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Pharmacology > Palliative Drugs > Flashcards

Palliative Drugs Flashcards

1
Q

Name two dopaminergic antiemetics

A

Domperidone

Metclopramide

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2
Q

When are anti-dopaminergic antiemetics indicated

A

N+V due to reduced gut motility

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3
Q

Where are D2 receptors found

A

Chemoreceptor trigger zone

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4
Q

What is role of domperidone and metclopramide

A

D2 receptor antagonists

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5
Q

What is role of D2 in the gut

A

Causes relaxation of LOS and gut

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6
Q

What is the role of D2 receptor antagonists

A

Increase peristaltic contraction

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7
Q

What is a gastric side effect of anti-dopaminergic anti-emetics

A

Diarrhoea

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8
Q

What can metclopramide cause

A

Extrapyramidal side effects - usually in the form of acute dystonic reaction

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9
Q

What is acute dystonia

A

Sustained muscle contraction

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10
Q

Name two types of acute dystonic reaction

A
  • Torticolis

- Oculogyric crisis

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11
Q

What is an oculogyric crisis

A

Sustained upward deviation of the eyes

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12
Q

Why does domperidone not cause extra-pyramidal SEs

A
  • As it does not cross the BBB
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13
Q

What is a specific side effect of domperidone

A
  • Prolongs the QT interval predisposing to arrhythmias
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14
Q

What is done to reduce risk of extrapyramidal SEs with metlcoptramide

A
  • Prescribe for less than 5 days
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15
Q

What are two absolute CIs of metclopramide and domperidone

A
  • Neonates (Increase adverse effects)

- Intestinal obstruction and perforation

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16
Q

What is an absolute CI of domperidone

A

Prolong QT Syndrome

17
Q

When should metclopramide be avoided

A

Parkinson’s Disease

18
Q

What drug should metclopramide not be combined with

A

Dopaminergic agents for PD - as antagonist each other

19
Q

What drugs should domperidone not be prescribed with

A
  • Other drugs prolong QT (SSRI, Macrolide)

- CYP450 Inhibitors

20
Q

What increases risk of extra-pyramidal SEs

A

prescribing with an antipsychotic

21
Q

Name 3 anti-histamine anti-emetics

A

Cylizine
Promethazine
Cinnarizine

22
Q

When are anti-histamine anti-emetics useful

A
  • Motion sickness

- Nausea due to vestibular problems

23
Q

Where are H1 and muscarinic receptors located in nausea

A

Vomiting centres

24
Q

What is the main side effect of H1 antagonism

A

Drowsiness

25
Q

What is the least sedative anti-H1 anti-emetic

A

Cyclizine

26
Q

Due to additional anti-cholinergic effects, what SEs may cylizine cause

A

Dry mouth

27
Q

After initial IV infusion what can anti-H1 anti-emetics cause and how is this experienced

A

Transient tachycardia- can cause palpitations

28
Q

When should anti-H1 anti-emetics be used with care

A
  • Those at risk of hepatic encephalopathy

- Those at risk of anti-cholinergic side effects

29
Q

What could cyclizine cause if used in someone with BPH

A

Acute urinary retention

30
Q

What drugs should cyclizine not be prescribed with

A

Other sedatives

31
Q

When may anti-cholinergic effects be more pronounced

A

Prescribe with tiotropium or ipratropium

32
Q

Name 2 5HT3 receptor antagonists

A
  • Ondansetron

- Graniestron

33
Q

When are 5HT3 antagonist anti-emetics useful

A
  • Chemotherapy or GA anesthesia
34
Q

Where is there a high concentration of 5HT3

A

CTZ

35
Q

Where else are 5HT3 receptors found

A

Gut - they stimulate vagus nerve to stimulate solitary tract nucleus and vomiting centres

36
Q

Explain SE ondansetron

A

SE’s are rare - can cause constipation, diarrhoea and headaches

37
Q

What is a risk with 5-HT3 antagonists

A

Prolong QT interval

38
Q

What drugs should 5HT3 antagonists not be prescribed with

A

Drugs prolong QT interval

Pharmacology (12 decks)

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