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pharmacology module III exam II > nausea/vomiting > Flashcards

nausea/vomiting Flashcards

1
Q

which drugs are used for nausea and vomiting

A

cholinergic antagonists
dopamine receptor antagonists
serotonin receptor antagonists
cannabinoids
histamine antagonists

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2
Q

cholinergic antagonists

A

scopolamine

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3
Q

scopolamine MOA

A

blocks acetylcholine at parasympathetic sites (smooth muscle, secretory glands, CNS) - reduces histamine and serotonin activity

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4
Q

what forms does scopolamine come in

A

patch / injectible

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5
Q

scopolamine onset and duration

A

6-8 hrs, 72 hrs

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6
Q

scopolamine metabolism

A

hepatic

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7
Q

scopolamine side effects

A

initially bradycardia - then tachycardia, flushing, orthostatic hypotension, cognitive impairment, psychosis, and hallucinations

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8
Q

scopolamine contraindications

A

narrow angle glaucoma
other agents containing belladonna

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9
Q

scopolamine drug interactions

A

anticholinergics, CNS depressants, mag sulfate, nitro, potassium citrate, SSRIs, thiazides

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10
Q

dopamine receptor antagonists

A

phenothiazides (prochlorperazine)
butyrophenones (haloperidol)
benzamides (metoclopramide)

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11
Q

metoclopramide MOA

A

acts primarily on CTZ and afferent pathways in the gut - antagonizes D2 dopamine in area postrema (midbrain) and serotonin activity
M1 and H1 blocking affect
weak 5-HT3 blockage at higher doses

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12
Q

metoclopramide side effects

A

extrapyramidal rxn - dystonia, tarditive dyskinesia, hypotension, ECG abnormalities (prolonged QT), CNS effects, psychological effects, hyperprolacitnemia

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13
Q

metoclopramide drug-drug interactions

A

TCAs, SSRIs, antipsychotics, opioids, anticholinergics, anti-parkinson drugs, alcohol, potassium

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14
Q

metoclopramide duration and excretion

A

1-2 hrs urine

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15
Q

metoclopramide metabolism

A

CYP2D6

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16
Q

serotonin receptor antagonists

A

ondansetron
granisetron

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17
Q

ondansetron MOA

A

blocks sterotonin centrall (chemorecptor trigger zone) and peripherally (vagal nerve terminals)

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18
Q

ondansetron onset and peak

A

30min 1-2hrs

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19
Q

ondansetron metabolism

A

CYP3A4

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20
Q

ondansetron excretion

A

urine and feces

21
Q

ondansetron side effects

A

QT prolongation, dizziness, confusion, SOB, constipation

22
Q

ondansetron monitoring

A

ECG, pot and mag levels (serotonin syndrome)

23
Q

ondansetron drug-drug interactions

A

amiodarone, CYP3A4 inducers, QT prolonging agents

24
Q

cannabinoids

A

dronabinol

25
Q

dronabinol MOA

A

activated cannabinoid receptors

26
Q

dronabinol onset, duration, peak

A

30-60min, 4-6hrs, 2-4hrs

27
Q

dronabinol side effects

A

euphoria, CNS changes, vomiting, flushing, palpitations, hypotension, xerostomia, vertigo

28
Q

dronabinol monitor

A

HR/BP psychiatric changes, worsening nausea, vomiting, abd pain, propylene glycol, substance abuse history

29
Q

dronabinol drug-drug interactions

A

alcohol, CNS depressants, CYP2A4 inhibitors/inducers, metronidazole, disulfiram, warfarin

30
Q

histamine antagonists

A

promethazine
meclizine
dimenhydrinate

31
Q

promethazine MOA

A

blocks mesolimbic dopaminergeric receptors in postsynaptic sites - blocks the release of hormones from the hypothalamus (alpha-andergic blocker) - blocks histamine receptors in brainstem

32
Q

promethazine onset and route

A

IV 5 min duration 4-6 hrs

33
Q

promethazine metabolism

A

CYP2D6 CYP2B6

34
Q

promethazine side effects

A

ECG changes, anticholinergic affects, CNS depressioon, extrapyramidal effects, orthostatic hypotension, photosensitivity

35
Q

promethazine IV side effects

A

tissue injuries with extravasation

36
Q

promethazine drug-drug interactions

A

alcohol, dronabinol, epinephrine, opioids, glycopyrolates, kava kava, mag, dopamine antagonists, CNS depressants, nitro, pot, SSRI

37
Q

meclizine MOA

A

blocks H1 histamine receptor and prevents vasodilation, increased permeability, bronchoconstriction, spasmotic contractiono of GI smooth muscles, depresses labyrinth excitability and vestibular stimulation
may affect medullary chemoreceptors trigger zone

38
Q

meclizine onset and duration

A

1 hr, 24 hrs

39
Q

meclizine metabolism

A

hepatic

40
Q

meclizine side effects

A

sedation, HA, vomiting, blurred vision

41
Q

meclizine contraindications

A

glaucoma, asthma, urinary retneiton, pyloric/duodenal obstruction

42
Q

meclizine drug-drug interactions

A

alcohol, amphetamines, anticholinergic agents, azelastine, cannabis, CNS depressants, SSRIs, opioids, pot, nitro

43
Q

dimenhydrinate MOA

A

binds to H1 receptor sites in peripheral sites including GI tract, respiratory tract, and blood vessels - blocks chemoreceptor trigger zones - depresses labyrinthine function and vestibular stimulation - central anticholinergic activity

44
Q

dimenhydrinate onset and duration

A

30min IM/oral 4-6 hrs

45
Q

dimenhydrinate metabolism

A

hepatic

46
Q

dimenhydrinate excretion

A

renal

47
Q

dimenhydrinate side effects

A

tachycardia, sedation, dizziness, xerostomia, anorexia, epigastric distress, blurred vision, thickened bronchial secretions
rarely - SJS

48
Q

dimenhydrinate use of with caution in pts with

A

CVD, thyroid dysfunction, respiratory disease, urinary obstruction, glaucoma, and seizures
DONT USE W ANTIBIOTICS

49
Q

dimenhydrinate drug- drug interactions

A

alcohol, amphetamines, anticholinergics, azelastine, CNS depressants, SSRIs, opioids, pot, nitro

pharmacology module III exam II (6 decks)

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