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Fall 2014 - Pharm GI/ENT > Nausea/Vomiting > Flashcards

Nausea/Vomiting Flashcards

1
Q

Nausea

A

inclination to vomit or a feeling in the throat or epigastric region alerting an individual that vomiting is imminent

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2
Q

Vomiting

A

forceful expulsion of gastric contents due to retroperistalsis

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3
Q

Mose Common Causes of N & V

A
  • infection (gastroenteritis)
  • pregnancy
  • medications
  • motility disorders
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4
Q

Pathophysiology of Vomiting

A
  • triggered by afferent impulses to cells in medulla from GI tract; impulses received by chemoreceptor trigger zone, cerebral cortex, vestibular apparatus
  • cause efferent signals to go to GI and other tissues resulting in vomiting
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5
Q

Chemoreceptor Trigger Zone (CTZ)

A
  • major area of chemosensory info

- stimulation of CTZ by chemicals usually results in vomiting

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6
Q

General Principles Important for Tx of N&V

A
  • identify underlying cause
  • usually self-limited
  • maintain adequate hydration
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7
Q

Drug-Induced N&V

A
  • common
  • timing and reproducibility of NV in relationship to the administration of a drug
  • discontinuing drug is the best therapy
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8
Q

Drugs that Commonly Cause N&V

A
  • chemotherapy agents
  • oral and some IV abx
  • anticonvulsants (toxic levels)
  • amphotericin (antifungal)
  • narcotic analgesices
  • theophyllien (toxic levels)
  • digoxin (toxic levels)
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9
Q

Anticipatory N/V

A
  • defined as N/V occurring before an expected event
  • generally associated with the administration of chemo
  • can result in sig. problems including delay of chemo administration
  • commonly treated w/ benzodiazepines due to their amnestic properties
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10
Q

Refractory N/V

A
  • defined as N/V despite the use of standard antiemetic therapy
  • seen in up to 30% of chemo pts
  • generally requires use of combination antiemetic regimens w/ more than one site or MOA
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11
Q

Anticholinergics MOA

A

-block muscarinic ACh receptors in vestibular system

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12
Q

Anticholinergics Generic

A

scopolamine

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13
Q

Scopolamine Trade Name

A

Transderm Scope

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14
Q

Anticholinergics Efficacy

A
  • effective for preventing and treating motion sickness

- possibly post op NV

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15
Q

Anticholinergics AEs

A
  • common: dry mouth and eyes, drowsiness, impaired eye accommodation
  • rare: disorientation, memory disturbance, dizziness, hallucinations
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16
Q

Antihistamines MOA

A

-block H1 and muscarinic ACh receptors in vestibular system

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17
Q

Antihistamines Generics

A
  • Dimenhydrinate
  • Diphenhydramine
  • Meclizine
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18
Q

Antihistamines Trade Names

  1. Dimenhydrinate
  2. Diphenhydramine
  3. Meclizine
A
  1. Dramamine
  2. Benadryl
  3. Antivert
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19
Q

Antihistamines Efficacy

A
  • moderately effective

- more effective when combined w/ other antiemetics for chemo induced NV

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20
Q

Antihistamines AEs

A
  • common: sedation, dry mouth, constipation

- less common: confusion, blurred vision, urinary retention

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21
Q

Phenothiazines MOA

A

-block dopamine stimulation of chemoreceptor trigger zone

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22
Q

Phenothiazines Generic

A

-Prochlorperazine

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23
Q

Prochlorperazine Trade Name

A

Compazine

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24
Q

Phenothiazines Efficacy

A
  • effective for severe motion sickness
  • vertigo
  • NV with pregnancy
  • chemo NV
  • post op NV
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25
Q

Phenothiazines AEs

A
  • sedation
  • orthostasis
  • EPS such as dystonia, tardive dyskinesia (abnormal lip/mouth movement), akathisia
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26
Q

Butyrophenones MOA

A

-block dopamine stimulation of chemoreceptor trigger zone

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27
Q

Butyrophenones Generics

A
  • Droperidol

- Haloperidol

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28
Q

Butyrophenones Trade Names

  1. Droperidol
  2. Haloperidol
A
  1. Inapsine

2. Haldol

29
Q

Butyrophenones Efficacy

A
  • effective for preventing post op NV

- may be used for chemo NV for pts who can’t tolerate usual tx

30
Q

Butyrophenones AEs

A
  • sedation, agitation, restlessness
  • droperidol may prolong QT interval
  • EKG before and after dosing
  • EPSE
31
Q

Benzamides MOA

A
  • block central and peripheral dopamine receptors

- increase GI motility (cholinergic effect)

32
Q

Benzamides Generics (2)

A
  • metoclopramide

- trimethobenzamide

33
Q

Benzamides Trade Names

  1. Metoclopramide
  2. Trimethobenzamide
A
  1. Reglan

2. Tigan

34
Q

Benzamides Efficacy

A
  • used for post op NV, chemo NV, NV preg

- GERD, gastroparesis and migraine HA

35
Q

Benzamides AEs

A
  • common: sedation, restlessness, drowsiness, agitation, CNS depression
  • less common: EPSE, HoTN, neuroleptic syndrome, SVT
36
Q

Corticosteroids MOA

A
  • through to be due to release of serotonin
  • decrease BBB permeability
  • decrease inflammation
37
Q

Corticosteroids Generics (2)

A
  • dexamethasone

- methylprednisolone

38
Q

Corticosteroids Trade Names

  1. Dexamethasone
  2. Methylprednisolone
A
  1. Decadron

2. Medrol

39
Q

Corticosteroids Efficacy

A

-used alone or in combo for post op, chemo, and radiation induced NV

40
Q

Corticosteroids AEs

A
  • common: GI upset, anxiety, insomnia

- less common: increase blood glucose, facial flushing, euphoria

41
Q

Cannabinoids MOA

A

-work centrally but exact mechanism unknown

42
Q

Cannabinoids Generics (2)

A
  • dronabinol

- nabilone

43
Q

Cannabinoids Trade Names

  1. Dronabinol
  2. Nabilone
A
  1. marinol

2. cesamet

44
Q

Cannabinoids Efficacy

A

-used to prevent or treat refractory chemo NV

45
Q

Cannabinoids AEs

A

-common: drowsiness, euphoria, abnormal thinking, dysphoria

46
Q

Benzodiazepines MOA

A

-through to block input from cerebral cortex and limbic system from reaching vomiting center

47
Q

Benzodiazepines Generics (2)

A
  • lorazepam

- alprazolam

48
Q

Benzodiazepines Trade Names

  1. Lorazepam
  2. Alprazolam
A
  1. ativan

2. xanax

49
Q

Benzodiazepines Efficacy

A

-used to prevent and treat chemo NV

50
Q

Benzodiazepines AEs

A
  • common: sedation, amnesia

- less common: respiratory depression (caution in COPD), ataxia, blurred vision, hallucinations, paradoxical reactions

51
Q

5HT3 Antagonists MOA

A

-selectively block 5HT3 receptors

52
Q

5HT3 Antagonists Generic

A

ondansetron

53
Q

Ondansetron Trade Name

A

Zofran

54
Q

5HT3 Antagonists Efficacy

A

-very effective for prevention or tx of chemo or post op NV

55
Q

5HT3 Antagonists AEs

A
  • generally well-tolerated
  • constipation, HA, somnolence, diarrhea
  • all except palonsetron can prolong QT interval
56
Q

NK1 Antagonist MOA

A

-block neurokinin1 receptors in CTZ and GI tract

57
Q

NK1 Antagonist Generic

A

aprepitant

58
Q

Aprepitant Trade Name

A

Emend

59
Q

NK1 Antagonist Efficacy

A
  • effective for preventing acute and delayed chemo NV in combo with 5HT3 antagonists and CS
  • also effective for prevention of post op NV
60
Q

NK1 Antagonist AEs

A
  • common: fatigue, hiccups,
  • less common: dizziness, HA, insomnia
  • rare: transient increase in LFTs
61
Q

2 Non-Pharm Options for NV Tx

A
  • wrist bands with acupressure point 3 fingers below wrist fold
  • ginger ale
62
Q

Recommended Therapy for Motion Sickness

A
  • dimenhydrinate/dramamine 50-100 mg q4-6 hr PRN

- scopolamine 0.5 mg q72 hr PRN

63
Q

Recommended Therapy for Preg Induced NV

A
  • pyridoxine (B6) +/- doxylamine (unisom); 10-25/12.5-20 mg 1-4x/day
  • can also add promethazine, metoclopramide, trimethobenzamide, ondansetron
64
Q

Recommended Therapy for Anticipatory NV

A

-lorazepam/ativan: 0.5 to 4 mg prior to chemo then q4-6 hr PRN

65
Q

Recommended Therapy for Chemo Induced Highly Emetogenicity or Moderate AC

A

-5HT3 Antagonist + dexamethasone + aprepitant

66
Q

Recommended Therapy for Chemo Induced Moderately Emetogenicity

A

-5HT3 Antagonist + dexamethasone

67
Q

Recommended Therapy for Chemo Induced Low Emetogenicity

A

-dexamethasone 8 mg PO x1

68
Q

Recommended Therapy for Post Op NV

A
  • 5HT3 Antagonists (dolasetron, granisetron, ondansetron, tropisetron)
  • dexamethasone
  • droperidol
69
Q

Recommended Therapy for Refractory NV

A

-add chlopromazine, prochlorperazine, promethazine, methylprednisolone, lorazepam, metoclopramide, dexamethazone if needed

Fall 2014 - Pharm GI/ENT (14 decks)

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