nausea and vomiting

Question 1

phenothiazines

Answer 1

promethazine, prochlorperazine
dopamine antagonist in the CTZ
1st line treatment, not prevention, for NV
AE: drowsy, anti-SLUD, EPS, agranulocytosis, respiratory depression in children (don’t use <2)
interactions: other respiratory depressants

Question 2

butyrophenones

Answer 2

droperidol
dopamine antagonist in the CTZ
2nd line NV tx- used in hospital patients
AE: dysphoria, EPS, QT prolongation, drowsiness
interactions: other drugs that prolong QT- FQ, antidepressants, antipsychotics, antiarrhythmics

Question 3

metoclopramide

Answer 3

dopamine antagonist in CTZ and prokinetic agent
2nd line NV treatment and prevention
could be used 1st line in pts with gastroporesis
AE: drowsy, EPS
BBW: tardive dyskinesia at high dose
interactions: other drugs that cause EPS

Question 4

cannabinoid

Answer 4

dronabinol and nabilone
3rd line anti-emetic treatment, not prevention
AE: euphoria, hypotension, drowsy, dizzy
used often in chemotherapy induced NV to stimulate appetite

Question 5

serotonin antagonists

Answer 5

ondansetron, dolasetron, granisetron, palonsetron

1st line for prevention of chemotherapy induced NV and PONV- 2nd line for other NV uses

Question 6

aprepitant

Answer 6

neurokinin-1 antagonist in CTZ
1st line prevention for cancer pts in combo with serotonin antagonists and steroids
2nd line to prevent PONV
interactions: it is a cyp3A4 inhibitor- don’t sue with pimozide, terfenadine, astemizole, or cisapride
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Question 7

scopolamine patch

Answer 7

anticholinergic- blocks receptors in vestibular system
1st line to prevent motion sickness
2nd line to prevent PONV
AE: drowsy, anti-SLUD, visual disturbances, hallucinations, confusion, tachycardia
contraindications: COPD, hepatic, glaucoma, prostatic hypertrophy, pyloric obstruction, renal
interactions: other anti-cholinergics