NVDC Tx I Flashcards
What are the 2 groups of D2 R antagonists antimetics
substituted benzamides and phenothiazines
what is the substituted benzamide antimetics
metoclopramide
what are the phenothiazines antimetics
prochlorperazine
what are the antihistamines antimetics
diphenhydramine
promethazine
what are the antimuscarinic anitmetics
scoppolamine
what are the cannabinoid antimetics
dronabinol
what are the opiod antidiarrheal
loperamide
what are the mucosal protective agents for antidiarrhea
bismuth subsalicylate
what are the types of laxatives
bulk forming
osmotic
stimulant
stoof softners
what are the osmotic laxatives
saline and polyethylene glycol-electrolytes
what are the prokinetic (pro motility agents)
metoclopramide
what R are found in the vomiting center
Ach Muscarinic, histmaine, neurokinin1 and serotonin
MOA ondansetron
blocks central serotonin R in vomiting center and chemR trigger zone and on peripheral extrinsic vagal and spinal afferent nn
how is ondansetron taken and where is majoirty metabolized
PO or IV
hepatic metabolism
therapeutic use ondansetron
acute chemotherapy induced nausea and vomiting
post operative and post radiation
how cna you increase efficacy of ondansetron
when used in combination with corticosteroid and NK R antagonist
adverse effects ondansetron
HA, dizziness, constipation
QT prolongation
drug interactions with ondansetron
no significant ones
MOA metoclopramide and prochlorperazine
block D2-like R in CTZ and solitary tract nucleus
therapeutic use metoclopromide
chemo induced emesis
therapeutic use phenothiazine
general purpose antiemetic
antihistaminic and antichoinergic activities
adverse effects metoclopromide
cross bbb so restlessness, dystonias, parkinsonian Sx
adverse effects chronic use phenothiazine
hypotension, sedation, hyperprolactinemia, extrapyramidal movement disorders
MOA antihistamines
H1 antagonism with anticholinergic and antidopaminergic properties
therapeutic use of antihistamines
mostion sickness
post operative nausea and vomiting
suppress vertigo
adverse effects antihistamines
dizziness, sedation, confusion, drymouth and urinary retention
MOA scopolamine
prototypical cholinergic antagonis
therapeutic use scopalamine
motion sickness
adverse effects scopolamine
anticholinergic effects
better tolerated as transdermal patch
MOA cannabinoids
unknown, maybe stimulation of central CB1 R
therapeutic use cannabinoids
appetite stimulant and antiemetic
adverse effects cannabinoids
euphoria, dysphoria, sedation, hallucinations, dry mouth, increased appetite
tachycardia, conjunctival injection and orthostatic hypotension
What is prototype neurokinin R antagonist
aprepitant
MOA aprepitant
substance P is a peptide NT that is highly selective. crosses bbb
therapeutic use NK R antagonist aprepitant
used in combo with serotonin antagonists and corticosteroids for acute delayed nausea and vomiting
adverse effects NK R antagonists
fatigue, dizziness, diarrhea
drug interatctions NK R antagonists
CYP3A4
Will decrease INR in warfarin patients
prototype corticosteroids
dexamethasone
MOA dexamethasone
exact antiemetic mech unknown, may involve suppression of inflammation and PG production
therapeutic use dexamethasone
increase efficacy of serotonin antagonist for prevention acute and delayed nausea and vomiting in those having chemo.
post operative nausea and vomiting prevention
what are the benzodiazepines
lorazepam, alprazolam, diazepam
Acute nausea and vomiting definition from chemo
within 24 hours chemo
delayed definition chemo
nausea and vomtiing after 24 hours
anticipatory deficinition for chemo vomitiing
prior to chemo
learned, conditioned, usually by 4th cycle
risk factors for anticipatory vomiting and nause with chemo
<50y.o, nausea, vomiting after previous chemo, sweating, susceptibility to motion sickness
breakthrough emesis with chemo
emesis despite prophylactic antiemetic administration (need rescue agents)
refractory emesis with chemo
poor response to multiple antiemetic regimens
drug regimen for acute CINV highly emetogenic
day1: serotoni R antagonist + NK R antagonist+glucocorticoid
day 2: NKR antagonist+ glucocorticoid
day3: NKR antagonist
day4: glucocorticoid
moderate emetogenic chemo for acute CINV
day 1: 2 drug regimen of serotonin R antagonist+glucocorticoid
day 3: glucocorticoid
drug for acute CINV low emetogenic chemo
dexamethasone +
prochlorperazine or metoclopramide
or diphenhydramine
or lorazepam
anticipatory NV prophylaxis
alprazolam or lorazepam night before and morning of
rescue mediations for breakthrough/refractory CINV
prochlorperazine, promethazine, lorazepam, metoclopramide, serotonin antagonist, desxamethasone, cannabinoids
Post operative Tx for Nausea and vomitiing
serotonin antagonists, prochlorperazine, metoclopramide, haloperidol
when to administer dexamehtasone for post operative NV prevention
at time of anesthesia
what is used for mild to moderate motion sickness
promethazine
initial management for vomiting from pregnancy
dietary changes and lifestyle modificaion
persistant vomiting during pregnancy Tx
1st line: pyridoxine
dehydration Sx: IV and thiamine
ondansetron IV prn
when to use corticosteroids for pregnancy assoc nausea and vomiting
reserved for refractory Sx or hyperemesis gravidarum
