N/V

Question 1

Ondansetron

Answer 1

Antiemetic

MOA: blocks 5-HT3 receptors
Effects are enhanced if combined with corticosteroids and/or NK1 antagonists

Indications: acute CINV, RINV, PONV, acute gastroenteritis

AEs: Headache
GI (constipation/diarrhea)
Elevated LFTs
hQTc interval (from Kr channel block) –> increases risk for TdP

Question 2

Prochlorperazine

Answer 2

Antiemetic

MOA: blocks D2 receptors; also blocks M, H1, α1, Kr channels

Indications: general purpose

AEs: “movement disorder” (from blocking D2)
resting tremor, slow movements, rigidity
involuntary movements of eyes, mouth, head, arms (tardive dyskinesia)
- hyperprolactinemia (from blocking D2)
reproductive dysfunction, galactorrhea
- antimuscarinic (from blocking M)
- sedation (from blocking H1)
- orthostatic hypotension (from blocking α1)
- increases QTc interval (from Kr channel block) –> increase risk for TdP

Question 3

Metoclopramide

Answer 3

MOA: blocks D2 receptors; also blocks 5-HT3 and stimulates 5-HT4
Indications: CINV, PONV, migraine NV, GI motility related NV (gastroparesis)
AEs: “movement disorder” (from blocking D2)
resting tremor, slow movements, rigidity, dystonia, akathisia
involuntary movements of eyes, mouth, head, arms (tardive dyskinesia)
**Black box warning for tardive dyskinesia (don’t use > 3 months)
hyperprolactinemia (from blocking D2)
reproductive dysfunction, galactorrhea

Question 3

Metoclopramide

Answer 3

MOA: blocks D2 receptors; also blocks 5-HT3 and stimulates 5-HT4

Indications: CINV, PONV, migraine NV, GI motility related NV (gastroparesis)

AEs: “movement disorder” (from blocking D2)
- resting tremor, slow movements, rigidity, dystonia, akathisia
- involuntary movements of eyes, mouth, head, arms (tardive dyskinesia)

**Black box warning for tardive dyskinesia (don’t use > 3 months)

hyperprolactinemia (from blocking D2)
reproductive dysfunction, galactorrhea

Question 4

Scopolamine

Answer 4

M antagonists

MOA: blocks M receptors

Indications: motion sickness, vertigo

AEs: antimuscarinic
sedation

Question 5

Meclizine, Dimenhydrinate

Answer 5

H1 antagonists

MOA: blocks H1 receptors; also block M receptors

Indications: motion sickness, vertigo

AEs: antimuscarinic
sedation

Question 6

Aprepitant

Answer 6

NK1 antagonists

MOA: blocks NK1 receptors

Indications: CINV (in combination w/setron and corticosteroids)
PONV

AEs: Elevated LFTs
Headache, dizziness
Fatigue, hiccups, constipation

Question 7

Dexamethasone

Answer 7

Corticosteroids

MOA: stimulates GRs

Indications: CINV (in combination w/setron and NK1 antagonist)
PONV

AEs: Insomnia
increases plasma glucose

Other corticosteroid AEs are not typically seen because it is given for a short period of time

Question 8

Dronabinol

Answer 8

Cannabinoids

MOA: stimulates CB1 receptors

Indications: CINV (refractory to other treatments)

AEs: CNS
- increases laughing, emotional changes, hallucinations
- increases HR

Question 9

Drug Induced NV

Answer 9

• Opioids
• increase D2 activity (precursors to DA like L-DOPA or D2 receptor agonists)
• SSRIs
• Chemotherapeutic agents (mild, moderate, high emetogenic potential)
• increases ACh activity in brain (e.g, AChEIs)
• Lots of others