Pharm Flashcards
receptors that trigger N/V
5HT3, H1, M1, D2, NK1 (substance P)
what kind of receptor might we agonize to alleviate N/V
cannabinoid
what do we use to help with anticipatory N/V
benzodiazepines
-setron medications (ondansetron, dolasetron, granisetron, palonosetron) antagonize what receptor to help with N/V
5HT3
-pitant medications (aprepitant, fosaprepitant, netupitant, rolapitant) antagonize what receptor to help with N/V
NK1 (substance P)
what are H1 antagonists that alleviate N/V
diphenhydramine, dimenhydrinate, hydroxyzine, promethazine, meclizine, cyclizine
which M1-R antagonist is used to help control N/V
scopolamine
what are the cannabinoid receptor AGONISTS used to treat NV
dronabinol, nabilone
what are serotonin receptor antagonists indicated for
strong antiemetic- chemotherapy, radiation, post operative, or pregnancy induced NV
most worrisome adverse affect of 5HT3 antagonists (especially dolasetron)
dose dependent QT prolongation / torsades
QT prolonging agents and antiarrythmics are interactions with 5HT3R blockers because why
they all use cyp450
the only IV NK1 inhibitor
fosaprepitant
what are NK1 receptor antagonists indicated for
moderate antiemetic: chemotherapy or prophylaxis post operation
H1-R antagonists are weak anti emetics originally designed for other purposes but found to exhibit varying levels of central _____
anticholinergic at CTZ
what are H1 receptor antagonists indicated for use in NV related to motion sickness or vertigo
meclizine, cyclizine
H1-R, M1, and D2-R antagonists have what adverse side effects
typical anticholinergic (drowsy, dry mouth, constipation, urinary retention, blurred vision, low BP)
what are the 2 families of D2 R antagonists used in NV tx
phenothiazine, metoclopramide
when is a D2 inhibitor indicated
weak to moderate antiemetic: also enhances GI motility (especially metoclopramide)
when are cannabinoids indicated for use
strong antiemetic only indicated after a patient has tried other anti emetics that are not effective (chemotherapy), appetite stimulation
cannabinoids have interactions with what kinds of drugs
CNS depressants, CV agents, sympathomimetics
high emetogenic (severe NV due to chemotherapy) regimen
3 drugs (NK antagonist, 5HT3 antagonist, corticosteroid) ((add cannabinoid if tx resistant))
moderate emetogenic (NV due to chemotherapy) regimen
2 drugs (5HT3 R antagonist, corticosteroid)
this med is given for diabetic gastroparesis which helps with NV and dysmotility
metoclopramide
antacids do not affect the amount of acid produced, they simply neutralize whatever is in the lumen. what else do they do
increase LES tone
what are the two preferred OTC antacids
calcium, magnesium
dose related side effects of using aluminum as an antacid
constipation, hypophosphatemia
what are the side effects of using calcium as antacid
constipation, hypercalcemia, hypophosphatemia
antacids have what unique risk when it comes to drug interactions
ALL meds should be taken 1-2 hr after or 2-4 hr before antacids (messes with absorption otherwise)
-tidine meds (cimetidine, famotidine, nizatidine, rinitidine) antagonize what receptor to help fix ulcers
H2
-prazole meds (lansoprazole, dexlansoprazole, omeprazole, esomeprazole, pantoprazole, rabeprazole) antagonize what receptor to help with ulcers
PPI’s
how does sucralafate (sucrose + aluminum) help with ulcers
surface acting agent (a bandaid)
how does misoprostol help with ulcers
PGE1 analog
which H2 blocker (used for ulcers) is the prototypical inhibitor of several CYP450 enzymes
cimetidine
which class of anti-ulcer drug can potentially block ALL formation of acid in the stomach
PPI’s (block H/K ATPase of parietal cells)
PPI’s and H2 blockers can help to heal an ulcer in 4-8 weeks EXCEPT under what circumstance
H pylori ulcers: these require an antibiotic also!
why must we stop PPI use in a patient who develops diarrhea
CDAD (C diff associated diarrhea – can lead to death)