Oto Pharm

Question 1

Irreversible ototoxic drugs

Answer 1

Aminoglycosides, cisplatin, and maybe loop diuretics (furosemide)

Question 2

MOA of ototox seen in aminoglycosides

Answer 2

Entry into outer hair cell through mechanoelectrical transucer channels -> formation of AG-Fe complex to form ROS -> Activation of JNK -> nucleus for increase in cell death pathway -> to mitochondria -> increase cytochrome c -> increase capsases and cases-independent apoptosis

Question 3

MOA of cisplatin ototox

Answer 3

entry into outer hair cell -> formation of monohydrate complex -> activate NOX -> increase ROS -> activate JNK -> … -> apop via CAPSASE DEPENDENT MECH ONLY

Question 4

MOA of ototox seen with furosemide (loop diuretics)

Answer 4

Block Na/K/2Cl channels also in ear= disruption of fluid balance with edema and loss of fx

Question 5

T/F: Dose dependent ototox with aminoglycosides and loop diuretics

Answer 5

True

Question 6

Which drugs are considered inappropriate for use in geriatric pts

Answer 6

Antihistaminergics aka Diphenhydramine, meclizine, and promethazine

Question 7

Vertigo tx with longest duration

Answer 7

Scopalamine

Question 8

Which antihistaminergic has a BBW for use by injection

Answer 8

Promethazine

Question 9

AntiCHOLINERGIC used in vertigo that blocks M1 and stimulation of VIII

Answer 9

Scopalamine

Question 10

Antihistamines utilized in vertigo affect which receptors

Answer 10

H1 and M1 (block)

Question 11

Major receptors found in chemoreceptor trigger zone (CTZ).

Answer 11

Serotonin (5-HT), dopamine (D2), and opiods

Question 12

Major receptors found in solitary nucleus tract (STN)

Answer 12

Enkephalin, histamine, Ach, and Serotonin (5-HT3)

Question 13

3 phases of vomiting

Answer 13

Pre-ejection, retching, and ejection

Question 14

Location of the central emesis center

Answer 14

Lateral reticular formation

Question 15

How does CTZ monitor blood and CSF for toxic substances to trigger nausea and vomiting sensations through central emesis center?

Answer 15

Lack of BBB

Question 16

Central emesis center receives information from what areas?

Answer 16

Gut (vagus n), CTZ, Cerebral cortex (anticipatory vomiting), and vestibular apparatus (motion sick)

Question 17

Efferents from central emesis go where?

Answer 17

Nuclei in charge of salivation, respiration and vasomotor activity

Question 18

Ex of serotonin antagonists

Answer 18

OndanSETRON, graniSETRON, dolaSETRON

Question 19

ADE of Setrons

Answer 19

Hypersensitivity rxn, QT prolongation, interactions with CYP inhibitors

Question 20

What drug increases the 5HT-3 blockage of setrons?

Answer 20

Dexamethasone

Question 21

Most effective class of anti-emetics

Answer 21

Setrons (serotonin blockers)

Question 22

T/F: D2 antagonists are for use in Chemo-induced NV

Answer 22

False

Question 23

D2 receptor antagonism works at which part of the NV cascade

Answer 23

Chemoreceptor trigger zone

Question 24

ADE with chronic use of Clor-azine

Answer 24

Bone marrow suppression and blood dyscrasias and QT prolongations

Question 25

What drug class are you worried about mixing with chlor-azines

Answer 25

Antipsychotics

Question 26

Two D2 receptor antagonists

Answer 26

ProCHLORperAZINE and CHLORpromAZINE

Question 27

MOA of AREPITANT and fosapREPITANT

Answer 27

Substance P/neurokinin-1 recep antagonist (work in solitary tract)

Question 28

T/F: REPITANTS do not interact with CYP

Answer 28

F (CYP 3A4)

Question 29

Two cannabinoid recep agonists

Answer 29

Dronabinol and THC

Question 30

MOA of Dronabinol and THC

Answer 30

Opposes 5-HT3 mediated stimulation of vagus and appetite stimulation

Question 31

ADE of Dronabinol and THC (if its really an ADE)

Answer 31

Getting highhhhhhhhh and the munchies

Question 32

In terms of an antiemesis effect, where do corticosteroids work

Answer 32

Steroid receptors in STN

Question 33

Drug used in anticipatory vomiting (CNS effect) and vertigo

Answer 33

Diazepam

Question 34

Cisplatin, mechlorethamine, streptozotocin, cyclophosphamide, carmustine and dacarbazine have what in common?

Answer 34

All high likelihood of emesis when used as chemotherapy