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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
What is the PK of dronabinol?
Oral admin, onset in 30-60 minutes Duration 4-6 hours Hepatic metabolism
26
What are the SE assocaited with dronabinol?
Euphoria, CNS changes, abd pain, vomiting, flushing, hoptension, vertigo
27
What should be monitored while on dronabinol?
HR and BP, and cannibis hyperemesis
28
What are the contraindications for dronabinol?
Psych disorders and SUD
29
What are the indications of us for promethazine?
- reduce emesis ass with surgery, cancer chemo, and toxins - widely used in children - motion sickness
30
What antiemetic agent is widely used in children?
Promethazine
31
What is the MOA of promethazine?
Antihistamine --> blocks D2 receptors in the CTZ and blocks H1 receptors in the brainstem
32
What is the PK of promethazine?
- Oral, IM, or IV - Duration 4-6 hours - CYP metabolism
33
Are EKG changes associated with promethazine use?
Yes
34
What antiemetic agents are OCT to treat motion sickness?
Meclizine (Bonine) Dimenhydrinate (Dramamine)
35
What is the MOA of Meclizine?
Blocks H1 and M1 receptors --> Depresses labyrinth excitability and vestibular stimulation
36
Meclizine should be avoided in what conditions?
Glaucoma, asthma, urinary retention, pyloric/duodenal obstruction
37
What antiemetic agent depresses labyrinth excitability and vestibular stimulation in the treatment of motion sickness?
Meclizine
38
What is the MOA of Dimenhydrinate (Dramamine)?
Blocks H1 receptors in peripheral sites and CTZ Has anti-cholinergic effects
39
What is the PK of dimenhydrinate (dramamine)?
- Oral and IM admin - Onset 30 minutes, duration 4-6 hours - Hepatic metabolism
40
What are the side effects associated with dimenhydrinate?
Tachycardia, anorexia, epigastric distress, sedation, dizziness, xerostomia, blurred vision, SJS
41
What are the bulk-forming laxatives and what are the MOA?
Methylcellulose Psyllium (Metamucil) MOA: absorb and retain water in the intestine --> increase mass of stool, promotes peristalsis Same effect as dietary fiber
42
What are the SE of bulk-forming laxitives?
- Systemic sx rare - Esophageal obstruction possible if not swallowed with water - Bloating, flatulence, GI distress
43
What patients is lactulose recommended?
Not commonly used, reserved for pts who do not respond to bulk-forming agents
44
What is the MOA of magnesium oxide (milk of magnesia)?
Saline-laxative, retains water in the intestines --> increases intraluminal pressure and promotes peristalsis
45
What is the gold standard osmotic laxative for colonoscopy preps?
Polythyleneglycol-PEG (MiraLAX)
46
What is a major drug interaction with Polythyleneglycol-PEG?
Digoxin
47
What laxatives can be used in opioid induced constipation?
Nalaxegol Methylnaltrexone Lubiprostone

Pharmacology: GI (5 decks)

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