Module 1 Notable Drugs List (incomplete- see Anika's deck) Flashcards
DOMPERIDONE:
Indication?
Nausea and Vomiting.
Gastroparesis.
DOMPERIDONE:
Class?
Dopamine Antagonist Anti-emetic
DOMPERIDONE:
Notable Precautions/contraindications?
- PROLONGED QT INTERVAL- Contraindicated in patients with a prolonged QT interval as domperidone may increase the QT interval at high concentrations
*Use in patients with CARDIAC DISEASE, e.g. heart failure or significant electrolyte disturbances. - Use with strong CYP3A4 inhibitors (clarithromycin, erythromycin, diltiazem…)
- Intermediate/severe hepatic and renal states
DOMPERIDONE:
Info on which demographics can/can’t use domperidone.
- Elderly Warning - Risk of arrhythmias and/or sudden cardiac death may be increased, due to prolonged QT Interval.
- AVOID use in children
- AVOID use in pregnant women
- Safe in breastfeeding
DOMPERIDONE:
ADRs?
COMMON = Dry mouth, headache
Rare= EPSE, allergic reactions, prolonged QT interval
DOMPERIDONE:
Dosing?
Nausea and vomiting:
Adult, oral 10 mg 3 times daily for up to 1 week. Max dosage is 30mg p/day
DOMPERIDONE:
Monitoring Requirements?
Nothing specifically noted about monitoring, however, practice points indicate:
“avoid using domperidone where possible; concerns about its safety continue to be raised by Australian and international regulatory agencies”. So implies need for monitoring, particularly in vunerable demographics.
METOCLOPRAMIDE:
Indications?
- Nausea and vomiting
- including chemotherapy induced N & V
- Gastric stasis (e.g. after gastric surgery, diabetic gastroparesis)
METOCLOPRAMIDE:
Class:
Dopamine Antagonist Anti-emetic
METOCLOPRAMIDE:
Precautions?
- Parkinson’s disease—avoid if possible as symptoms may worsen; domperidone is preferred.
- Depression—avoid long-term use as mental state may worsen.
METOCLOPRAMIDE:
Warnings surrounding who can and can’t use?
- Adults < 20 y/o (increased EPSE risk)
- Renal - Reduce dose if CrCl <10 mL/minute (EPSE common)
- Elderly (particularly women) - avoid high doses/prolonged use, increased ADRs
- Contraindicated in children <1 y/o, not recommended for any children
- Pregnancy and breastfeeding safe
METOCLOPRAMIDE:
ADRs
COMMON - akathisia, dizziness, drowsiness, headache
RARE- agranulocytosis, arrhythmias
METOCLOPRAMIDE:
Standard dosage
- Maximum treatment length 5 DAYS
- Weight dependant dose
- Total daily dose should not exceed 0.5 mg/kg or 30 mg (whichever is less).
- > 60 kg, 10 mg 3 times daily.
- 30–60 kg, 5 mg 3 times daily.
- Administration advice
Give IV injection over at least 3 minutes to minimise transient agitation and restlessness.
METOCLOPRAMIDE:
Dosing variations:
- Chemotherapy-induced nausea and vomiting
Dose may vary according to local protocols and include higher doses - Renal impairment
CrCl <10 mL/minute, initially halve dose.
ONDANSETRON:
Class/Mode of Action:
5HT3 Antagonist Antiemetic
ONDASETRON:
Indication:
Nausea and vomiting:
* associated with cancer chemotherapy
* radiotherapy-induced
* postoperative (PONV)
*If they weren’t given an antiemetic to prevent the PONV, first-line treatment is prescribing of a serotonin 5HT3 antagonist via IV e.g. ondansetron 4mg
ONDANSETRON:
Precautions
- Hepatic - Reduce dose in severe impairment.
- Elderly- Reduce maximum IV dose if age >75 years (due to increased risk of prolonged QT interval)
- Pregnancy- May be used if other drugs are inadequate; Ondansetron is preferred out of 5HT3 antagonists, but there is conflicting evidence that indicates malformations in 1st trimester
ONDANSETRON:
ADRs?
COMMON- constipation, headache, dizziness
RARE-transient visual disturbances (blurred vision from rapid IV) EPSE, seizures
ONDANSETRON:
Interactions
potent CYP3A4 inducers, tramadol, SSRIs, SNRIS
ONDANSETRON:
Dosage?
Postoperative nausea and vomiting:
Adult - Prevention, IV/IM 4 mg at induction or oral 16 mg 1 hour before anaesthesia.
Treatment, IV/IM 4 mg single dose. Doses up to 8 mg have been used.
Chemotherapy:
Adult- Highly emetogenic, initially, IV 8–12 mg (maximum 16 mg; maximum 8 mg if age >75 years) immediately before chemotherapy or oral 16–24 mg 1–2 hours before chemotherapy.
Severe hepatic impairment
Do not exceed 8 mg daily.
DEXAMETHASONE:
Class/Mode of Action
Corticosteroid
DEXAMETHASONE:
Indication
Antiemetic
PONV
Chemotherapy-induced N & V
Cerebral Oedema
Some respiratory disorders, such as acute asthma and croup due antiinflammatory properties of drug
DEXAMETHASONE:
Precautions
- Infections - due to the immunosuppressant nature of the drug, we need to consider patients with a history of recurrent infections.
- Children - Chronic use of corticosteroids (at pharmacological doses) may retard growth
- Pregnancy - Considered safe to use at the lowest effective dose for the shortest possible time.
DEXAMETHASONE:
ADRs
COMMON - transient itching, burning or tingling in the perineal area. Adrenal suppression, Hypertension, hypokalaemia, hyperglycaemia. Infection.
RARE- peptic ulceration, hypersensitivity reactions
DEXAMETHASONE:
Dosage
PONV: Acts as PREVENTATIVE. Give before induction of anaesthesia.
Adult, IV 4–10 mg.
Child >1 month, IV 0.1–0.2 mg/kg (maximum 8 mg).
CHEMO:
Adult, oral/IV 4–20 mg 30 minutes before chemotherapy. If delayed emesis is anticipated, follow with 8 mg orally once or twice daily for 2–4 days.
DEXAMETHASONE:
Practice Points
Take with or after food to avoid stomach upset
DEXAMETHASONE:
Monitoring requirements
- measure blood glucose, electrolytes, lipids, weight and BP at baseline, then monitor regularly during treatment
- Watch for infection
- Consider need for withdrawing treatment gradually as abrupt withdrawal can result in adrenal crisis
PEPPERMINT OIL:
Indications
Anti spasmodic for use in IBS for abdominal pain.
PEPPERMINT OIL:
Class
Drugs effecting gastrointestinal motility
AMOXICILLIN:
Indication (specific to course)
Penicillin antibiotic used in the treatment of H.Pylori infection
AMOXICILLIN:
Precautions
Allergies, renal impaired patients (could lead to electrolyte disturbances and neurotoxicity)
AMOXICILLIN:
ADRs
COMMON- generally well tolerated, however most common presentations are diarrhoea and nausea.
RARE- electrolyte disturbances (hypernatraemia or hypokalaemia due to sodium content of high parenteral doses)
