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GI II Exam 3 > Pharm of Nausea, Vomiting, Diarrhea > Flashcards

Pharm of Nausea, Vomiting, Diarrhea Flashcards

1
Q

Antiemetics - categories

A 
5-HT3 Antagonists
D2-Receptor Antagonists
Antihistamines
Antimuscarinics
Cannabinoids
Neurokinin-REceptor Antagonists
Corticosteroids
Benzodiazepines
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2
Q

Antiemetics- 5HT3 Antagonists

A
  • Ondansetron

Dolasetron
Granisetron
Palonosetron

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3
Q

Antiemetics- D2-Receptor Antagnoists

A

Substituted Benzamide:
* Metoclopramide (Reglan)

Phenothiazines:
Chlorpromazine (Thorazin)
* Prochlorperazine (Compazine)
Thiethylperazine

Butyrophenones:
Droperidol

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4
Q

Antiemetics: Antihistamines

A 
Dimenhydrinate (Dramamine)
* Diphenhydramine (Benadryl)
Hydroxyzine (Vistaril)
Meclizine (Antivert)
* Promethazine (Phenergan)
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5
Q

Antiemetics- Antimuscarinics

A

Scopalamine

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6
Q

Antiemetics- Cannabinoids

A

Dronabinol

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7
Q

Opioids

A

anti-diarrheal

  • Loperamide (Imodium)
  • Diphenoxylate (Lomotil)
    Difenoxin
    Paregoric (generic, camphorated opium tincture, morphine)
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8
Q

Somatostatin Analog

A

anti-diarrheal

Octreotide acetate

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9
Q

Mucosal Protective Agents

A

anti-diarrheal agent

Bismuth subsalicylate

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10
Q

Bulk-Forming Laxatives

A
  • Psyllium (Metamucil)
    Methylcellulose (Citrucel)
    Polycarbophil (FiberCon)
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11
Q

Stool Softeners

A
  • Docusate (Colace)
    Glycerin
    Mineral Oil
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12
Q

Osmotic Laxatives

A
  • Saline Laxatives
    Nondigestible sugars and alcohols
  • Polyethylene Glycol-Electrolytes
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13
Q

Stimulant Laxatives

A

Aloe
* Senna (Senokot)
Cascara
* Bisacodyl (Dulcolax)

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14
Q

Opioid Receptor Antagonists

A

Alvimopan
* Methylnaltrexone (Relistor)

(laxative)

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15
Q

motion sickness pathophys

A

vestibular system

H1 and M1 receptors

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16
Q

mechanism of action for the agent most appropriate for motion sickness?

A

H1 receptor agonist

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17
Q

Pick which drug is best for motion sickness:

Dronabinol
Fosaprepitant
Loperamide
Ondansetron
Promethazine
A

Promethazine- H1 receptor antagonist

Dronabinol - CB1 receptor agonist
Fosaprepitant- NK1 receptor antagonist
Loperamide- Opioid receptor agonist
Promethazine- 
Ondansetron is the 5-HT3 receptor antagonist
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18
Q

When do we use dronabinol?

A

Chemotherapy– breakthrough or refractory vomiting

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19
Q

When do we use Fosaprepitant

A

primary agent for chemotherapy

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20
Q

When do we use Loperamide?

A

slows GI motility

useful for diarrhea

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21
Q

ADRs of promethazine

A

dizziness
sedation, urinary retention, constipation, confusion, dry mouth; use caution when performing activities where you need to pay attention

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22
Q

When dimenhydrinate is not enough for rough waters induced motion sickness, waht should we take?

A

scopolamine

ADRs are the anti-muscarinic ones again

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23
Q

pyelonephritis –> nausea
pt also taking Risperidone (mixed seratonin 5-HT2 and dopamine D2 antagonist activity) and Sertraline (SSRI)

What’s the best medication?

A

don’t want to combine metoclopramide or prochlorperazine and resperidone because they are all D2 antagonists; can –> sedation, drowsiness, and Parkinson’s like issues (dyskinesia, anxiety, etc.: Extrapyramidal reactions)

Ondansetron is a good plan, but be careful of serotonin syndrome (hyperthermia, hypertension, tremor, vomiting, etc.)

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24
Q

How does diphenhydramine work?

A

H1 receptor antagonis

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25
Q

How does Metoclopramide work?

A

D2 receptor antagonist

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26
Q

How does ondansetron work?

A

5HT3 receptor antagonis

27
Q

How does Prochlorperazine work?

A

D2 receptor antagonist

28
Q

Agents for acute CINV

A 
Acute CINV:
5HT3 receptor antagonist
NK1 receptor antagonist
Corticosteroid
Olanzapine
29
Q

Agents for Delayed CINV

A

NK1 receptor antagonist
corticosteroid
olanzapine

30
Q

Agents for anticipatory CINV

A

benzodiazepines

31
Q

agents for breakthrough and refractory CINV

A

an antiemetic from different pharmacological class (prochlorperazine, promethazine, lorazepam, olanzapine, metoclopramide, 5HT3 antagonist, dexamethasone, cannabinoids)

32
Q

Chemotherapy nausea and vomiting pathophysiology

A

Chemorecetpor trigger zone (area postrema): D2 receptor, NK1 receptor? (5-HT3 receptor)

Vomiting center (nucleus of tractus solitarius: H1 receptor, M1 receptor, NK1 receptor? (5-HT3 receptor)

GI tract: mechanoreceptors, chemoreceptors, 5-HT3 receptors

CNS areas: cortex, thalamus, hypothalamus, meninges (related to anxiety)

33
Q

What agent causes QT prolongation?

A

ondansetron

espectially in combination with a bunch of other anti- drugs.

34
Q

negative effects of 5-HT3 receptor antagonist?

A

headache, dizziness, constipation

35
Q

negative effects of CB1 receptor agonist

A

euphoria, dysphoria, sedation, hallucinations, dry mouth

36
Q

side effects of H1 receptor antagonist

A

dizziness, sedation, confusion, dry mouth, urinary retention

37
Q

side effects of NK1 receptor antagonist?

A

fatigue, dizziness, diarrhea

38
Q

side effects of opioid receptor agonist?

A

constipation

39
Q

constipated guy (3 days no poo) on lisinopril, verapamil, acetaminophen, oxycodone.

What do we think?

A

acute constipation

potential causes: oxycodone (slows GI motility) and verapamil

Best therapy would be bisacodyl; fastest

psyllium will take too long (3-5 days)
docusate won’t help increase GI tract motility; better for prevention

40
Q

Bisacodyl suppository is what kind of drug?

A

stimulant laxative

stimulates enteric nervous system

41
Q

docusate table works how?

A

stool softener

allows lipids and water to penetrate the stool

42
Q

methylnaltrexone works how?

A

opioid antagonist

43
Q

psyllium powder works how?

A

bulk forming; absorbs water, distends colon, increases peristalsis

44
Q

sodium phosphate oral solution works how?

A

osmotic laxative - results in increased liquid in the stool

45
Q

time course of drug therapies- what softens stools in 1-3 days?

A

bulk-forming laxatives
emollients
osmotic laxatives (polyethylene glycol- low dose, lactulose, sorbitol)

46
Q

time course of drug therapies- what softens stools in 6-12 hours?

A

bisacodyl (PO, Senna, magnesium sulfate

47
Q

Time course of drug therapies- what causes watery evacuation in 1-6 horus?

A 
magnesium citrate
magnesium hydroxide
magnesium sulfate (high dose)
sodium phosphates
bisacodyl (PR)
Polyethylene glycol (bowel prep)
48
Q

methylnaltrexone MOA, use, CI

A

MOA: selective inhibition of mu - opioid receptors. Does not cross BBB. Inhibits peripheral receptors without affecting analgesia

Therapeutic use: opioid induced constipation in patients receiving palliative care for advanced illness (with inadequate response to other therapy)

CI: GI obstruction

Very effective but also very expensive

49
Q

Guy ate raw oysters and has watery, non-bloody diarrhea

A

viral gastroenteritis

address rehydration- he is still tolerating juice, so glucose/ soups rich in electrolytes

What should we give for the diarrhea?

an oral opioid agonist such as loperamide

50
Q

docusate therapeutic class?

A

stool softener

51
Q

loperamide therapeutic class?

A

opioid agonist

52
Q

octreotide therapeutic class?

A

somatostatin analog

53
Q

ondansetron therapeutic class?

A

antiemetic

54
Q

Senna therapeutic class?

A

stimulant laxative

55
Q

what do we reserve octreotide for?

A

endocrine tumors

56
Q

Best choices for acute chemotehrapy-induced nasuea and vomiting

A

(within 24 hours of chemotherapy administration)
COMBINATIONS: 5-HT3 receptor antagonist, NK1 receptor antagonist, dexamethasone, olanzapine, prochlorperazine, metoclopramide, diphenhydramine, lorazepam

57
Q

Best choices for delayed CINV?

A

Delayed (more than 24 hours after chemotherapy received)

Best management = prevent acute CINV

58
Q

Best choice for anticipatory (prior to chemotherapy) CINV?

A

benzodiazepine night before and morning of chemotherapy

59
Q

agents for Postoperative Nausea & Vomiting (PONV)

A

5-HT3 receptor antagonist + dexamethasone
Dimenhydrinate
Prochlorperazine
Metoclopramide

60
Q

agents for motion sickness

A

Scopolamine, dimenhydrinate, promethazine

61
Q

agents for pregnancy

A

pyridoxine

62
Q

agents for gastroparesis

A

metoclopramide

63
Q

Diarrhea- acute vs severe

A

Acute

  • Self-limiting 3-7 days
  • Outpatient, oral rehydration, symptomatic treatment, diet

Severe

  • Recover in days with timely management
  • Require hospitalization, restore fluid status (IV fluids + electrolytes), empiric antibiotics
64
Q

treating constipation

A

Identify cause and treat if appropriate

Increase fluid intake, physical activity, and dietary fiber
- FIBER! Gradually increase intake to 20-25 g/day
Effects in 3-5 days

Prevention
Bulk-forming laxatives & docusate first-line

GI II Exam 3 (14 decks)

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