NVDC tx Flashcards
Ondansetron
Antiemetic: 5-HT3 Antagonist (Seratonin Receptor antagonist)
MOA: blocks central 5-HT3 receptors in vomiting center
Use: acute chemotherapy-induced nausea (not helpful for delayed CINV)
- efficacy increased when used w/ corticosteroid- dexamethasone
- used on an as needed basis in hospital for N/V
(little efficacy on delayed CINV - due to short half-life)
ADRs: h/a, dizziness, constipation
*** QT prolongation (use cautiously w/ dolasetron)
Metoclopramide
Antiemetic
D2 Receptor Antagonist
MOA: inhibits D2 receptors (dopamine ) in the CTZ and solitary tract nucleus
* also has 5-Ht3 antagonism like effectiveness
prokinetic ability - *dopamine decreases force of contraction - antagonizing these lead to increased peristalsis (useful in diabetic gastroparesis)
Use: chemotherapy induced emesis, diabetic gastroparesis
ADRs:
** crosses BBB = see extrapyramidal sx: restlessness, dystonias, parkinsonian sx
Prochlorperazine
Antiemetic
D2 Receptor Antagonist
MOA: blockade of D2-like (D2, D3, D4) receptors in the CTZ and solitary tract nucleus
* also has 5-Ht3 antagonism like effectiveness
(antihistamine and anticholinergic effects!)
Use: first line general nausea/motion sickness
**ADRs: hypotention, sedation, hyperprolactinemia, extrapyramidal mvmt disorders
Diphenhydramine
“Benadryl”
= Antiemetic/antihistamine
MOA: H1 histamine antagonists w/ anticholinergic properties
Use: motion sickness **, post-op N/V, vertigo
ADRs: dizziness, sedation, confusion, dry mouth, urinary retention (anticholinergic effects)
promethazine
antiemetic/antihistamine
MOA: H1 histamine antagonists w/ antichoinergic properties
Use: motion sickness** , post-op N/V, inpatient N/V
ADRs: dizziness, sedation, confusion, dry mouth, urinary retention
scopolamine
antiemetic: antimuscarinic
MOA: muscarinic cholinergic receptor antagonist
USe: prevetion of motion sickness *** one of the best
ADRs: high incidence of anticholinergic SE’s when given orally - dizziness, dry mouth, etc - better tolerated as transdermal patch
dronabinol
cannabinoid antiemetic
MOA: stimulation of central CB1 cannabinoid receptor
USE: appetite stimulate and antiemetic - though not the most effective, so now not as commonly used
ADRs: euphoria, dysphoria, sedation, hallucinations, dry mouth, increased appetite, tachychardia, orthostatic hypotension
loperamide
opioid antidiarrheal agent
MOA: inhibit presynaptic cholinergic nerves in submucosa and myenteric plexus, increase transit time, increase fecal water absorption, decrease mass colonic mvmts
- non-prescription opioid: does not cross BB, no analgesic properties, no potential for addiction, tolerance to long-term use not reported
USE: mainstay of nonspecific tx for diarrhea; effective against moderate -severe- diarrhea
- controls sx of travelers diarrhea
- used as an adjunct for chronic diarrheal disease
ADR’s: generally well tolerated,
** may cause toxic megacolon in those with active IBD
dont use in pts. w/ UC colitis or dysentery
** discontinue use w/in 48 hours if sx don’t improve
Bismuth subsalicylate
“pepto-bismol” = Mucosal protective agent antidarrheal
see other flashcards
Psyllium
bulk forming laxative
contains: wheat bran, metamucil, methylcellulose, polycarbophil compounds etc….
MOA: indigestible, hydrophilic colloids will absorb water - forms bulky emollient gell that distends the colon and and promotes peristalsis
ADRs: bloating, flatus - imp to intake sufficient fluid to avoid obstruction
safe for long term use
saline laxatives
osmotic laxatives (ex. lactulose)
MOA: soluble but non-absorbable; increase stool liquidity due to obligate increase in fecal fluid
USE: tx acute constpiation or prevent chronic constpaiton
ADRs: do not use for prolonged periods w/ those w/ renal insufficiency
high doses promote prompt bowel evacuation w/in 1-3 hours - leads to rapid mvmt of water into distal small bowel and colon thus must increase fluid intake when taking these agents
polyethylene glycol-electrolytes
sugar/alcohol osmotic laxatives
USE: complete colon cleansing before GI endoscopic procedures
MOA: (increases osmotic intestinal concentration thus drawing water int) isotonic fluid that contains inert non-absorbable, osmotically active sugar and other compounds. designed to that no significatn intravascular fluid or electrolyte shifts occur.
no significant cramps or flatulus
senna
stimulant laxatives
MOA: direct stimulation of enteric nervous system and colonic electrolyte and fluid secretion (should be used at low dose, short time)
USE: not recommended as first line therapy - reserved for pts. who fail to respond to bulking and osmotic laxatives
- may be reqd on long term basis for neurologically impaired pts.
- often given when pts. are prescribed opiods for pain - which would cause constipation
docusate
stool softener laxatives
Docusate and glycerin suppository
MOA: allows water and lipids to penetrate stool which softens it
USE: used in hospital to prevent constipation and minimize straining
- doesn’t treat constpation, but prevents it
- ineffective for tx but useful for prevention
metoclopramide
prokinetic - pro-motility agent
- enhance coordinated GI motility and transit of material in the GI tract (useful for diabetic gastroparesis)
MOA: central and peripheral dopamine (D2) antagonist; serotonin agonist; cholinesterase inhibitor - enhances motility of the upper GI tract, acclererates gastric emptying, increases esophageal peristaltic amplitude, increases lower esophageal sphincter pressure - has no effect on small intestine or colonic motility
USE: used prior to meals and at bedtime to control nausea and vomiting that accompany GI motility disorder, diabetic gastroparesis, GERD and pregnancy
* also used during cancer chemo as antiemetic
ADRS: crosses the BBB thus results in extrapyramidal sx of restlessness, drowsiness, insomnia, anxiety, agitation, depression
** hyperprolactinemia –> galactorrhea, breast tenderness and menstrual irregularities
