Module 3: GI Unit D: Antiemtic and Oral Ulcer Treatment

Question 1

What conditions should anticholinergic drugs be avoided in?

Answer 1

glaucoma, seizure disorder, cardiovascular disease, severe liver disease.

Question 2

Which antiemetics are anticholinergic?

Answer 2

Antihistamines 
Dimenhydrinate (Dramamine) 
Meclizine (Antivert)
Phenergan 
Muscarinic antagonist (Scopolamine).

Question 3

Which drugs in this unit may produce extrapyramidal side effects?

Answer 3

Promethazine (Phenergen)
Droperidol (Inapsine)
Reglan

Question 4

Example of Serotonin Receptor Antagonist?

Answer 4

Ondosteron (Zofran)

Question 5

Antiemetic Drugs that prolong QT?

Answer 5

Zofran, Droperidol (Inapsine)

Question 6

Indications for zofran?

Answer 6

Chemo Induced Nausea Vomiting
Off-label viral gastroenteritis
morning sickness

Question 7

Indication for NK1 antiemetic Aprepitant (Emend)?

Answer 7

Post op N&V

Chemo INV

Question 8

MOA of NK1 antiemetic?

Answer 8

Blockade of neurokinin -1-type receptors in the CTZ

Question 9

Safety considerations/contraindications/

D2D of Aprepitant (Emend)

Answer 9

inhibitor and inducer of CYPs

Question 10

Example of Dopamine antagonist (Phenothiazines)

Answer 10

Promethazine (Phenergan) and Droperidol (Inapsine)

Question 11

Indication for Dopamine antagonist (Phenothiazines) (Phenergan and Inapsine)

Answer 11

Post op emesis
chemotherapy
toxins.

Question 12

MOA of Dopamine antagonist (Phenergan and Inapsine) and prokinetic (Reglan)?

Answer 12

Blocks dopamine two receptors in CTZ.

Question 13

Safety Concerns with Dopamine antagonist

(Phenothiazines) Phenergan and Inapsine?

Answer 13

Contraindicated: Parkinson’s disease

Question 14

BBW for Phenergan?

Answer 14

Respiratory depression can be severe. Contraindicated for children under two and used with caution for children above 2

Question 15

Safety considerations with Droperidol (Inapsine)

Answer 15

Extrapyramidal side effects
hypotension.
Prolonged Qt.

Question 16

Example of Prokinetic antiemetic?

Answer 16

Metoclopramide (Reglan)

Question 17

Indication for Reglan?

Answer 17

Emesis post-op,
chemotherapy,
toxins.

Question 18

Examples of cannaboids for antimetics?

Answer 18

Dronabinol (Marinol) Delta 9 THC

Nabilone (Cesamet)
A synthetic derivative of dronabinol.

Question 19

Indication for cannaboids (Cesamet and Marinol) for NV?

Answer 19

Chemo induced Nausea and vomtiting (CINV)

Question 20

MOA of cannaboids (Cesamet and Marinol)?

Answer 20

Unknown but possibly activating cannabinoid receptors in the vomiting center.

Question 21

Safety considerations with cannaboids (Cesamet and Marinol)?

Answer 21

Schedule III
Tachycardia and hypotension.

Higher potential for abuse.

Drowsiness.

Question 22

Example of Muscarinic antagonist

Answer 22

Scopalamine

Question 23

Indication for Muscarinic antagonist (Scopalamine)

Answer 23

Motion sickness

Question 24

MOA of Scope patch?

Answer 24

Suppresses nerve traffic to the vestibular apparatus. Decreases saliva.

Question 25

Safety considerations with Scope patch?

Answer 25

Anticholinergic. Drowsiness, blurred vision, urinary retention, and disorientation. Avoid in the elderly.

Question 26

What steps should you take with nausea and vomiting in pregnancy?

Answer 26

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)

Question 27

Is ginger effective in the treatment of nausea in pregnancy?

Answer 27

Yes. 1 gram per day.

Question 28

Treatment options for canker sores?

Answer 28

Orabase or orajel, lavender. Prescription options are "magic mouthwash" (Lidocaine, carafate, diphenhydramine), Aphthasol (amlexanox) or a topical steroid (triamcinolone dental paste)

Question 29

What are two potential concern with Reglan?

Answer 29

Tardive dyskinesia and psych issues.

Question 30

Patient teaching with a scope patch?

Answer 30

Drowsiness. Don't drive or operate machines!