Lecture N/V

Question 1

Antiemetics and motion sickness medicines include:

Answer 1

1. anticholinergic agents and antihistamines
2. serotonin receptor antagonists 5-HT3 (ondansetron)
3. benzodiazepines
4. phenothiazines
5. Butyrophenones

Question 2

scopolamine

Answer 2

anticholinergic agents used as antiemetics with motion sickness

Oral, SQ, transdermal [Transderm Scōp]

Transdermal is often a patch behind ear

AE: dry mouth, blurred vision, drowsinessurinary retention, constipation, disorientation

Question 3

ondansetron [Zofran]

Answer 3

serotonin receptor antagonist 5-HT3 class of drug for antiemetics and motion sickness

granisetron [Granisol], dolasetron [Anzemet], palonosetron [Aloxi]

Indications:
Chemotherapy-induced (CINV)
post-op
hyperemesis gravidarum

AE:
HA, diarrhea, dizziness
prolonged QT interval

Question 4

lorazepam [Ativan]

Answer 4

benzodiazepine drug for antiemetics and motion sickness

Ineffective when used alone
Used for CINV (chemo induced N/V)

3 primary benefits

i. sedation
ii. suppresses anticipatory emesis
iii. retrograde amnesia

Question 5

diphenhydrinate

Answer 5

antihistamine drug for antiemetics and motion sickness

also meclinzine [Antivert] and cyclinzine [Cyclivert]

Question 6

promethazine [Phenergan]

Answer 6

Phenothiazine drug for antiemetics and motion sickness
(also prochlorperazine)

Indications: CINV, post-op, toxins

Adverse Effects:
EPS (extrapyramidal side effects), sedation, hypotension, anticholinergic effects

promethazine [Phenergan] also causes:
respiratory depression
tissue injury

Question 7

haloperidol [Haldol] and droperidol [Inapsine]

Answer 7

Butyrophenone drugs used for antiemetics and motion sickness

Indications: post-op, CINV, toxins

adverse effects:
EPS (extrapyramidal side effects),
sedation,
hypotension

Question 8

N/V drugs used are:

Answer 8

1. Cannaboids
2. Glucocorticoids
3. Substance P/Neurokinin1 Antagonist
4. metoclipramide

Question 9

dronabintol [Marinol] and nabilone [Cesamet]

Answer 9

cannabinoids used for N/V

Indications: CINV, AIDS anorexia

AE: Relaxation; less euphoria compared to marijuana

Question 10

methylprednisone and dexamethasone

Answer 10

glucocorticoids used for N/V

Indications: CINV

Question 11

aprepitant and fosaprepitant

Answer 11

Substance P/Neurokinin1 Antagonist used for N/V

indications: post-op, CINV

well-tolerated, moderately effective

Question 12

metoclopramide [Reglan]

Answer 12

used for N/V

indications:
Suppresses emesis - (IV) post-op, CINV, facilitate small bowel intubation & radiologic exams
Increases upper GI motility - (po) diabetic gastroparesis, GERD

Adverse effects: sedation, diarrhea, tardive dyskinesia

Question 13

pancreatic enzymes

Answer 13

pancrelipase

Deficiency of pancreatic digestive enzymes due to CF, pancreatectomy, pancreatitis

Affects digestion of FATS, carbs, proteins

Question 14

dissolve gallstones

Answer 14

chenodiol and ursodiol