementia

Reduced Absortion of Calcium, B12, Mag, and Iron

54
Q

Which drugs reduce Surface Tension and allow water & lipids to penetrate stool?

A

Stool Softeners

Colace/Docusate

Ineffective on their own

55
Q

Which Drugs Irritate the GI Tract and cause contractions and H2O influx?

A

Stimulant Laxatives

Senna

Dulcolax

Biscodyl

Cause Abdominal Cramps

56
Q

Which drugs prevents H2O Reabsorption w/ oil barrier?

A

Rectal Lubricant

Mineral Oil

Risk of Aspiration

57
Q

Which drugs draws water into GI tract to soften stool?

A

Osmotic Laxatives

Miralax

Mg++

Glycerin

Fleets

Lactulose (↓K & ↓NH3)

58
Q

Which drug produces Chloride Rich Fluid Excretion?

A

Chloride Channel Activator

Lubiprostone (Amitiza)

1st dose may cause Syncope & Dyspnea

59
Q

Which drugs Increase cGMP for GI Contraction & Speed Transit Time?

A

Guanylate Cyclase-C Activators

Linaclotide (Linzess)

Plecanatide (Trulance)

Black Box Warning - dehydration in kids

60
Q

Which drugs Stimulate Colonic Peristalsis?

A

5HT4 Agonists

Prucalopride (Motegrity)

Tegaserod (Zelnorm)

Black Box Warning - suicidal ideation, CVA, TIA, MI

61
Q

Which drugs block the effects of Opiates at the GI Tract?

A

Mu Antagonist

Naldemedine (Symproic)

Naloxegol (Movantik)

Methylnaltrexone (Relistor)

Only reduces GI effects, not pain

62
Q

Which constipation drug Blocks Sodium/Hydrogen Exchange?

A

NHE3 Inhibitor

Tenapanor (Ibsrela)

Black Box Warning: Dehydration in Kids < 6 y.o

63
Q

Which Diarrhea drug blocks Calcium for less GI Contraction?

A

Mu Agonists

Loperamide (Imodium)

Abuse/Misuse = Fatal Arrhythmias

64
Q

Which Diarrhea medication reduces GI Motility and Blocks ACh Release?

A

Anticholinergics w/ Mu Agonist

Diphenoxylate/Atropine (Lomotil)

65
Q

Which medication acts as a GI Protectant and Blocks Irritation?

A

Bismuth Subsalicylate (Pepto)

Black Stools might be mistaken for bleed

66
Q

Which Diarrhea medication reduces water and stool more formed?

A

Psyllium (Metamucil)

Causes stomach pain & bloating

67
Q

Which Diarrhea medication binds bile acids to reduce colon impaction?

A

Cholestyramin (Questran)

Can bind other meds, wait 1 hour after other meds or wait 4 hours before other meds if given before

68
Q

What happens with Alpha-1 Receptor Stimulation?

A

Vasoconstriction

Bronchoconstriction

Smooth Muscle Contraction

GI Relaxation

69
Q

What happens with Alpha-2 Receptor Stimulation?

A

Located in CNS

Reduce Sympathethic Outflow

Hypotension

Sedation

70
Q

What happens w/ Beta-1 Receptor Stimulation?

A

Effects Heart

↑HR

↑Conduction Velocity

↑Inotropy

71
Q

What happens w/ Beta-2 Receptor Stimulation?

A

Smooth Muscle Relaxation

Peripheral Vasodilation

Bronchodilation

↑Insulin Secretion

Hypotension

72
Q

What happens w/ Dopamine 1 Receptor Stimulation?

A

Vasodilation

Diuresis

↑IOP

↓Gastric Secretion

Inhibit Aldosterone Release

73
Q

What happens w/ Dopamine 2 Receptor Stimulation?

A

Vasodilation

Emesis

Prostaglandin Production

↑Gastric Secretion

Inhibit Aldosterone Secretion

74
Q

Which receptors does Vasopressin work on?

A

Vasopressin Receptors: V1 & V2 Receptors

75
Q

What happens w/ V2 Receptor Stimulation?

A

Water Reabsorption –> ↑Volume –> ↑BP

76
Q

What happens w/ V1 Receptor Stimulation?

A

↑Baroreflex Sensitivity

Vascular Contraction

Starts SNS Activity

Stimulates RAS (Renin-Angiotensin System)

77
Q

Which meds are Endogenous Catecholamines?

A

Epinephrine

Norepinephrine

Dopamine

78
Q

Which receptors does Epinephrine work on?

A

Binds to Everything

  • Low Dose: Beta-2
  • Moderate Dose: Beta-1
  • High Dose: Alpha-1
79
Q

Which receptors does Norepinephrine work on?

A

Alpha-1

Alpha-2

Beta-1
(Inotropy > HR)

80
Q

Which receptors does Dopamine work on?

A

Low Dose: D1 & D2

Moderate Dose: Beta-2 & Beta-1

High Dose: Alpha-1

81
Q

Which receptors does Isoproterenol work on?

A

Beta-1

Beta-2

Most Arrhthmogenic

82
Q

Which receptors does Dobutamine work on?

A

Very selective Beta-1

83
Q

Which medications are Synthetic Catecholamines?

A

Isoproterenol & Dobutamine

84
Q

Which drug is a Direct Acting Non-Catecholamine?

A

Phenylephrine

85
Q

Which receptors does Phenylephrine work on?

A

Alpha-1

Alpha-2

86
Q

Which medication is an Indirect Synthetic Non-Catecholamine?

A

Ephedrine

Promotes release of Norepinephrine

Alpha-2 Negative Feedback - Tachyphylaxis (Weaker effects)

87
Q

Which receptors does Ephedrine work on?

A

Alpha, Beta, and Indirect Norepi Effects

spring 2020 - pharmacology 1 (11 decks)

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