Module 3: GI Unit D: Antiemtic and Oral Ulcer Treatment Flashcards
What conditions should anticholinergic drugs be avoided in?
glaucoma, seizure disorder, cardiovascular disease, severe liver disease.
Which antiemetics are anticholinergic?
Antihistamines Dimenhydrinate (Dramamine) Meclizine (Antivert) Phenergan Muscarinic antagonist (Scopolamine).
Which drugs in this unit may produce extrapyramidal side effects?
Promethazine (Phenergen)
Droperidol (Inapsine)
Reglan
Example of Serotonin Receptor Antagonist?
Ondosteron (Zofran)
Antiemetic Drugs that prolong QT?
Zofran, Droperidol (Inapsine)
Indications for zofran?
Chemo Induced Nausea Vomiting
Off-label viral gastroenteritis
morning sickness
Indication for NK1 antiemetic Aprepitant (Emend)?
Post op N&V
Chemo INV
MOA of NK1 antiemetic?
Blockade of neurokinin -1-type receptors in the CTZ
Safety considerations/contraindications/
D2D of Aprepitant (Emend)
inhibitor and inducer of CYPs
Example of Dopamine antagonist (Phenothiazines)
Promethazine (Phenergan) and Droperidol (Inapsine)
Indication for Dopamine antagonist (Phenothiazines) (Phenergan and Inapsine)
Post op emesis
chemotherapy
toxins.
MOA of Dopamine antagonist (Phenergan and Inapsine) and prokinetic (Reglan)?
Blocks dopamine two receptors in CTZ.
Safety Concerns with Dopamine antagonist
(Phenothiazines) Phenergan and Inapsine?
Contraindicated: Parkinson’s disease
BBW for Phenergan?
Respiratory depression can be severe. Contraindicated for children under two and used with caution for children above 2
Safety considerations with Droperidol (Inapsine)
Extrapyramidal side effects
hypotension.
Prolonged Qt.
Example of Prokinetic antiemetic?
Metoclopramide (Reglan)
Indication for Reglan?
Emesis post-op,
chemotherapy,
toxins.
Examples of cannaboids for antimetics?
Dronabinol (Marinol) Delta 9 THC
Nabilone (Cesamet)
A synthetic derivative of dronabinol.
Indication for cannaboids (Cesamet and Marinol) for NV?
Chemo induced Nausea and vomtiting (CINV)
MOA of cannaboids (Cesamet and Marinol)?
Unknown but possibly activating cannabinoid receptors in the vomiting center.
Safety considerations with cannaboids (Cesamet and Marinol)?
Schedule III
Tachycardia and hypotension.
Higher potential for abuse.
Drowsiness.
Example of Muscarinic antagonist
Scopalamine
Indication for Muscarinic antagonist (Scopalamine)
Motion sickness
MOA of Scope patch?
Suppresses nerve traffic to the vestibular apparatus. Decreases saliva.
Safety considerations with Scope patch?
Anticholinergic.
Drowsiness, blurred vision, urinary retention, and disorientation.
Avoid in the elderly.
What steps should you take with nausea and vomiting in pregnancy?
Step 1: “Lifestyle and Diet Changes”
Step 2: “Treatments that Do Not Use Medications” (for the ginger regimen, 1 day = 24 hours)
Step 3: “Medications” (Over the Counter & Prescription)
Is ginger effective in the treatment of nausea in pregnancy?
Yes. 1 gram per day.
Treatment options for canker sores?
Orabase or orajel, lavender. Prescription options are “magic mouthwash” (Lidocaine, carafate, diphenhydramine), Aphthasol (amlexanox) or a topical steroid (triamcinolone dental paste)
What are two potential concern with Reglan?
Tardive dyskinesia and psych issues.
Patient teaching with a scope patch?
Drowsiness. Don’t drive or operate machines!
