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Pharm Dedo Exam3 > Nausea & Vomiting > Flashcards

Nausea & Vomiting Flashcards

1
Q

Nausea…

A

Unpleasant sensation of being about to vomit, which may occur alone or with vomiting

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2
Q

Vomiting…

A

forceful expulsion of gastric contents

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3
Q

Retching (aka dry heaves)…

A

differs from vomiting bc NO expulsion of gastric contents

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4
Q

GI motor function is controlled at 3 levels:

A

1 symp & parasymp NS
2 enteric neurons
3 smooth m cells

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5
Q

physiologic pathways involved with vomiting in the medulla…

A

1 vestibular fiber stimulation
2 afferent visceral fiber stimulation
3 Chemoreceptor trigger zone input (base of 4th ventricle)

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6
Q

5 main neurotransmitter receptor sites related to vomiting reflex:

A 
M1 (muscarinic)
H1 (histaminic)
D2 (dopamine)
5-HT3 (seratonin) 
NK1 (substance P)
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7
Q

Which receptor sites are most important from an inner ear perspective?

A

M1 & H1

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8
Q

Which receptor sites are most important in the GI tract?

A

D2 & 5HT3

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9
Q

consequences and complications of N/V:

A

fluid depletion, hypokalemia, metabolic alkalosis

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10
Q

Anticholinergic Agents work on what receptor type?

A

M1

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11
Q

M1 receptor antagonists

A

Scopolamine

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12
Q

route of scopolamine

A

transdermal patch (place on mastoid process)

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13
Q

MOA of M1 antagonists

A

block ACh at parasymp sites in smooth muscle, secretory glands, and CNS

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14
Q

indications for scopolomine

A

motion sickness prophylaxis

off label= dry OP secretions –> minimize aspirations post stroke

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15
Q

duration of action of scopolomine

A

starts 6-8hrs post application of patch

can last up to 72 hrs

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16
Q

Why do we prefer M1 blockers over H1 blockers for prevention of motion sickness?

A

they do not make pts sleepy (better if pt wants to be awake during travel)

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17
Q

ADRs of scopolamine

A

xerostomia, sedation, urinary retention, blurred vision (pupil dilation)

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18
Q

Antihistamines work on what receptors?

A

H1 receptor antagonists

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19
Q

H1 blocker drugs

A

Dimenhydrinate, Meclizine

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20
Q

MOA of H1 blockers

A

central anticholinergic action (blocks CTZ) and decreases excitability of middle ear labyrinth & blocks conduction of middle ear-cerebellar pathways

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21
Q

clinical indications for H1 blockers

A

motion sickness (quick onset and doesnt last very long)

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22
Q

Which H1 blocker is best for treating vertigo?

A

meclizine

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23
Q

Phenothiazine derivatives work on which receptors?

A

H1 and D2 antagonists

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24
Q

Example of phenothiazine derivatives:

A

promethazine

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25
Q

MOA of promethazine?

A

D2 blocker in CTZ (decreases emetic input to medullary vomiting center) & a adrenergic blocker (decreases release of hypothalamic/hypophyseal hormones) & competes with histamine for H1 receptor

26
Q

Clinical indications of promethazine

A
  • motion sickness
  • antiemetic
  • adjunctive for pain management (and migraines)
  • tx allergic conditions
27
Q

why do you not give promethazine to kids <2yrs?

A

potentially fatal respiratory depression

28
Q

Drug interactions of promethazine:

A
  • CYP2D6 substrate
  • anticholinergics & CNS depressants
  • Levodopa
  • QTc prolongation
29
Q

ADRs of promethazine

A

similar to typical antipsychotics:

  • EPS
  • may alter cardiac conduction –> dysrhythmias
  • NMS
  • Amenorrhea/gynecomastia
  • Antihistaminic/cholinergic ADRs (like scopolamine)
30
Q

Dopamine Antagonists 3 classes:

A
  • Phenothiazines
  • Butyrophenones
  • Benzamides
31
Q

Phenothiazine drug

A

prochlorperazine

32
Q

MOA of prochlorperazine

A

blocks D1 & D2 receptors in the brain (including CTZ)

has a strong a adrenergic blocking effect

33
Q

clinical indications for prochlorperazine

A

antiemetic (used mostly by anesthesia and chemotherapy)

*only moderately effective

34
Q

contraindications of prochlorperazine

A
  • do not use in kids <2yrs (resp depression)

- do not use in pregnant women

35
Q

drug interactions and ADRs of prochlorperazine?

A

same as promethazine

36
Q

Butyrophenone drug

A

droperidol

37
Q

droperidol MOA

A

blocks central D1 & D2 receptors in brain (including CTZ)

38
Q

clinical uses of droperidol

A

preanesthetic agent for PONV

39
Q

droperidol BBW:

A

QTc prolongation

40
Q

Benzamide drugs

A
  • metoclopramide

- trimethobenzamide

41
Q

metoclopramide MOA

A

centeral & peripheral D2 blocking, blocks serotonin receptors in CTZ at high doses
*enhanced motility in UGI tissues

42
Q

metoclopramide indications

A

DM gastroparesis!!

use for PONV if pt unresponsive to other tx

43
Q

ADRs of metoclpramide

A

drowsiness

EPS (especially acute dystonia)

44
Q

What is metoclpramide’s BBW for?

A

acute dystonia

45
Q

Serotonin antagonists 1st generation

A
  • ondansetron
  • granisetron
  • dolasetron
46
Q

Serotonin antagonists 2nd generation

A

palonosetron

47
Q

serotonin antagonists MOA

A

block 5HT3 receptors in small bowel, Vagus N, and CTZ

These are the 1* tx for variety of causes of nausea

48
Q

setotonin antagonist clinical indications:

A
  • prevent CIE –> ALWAYS SCHEDULE THEM
  • nausea from irradiation
  • prevention & tx of PONV
49
Q

Ondansetron unlabeled use

A

peds with gastric enteritis in ED

50
Q

Ondansetron CYP interactions

A

3A4 substrate

51
Q

serotonin blockers class ARDs

A

HA = m/c

all have issues w QTc prolongation

52
Q

do these agents (aka serotonin antagonists) “chase down nausea” very well?

A

NAH BRAH!!

always start preemptively or right at the start of nausea for best results

53
Q

what weird method for treating nausea is “on the horizon”??

A

inhaled isopropyl alcohol

54
Q

N/V management in pregnancy:

A 
1 lifestyle changes
2 pyridoxine (Vit B6)
3 add H1 blocker to B6 
--Doxylamine*
--Dimenhydrinate
--Diphenhydramine
4 low dose ondansetron
5 phenothiazine
--promethazine
--metoclopromide
55
Q

why do we not like to use ondansetron in 1st trimester?

A

linked to a slight increased risk of CHD & cleft palate (also prolongs QTc interval)

56
Q

Other measures to help with nausea in pregnancy?

A

GINGER

57
Q

Management of Gastroparesis:

A 
1 dietary management 
2 optimize DM tx
3 avoid meds that can delay gastric emptying
4 use metoclopramide
5 try erythromycin
6 use doperidone or cisapride
58
Q

common causes of gastroparesis

A

DM, abd surgery, and drugs that decrease GI motility

59
Q

meds that can delay gastric emptying:

A
  • opioids
  • antichoilinergics
  • DM meds
  • lubiprostone
60
Q

domperidone & cosapride ADRs

A

QTc prolongation

*use only in refractory or severe gastroparesis!

61
Q

agent to try and use for refractory abd pain & nausea:

A

TCAs

Pharm Dedo Exam3 (3 decks)

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