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Pharmacology > GI System > Flashcards

GI System Flashcards

1
Q

For surgical patients, is there ever a chance for zero PONV

A

No

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2
Q

Define retching

A

rhythmic action of respiratory muscles preceding vomiting

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3
Q

Define Nausea

A

SUBJECTIVE personal patient experience with or without associated vomiting

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4
Q

The Vomiting Center is located where

A

Lateral reticular formation within the medulla oblongata

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5
Q

What two regions located near the vomiting center, once stimulated will initiate vomiting

A

Nucleus solitarius

Chemoreceptor Trigger Zone (located in the areas postrema near the bottom of the 4th ventricle)

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6
Q

What factors stimulate the vomitng center

A

Peripheral stimulation (sensory afferents of vagal nerve to VC)

CNS (directly relay to CTZ, AP, and NTS)

Chemicals in the CNS/Blood (directly stimulate VC)

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7
Q

What are the five CNS areas that are located near the VC and what are the physiological reactions associated with N/V

A 
Balance center (motion sickness)
Vasomotor center (diaphoresis, pallor, tachycardia, cardiac dysrhythmias)
Salivation center
Respiratory center (tachypnea)
Bulbar controls (cerebellum, medulla, and pons)
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8
Q

True/False
Although the CTZ, AP, and NTS contain receptors for vomiting, the vomiting reflex is INITIATED from within the vomiting center

A

True

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9
Q

What receptor population live withing the CTZ

A

Dopamine (D2)
Opioid
Enkephalin

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10
Q

What receptor population live within the AP

A

Dopamine
Opioid
Serotonin (5-HT)

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11
Q

What receptro population live within the NTS

A

Histamine
Enkephalin
Muscarinic

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12
Q

What physiologic state is a potent emetic stimulus

A

Blood in the stomach

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13
Q

Between 2-14, incidence of PONV increases or decreases

A

increases

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14
Q

After 14 yoa, incidence of PONV increases or decreases

A

decreases

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15
Q

What anesthetic agents increase PONV

A 
Neostigmine
Etomidate
Methohexital
Opioids
Ketamine
NITROUS OXIDE
All HALOGENATD AGENTS
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16
Q

What scoring system is used when a patient is at increased risk for PONV

A

Apfel scoring system

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17
Q

What four risk factors does the apfel scoring system assess

A

PONV
Use of Postop opioids
Female gender
Nonsmoker

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18
Q

If a patient has zero factors on apfel, what is the incidence of PONV

A

10%

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19
Q

If a patient has all four factors on apfel, what is the incidence of PONV

A

79%

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20
Q

If a paitent has 2 factors on apfel, what is the incidence of PONV

A

39%

*up/down by 20% from here

21
Q
  • What receptors can I stimulate to decrease PONV
A

Muscarinic (M3, M5)
Dopaminergic (D2)
Histamine (H1)
Serotonin (5-HT)

22
Q

What antimuscarinic drug does not cross the bbb and therefore, cannot be used to treat vomiting

A

Glycopyrollate

23
Q

Sucralfate is classified as an

A

anti-ulcer agent

24
Q

“prazoles” are

A

proton pump inhibitors

25
Q

Inhibition of acid production continues how long after administration of prazoles

A

up to 72 hours

*may not need to give to patient if taken within this time period prior to surgery

26
Q

Misoprostol is used in OB to

A

induce labor

27
Q

Misoprostal is contraindicated

A

during pregnancy

28
Q

What is the MOA of metaclopramide

A

increases LES spincter tone
increases gastric emptying
decreases gastric volume

*centrally acts as a dopaminergic antagonist resulting in antiemetic properties

29
Q

What are the precautions associated with metaclopramide

A

Contraindicated in intestinal obstruction or pheochromocytoma

Avoid in patient’s with parkinson’s

May cause tardive dyskinesia

30
Q

Cisapride is a

A

prokinetic

31
Q

What are the two anti-emetics discussed in lecture

A 
Metoclopramide
Droperidol (potent)
32
Q

True/false

Droperidol is a neuroleptic tranquilizer

A

true

33
Q

Peripherally, droperidol acts as a

A

alpha-adrenergic blocker

*decreases ABP

34
Q

Droperidol has what effect on patient’s with pheochromocytoma

A

stimulate the release of catecholamines from the adrenal medulla precipitating a HTN crisis

35
Q

What effect does Droperidol have on cerebral blood flow/ICP

A

decreases

*Does not decrease CMRO2, problem for pts with CVS disease

36
Q

Droperidol has antidopaminergic activity and therefore can precipitate

A

extrapyramidal reactions

*dont use in patient’s with parkinsons

37
Q

What drugs is countered by droperidol

A

dopamine

central a-adrenergic agonists

38
Q

What is the “Black Box” warning on droperidol

A

may cause QT prolongation/torsades de points leading to potentially fatal rhthyms

  • use only patients refractory to other anti-emetics. Must monitor EKG
39
Q

Ondansetron works on what receptor type

A

selective 5-HT3

*does not effect alpha, dopamine, or histamine receptors

40
Q

The phenothiazine hydroxyzine should ONLY be given

A

IM

*never IV

41
Q

Phenothizaines examples include promethazine, prochlorperazine, and hydroxyzine and involve many reactions including:

A 
sedative-tranquilizer
antiemetic
antihistamine/antipuritic
adrenolytic
anticholinergic
extrapyramidal activity
Potentiator of anesthetics
42
Q

Phenothiazines may cause what syndrome

A

Neuroleptic Malignant Syndrome

*Fever, muscle ridgidity, AMS, autonomic dysfunction, leukocytosis, elevated CPK

43
Q

Excess Fe is stored as

A

Ferritin

44
Q

What is the ONLY clinical indication for the use of iron

A

Treating iron deficiency anemia

45
Q

Iron sodium gluconate complex is given

A

ONLY IV

46
Q

What is the Gold standard treatment for acute iron toxicity

A

Deferoxamine

*activated charcoal DOES NOT work

47
Q

What is the central atom in vitamin b12

A

COBALT

48
Q

Without vitamin b12, what two ESSENTIAL enzymatic rxn couldn’t occur

A

methyltetrahydrofolate to tetrahydrofolate (folate)

methylmalonyl-CoA to succinyl-CoA

Pharmacology (27 decks)

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