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Pharmacology: GI > Nausea, Vomiting, Diarrhea and Constipation > Flashcards

Nausea, Vomiting, Diarrhea and Constipation Flashcards

1
Q

What receptors are located within the vomiting center in the brain?

A

Acetylcholine
Dopamine
5- FHT3 (seratonin)
Histamine

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2
Q

How is the vomiting/emesis center activated?

A
  • Afferent fibers in the gut
  • Chemoreceptors trigger zone
  • Cerebral cortex
  • Vestibular apparatus
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3
Q

What is the mechanism of action of scopolamine?

A
  • Blocks acetylcholine at parasympathetic sites (smooth muscle, secretory glands, CNS)
  • Reduces histamine and serotonin activity
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4
Q

What is the PK of scopolamine?

A

-SubQ or transdermal admin
-Change patch every 3 days
-Onset: 6-8hrs; duration 72hrs
-Hepatic metabolism

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5
Q

What are the side effects of scopolamine?

A

-Tachycardia, flushing, dry mouth, blurred vision, drowsiness, urinary retention, constipation, psychosis, hallucinations

*Similar to atropine

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6
Q

What are the special considerations for scopolamine?

A

Contraindicated in narrow-angle glaucoma or with other agents containing belladonna

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7
Q

What are the major interactions for scopolamine?

A

Anticholonergic agents
Other CNS depressants
SSRIs
Thiazides

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8
Q

What are the uses of Prochlorperazine (Compazine)?

A

N/V

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9
Q

What is the MOA of Prochlorperazine?

A

Antagonizes D2 receptors in the CTZ and gut, also blocks M1 and H1 receptors

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10
Q

What is the PK of Prochlorperazine?

A
  • Oral or rectal admin
  • Duration 3-4 hours oral, or 3-12 rectal
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11
Q

What antiemetic agents are associated with the side effect of tardive dyskinesia?

A

Prochlorperazine
Metoclopramide

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12
Q

What are the side effects of prochlorperazine?

A

Extrapyramidal effects, tardive dyskinesia, hypotension, long QT, CNS effects

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13
Q

What are the uses for metoclopramide?

A
  • Chemotherapy-induced and post-op N/V
  • Documented gastroparesis
  • Off label: tx of hiccups and N/V of early pregnancy
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14
Q

What drug can be used off label for the treatment of hiccups in pregnancy as well as N/V?

A

Metoclopramide

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15
Q

What is the PK of metoclopramide?

A

Oral or IV admin
- Short duration of action, dosed 3-4 times per day
- CYP2D6

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16
Q

What are the two big side effects associated with metoclopramide?

A

Tardive dyskinesia and hyperprolactinemia

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17
Q

What are the indications of use for ondansetron (zofran)?

A
  • Chemotherapy induced N/V, management of post-op N/V
  • Effective when used alone and even more effecting when in combo with dexamethasone
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18
Q

What drug can be combined with ondansetron to improve efficacy?

A

Dexamethasone

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19
Q

What is the MOA of ondansetron?

A

Selectively blocks 5-HT3 receptors in the periphery and brain

20
Q

What is the PK of ondansetron?

A
  • Oral or IV admin
  • Onset 30 min, peak 1-2 hours
  • Extensively metabolized in the liver
  • Dose adjust in hepatic impairment
21
Q

What are the SE of ondansetron?

A
  • HA, dizziness, confusion, SOB, constipation, Long QT***

Monitor EKG and watch for signs of serotonin syndrome

22
Q

What are the indications of use for dronabinol?

A
  • Second line for chemo-induced N/V
  • Stimulate appetite in patients with AIDS
23
Q

What medication can be used to stimulate appetite in patients with AIDS?

A

Dronabinol

24
Q

What is the MOA of dronabinol?

A

Activates cannabinoid receptors

25
Q

What is the PK of dronabinol?

A

Oral admin, onset in 30-60 minutes
Duration 4-6 hours
Hepatic metabolism

26
Q

What are the SE assocaited with dronabinol?

A

Euphoria, CNS changes, abd pain, vomiting, flushing, hoptension, vertigo

27
Q

What should be monitored while on dronabinol?

A

HR and BP, and cannibis hyperemesis

28
Q

What are the contraindications for dronabinol?

A

Psych disorders and SUD

29
Q

What are the indications of us for promethazine?

A
  • reduce emesis ass with surgery, cancer chemo, and toxins
  • widely used in children
  • motion sickness
30
Q

What antiemetic agent is widely used in children?

A

Promethazine

31
Q

What is the MOA of promethazine?

A

Antihistamine –> blocks D2 receptors in the CTZ and blocks H1 receptors in the brainstem

32
Q

What is the PK of promethazine?

A
  • Oral, IM, or IV
  • Duration 4-6 hours
  • CYP metabolism
33
Q

Are EKG changes associated with promethazine use?

A

Yes

34
Q

What antiemetic agents are OCT to treat motion sickness?

A

Meclizine (Bonine)
Dimenhydrinate (Dramamine)

35
Q

What is the MOA of Meclizine?

A

Blocks H1 and M1 receptors –> Depresses labyrinth excitability and vestibular stimulation

36
Q

Meclizine should be avoided in what conditions?

A

Glaucoma, asthma, urinary retention, pyloric/duodenal obstruction

37
Q

What antiemetic agent depresses labyrinth excitability and vestibular stimulation in the treatment of motion sickness?

A

Meclizine

38
Q

What is the MOA of Dimenhydrinate (Dramamine)?

A

Blocks H1 receptors in peripheral sites and CTZ
Has anti-cholinergic effects

39
Q

What is the PK of dimenhydrinate (dramamine)?

A
  • Oral and IM admin
  • Onset 30 minutes, duration 4-6 hours
  • Hepatic metabolism
40
Q

What are the side effects associated with dimenhydrinate?

A

Tachycardia, anorexia, epigastric distress, sedation, dizziness, xerostomia, blurred vision, SJS

41
Q

What are the bulk-forming laxatives and what are the MOA?

A

Methylcellulose
Psyllium (Metamucil)

MOA: absorb and retain water in the intestine –> increase mass of stool, promotes peristalsis
Same effect as dietary fiber

42
Q

What are the SE of bulk-forming laxitives?

A
  • Systemic sx rare
  • Esophageal obstruction possible if not swallowed with water
  • Bloating, flatulence, GI distress
43
Q

What patients is lactulose recommended?

A

Not commonly used, reserved for pts who do not respond to bulk-forming agents

44
Q

What is the MOA of magnesium oxide (milk of magnesia)?

A

Saline-laxative, retains water in the intestines –> increases intraluminal pressure and promotes peristalsis

45
Q

What is the gold standard osmotic laxative for colonoscopy preps?

A

Polythyleneglycol-PEG (MiraLAX)

46
Q

What is a major drug interaction with Polythyleneglycol-PEG?

A

Digoxin

47
Q

What laxatives can be used in opioid induced constipation?

A

Nalaxegol
Methylnaltrexone
Lubiprostone

Pharmacology: GI (5 decks)

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