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Therapeutics - Exam 6 > Lecture 68 > Flashcards

Lecture 68 Flashcards

NV (Scott)

1
Q

symptoms associated with NV

A

pallor
tachycardia
diaphoresis

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2
Q

etiology of NV

A

GI disorders (most notable, flu)
CNS disorders (anxiety, tumors, HA)
pain (acute or chronic)
excessive intake of anything
pregnancy
treatment induced
drug induced

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3
Q

treatment induced NV

A

cancer chemotherapy
radiation therapy (CNS and abdominal)
anesthesia (around 30%)
procedures (especially abdominal)

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4
Q

drug induced

A

main - anti-neoplastic agents
others - opioids, aspirins, NSAIDs, iron, some antibiotics (tetracycline, erythromycin), estrogen, anti-parkinson meds, SSRIs

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5
Q

Nonpharm treatment of NV

A
  1. determine the cause and put the gut to rest through clear liquid diet, IV hydration
  2. dietary
  3. physical
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6
Q

dietary treatment

A

avoid fatty, fried, sweet, and spicy foods
eat food that is cold or at room temp

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7
Q

physical treatment of IV

A

avoid unpleasant sights, sounds, and odors that may aggravate the NV
fresh air
avoid sudden movements
dim lights
acupressure - 3 fingers above the wrist

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8
Q

pharm treatments of NV

A

antihistamines, anticholinergics
phenothiazines
serotonin antagonists
NK1 antagonists
other

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9
Q

antihistamines treatment of NV

A

drugs - meclizine, dimenhydramine, scopolamine
mechanism - block histamine and/or muscarinic receptors in the CTZ and NTS centers
SE - drowsiness, sedation, dry mouth, constipation, blurred vision

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10
Q

phenothiazines treatment of NV

A

drugs - prochlorperazine, promethazine, chlorpromazine
mechanism - dopamine inhibition at CTZ
SE - dizziness, sedation, dry mouth, hypotension, EPS

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11
Q

serotonin antagonist treatment of NV

A

drugs - ondansetron, granisetron, palonosetron, dolasetron
mechanism - serotonin inhibition at CTZ, VC, and GI tract
SE - mild headache, dizziness, fatigue, constipation, recent concern about QT prolongation

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12
Q

ondansetron pros

A

multiple dosage forms including ODT
generic and low cost
under 10 per treatment course

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13
Q

granisetron pros

A

multiple dosage forms including patch and injection
generic and lower cost
under 10 per treatment course

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14
Q

palonosetron pros/cons

A

pros - longest duration of action (40hours)
cons - brand only; expensive; no oral dosage form

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15
Q

dolasetron pros/cons

A

pros - mouth only
cons - expensive

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16
Q

NK1 antagonist

A

drugs - aprepitant, fosaprepitant, rolapitant
mechanism - neurokin receptor inhibition
USE - primarily CINV
SE - fatigue hiccups, constipation, decreased appeptite

17
Q

other options for NV treatment

A

butyrophenone (haloperidol, droperidol)
metoclopramide
corticosteroids (dexamethasone)
cannabinoids

18
Q

metoclopramide in NV

A

dopamine inhibition and at high doses, serotonin inhibitions
give with benadryl due to EPS at high dose

18
Q

haloperidol, droperidol

A

BBW - EKG abnormalities so rarely used in treatment of NV

18
Q

corticosteroids (dexamethasone) in treatment of NV

A

inhibition of cortical input into vomiting center
enhances the efficacy of other anti-emetics

19
Q

cannabinoids treatment in NV

A

SE of sedation, dry mouth, euphoria, dysphoria, facial flushing, visual changes

20
Q

motion sicknessNK

A

prevention based
drugs - scopolamine (72h), dimehydrinate, meclizine
take 30-60 minutes before needed usually

21
Q

treatment of CINV

A

NK1 antagonists

22
Q

treatment of gastroenteritis or pain induced NV

A

treat the symptoms while treating the cause
drugs - ondansetron, promethazine

23
Q

post op NV

A

very common with older inhaled agents
prevention based
treatment is based on risk factors
breakthrough is through usage of Amisulpride

24
Q

risk factors of PONV

A

females
non-smoking status
history of PONV
history of motion sickness
anesthetic-based (intra-operative use of volatile anesthetics, use of nitrous oxide, or type of surgery)

25
Q

treatment of PONV with moderate-high risk

A

treat with 1 or 2 agents
only one is needed if propofol is used
drugs administered at the end of procedure

26
Q

treatment of PONV with highest risk

A

have 3+ risk factors
always use 2 agents - 5HT3 and metoclopramide or aprepitant

27
Q

Amisulpride (Barhemsys)

A

use in breakthrough PONV
selective dopamine-2 and dopamine-3 antagonists
not indicated for prophylaxis
has been associated with QT prolongation

28
Q

monitoring parameters for antiemetic therapies

A

efficacy and toxicity

Therapeutics - Exam 6 (11 decks)

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