nausea/vomiting

Question 1

which drugs are used for nausea and vomiting

Answer 1

cholinergic antagonists
dopamine receptor antagonists
serotonin receptor antagonists
cannabinoids
histamine antagonists

Question 2

cholinergic antagonists

Answer 2

scopolamine

Question 3

scopolamine MOA

Answer 3

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

Question 4

what forms does scopolamine come in

Answer 4

patch / injectible

Question 5

scopolamine onset and duration

Answer 5

6-8 hrs, 72 hrs

Question 6

scopolamine metabolism

Answer 6

hepatic

Question 7

scopolamine side effects

Answer 7

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

Question 8

scopolamine contraindications

Answer 8

narrow angle glaucoma
other agents containing belladonna

Question 9

scopolamine drug interactions

Answer 9

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

Question 10

dopamine receptor antagonists

Answer 10

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

Question 11

metoclopramide MOA

Answer 11

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

Question 12

metoclopramide side effects

Answer 12

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

Question 13

metoclopramide drug-drug interactions

Answer 13

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

Question 14

metoclopramide duration and excretion

Answer 14

1-2 hrs urine

Question 15

metoclopramide metabolism

Answer 15

CYP2D6

Question 16

serotonin receptor antagonists

Answer 16

ondansetron
granisetron

Question 17

ondansetron MOA

Answer 17

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

Question 18

ondansetron onset and peak

Answer 18

30min 1-2hrs

Question 19

ondansetron metabolism

Answer 19

CYP3A4

Question 20

ondansetron excretion

Answer 20

urine and feces

Question 21

ondansetron side effects

Answer 21

QT prolongation, dizziness, confusion, SOB, constipation

Question 22

ondansetron monitoring

Answer 22

ECG, pot and mag levels (serotonin syndrome)

Question 23

ondansetron drug-drug interactions

Answer 23

amiodarone, CYP3A4 inducers, QT prolonging agents

Question 24

cannabinoids

Answer 24

dronabinol

Question 25

dronabinol MOA

Answer 25

activated cannabinoid receptors

Question 26

dronabinol onset, duration, peak

Answer 26

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

Question 27

dronabinol side effects

Answer 27

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

Question 28

dronabinol monitor

Answer 28

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

Question 29

dronabinol drug-drug interactions

Answer 29

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

Question 30

histamine antagonists

Answer 30

promethazine meclizine dimenhydrinate

Question 31

promethazine MOA

Answer 31

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

Question 32

promethazine onset and route

Answer 32

IV 5 min duration 4-6 hrs

Question 33

promethazine metabolism

Answer 33

CYP2D6 CYP2B6

Question 34

promethazine side effects

Answer 34

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

Question 35

promethazine IV side effects

Answer 35

tissue injuries with extravasation

Question 36

promethazine drug-drug interactions

Answer 36

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

Question 37

meclizine MOA

Answer 37

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

Question 38

meclizine onset and duration

Answer 38

1 hr, 24 hrs

Question 39

meclizine metabolism

Answer 39

hepatic

Question 40

meclizine side effects

Answer 40

sedation, HA, vomiting, blurred vision

Question 41

meclizine contraindications

Answer 41

glaucoma, asthma, urinary retneiton, pyloric/duodenal obstruction

Question 42

meclizine drug-drug interactions

Answer 42

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

Question 43

dimenhydrinate MOA

Answer 43

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

Question 44

dimenhydrinate onset and duration

Answer 44

30min IM/oral 4-6 hrs

Question 45

dimenhydrinate metabolism

Answer 45

hepatic

Question 46

dimenhydrinate excretion

Answer 46

renal

Question 47

dimenhydrinate side effects

Answer 47

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

Question 48

dimenhydrinate use of with caution in pts with

Answer 48

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

Question 49

dimenhydrinate drug- drug interactions

Answer 49

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