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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
How does Metoclopramide work?
D2 receptor antagonist
26
How does ondansetron work?
5HT3 receptor antagonis
27
How does Prochlorperazine work?
D2 receptor antagonist
28
Agents for acute CINV
``` Acute CINV: 5HT3 receptor antagonist NK1 receptor antagonist Corticosteroid Olanzapine ```
29
Agents for Delayed CINV
NK1 receptor antagonist corticosteroid olanzapine
30
Agents for anticipatory CINV
benzodiazepines
31
agents for breakthrough and refractory CINV
an antiemetic from different pharmacological class (prochlorperazine, promethazine, lorazepam, olanzapine, metoclopramide, 5HT3 antagonist, dexamethasone, cannabinoids)
32
Chemotherapy nausea and vomiting pathophysiology
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
What agent causes QT prolongation?
ondansetron | espectially in combination with a bunch of other anti- drugs.
34
negative effects of 5-HT3 receptor antagonist?
headache, dizziness, constipation
35
negative effects of CB1 receptor agonist
euphoria, dysphoria, sedation, hallucinations, dry mouth
36
side effects of H1 receptor antagonist
dizziness, sedation, confusion, dry mouth, urinary retention
37
side effects of NK1 receptor antagonist?
fatigue, dizziness, diarrhea
38
side effects of opioid receptor agonist?
constipation
39
constipated guy (3 days no poo) on lisinopril, verapamil, acetaminophen, oxycodone. What do we think?
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
Bisacodyl suppository is what kind of drug?
stimulant laxative | stimulates enteric nervous system
41
docusate table works how?
stool softener | allows lipids and water to penetrate the stool
42
methylnaltrexone works how?
opioid antagonist
43
psyllium powder works how?
bulk forming; absorbs water, distends colon, increases peristalsis
44
sodium phosphate oral solution works how?
osmotic laxative - results in increased liquid in the stool
45
time course of drug therapies- what softens stools in 1-3 days?
bulk-forming laxatives emollients osmotic laxatives (polyethylene glycol- low dose, lactulose, sorbitol)
46
time course of drug therapies- what softens stools in 6-12 hours?
bisacodyl (PO, Senna, magnesium sulfate
47
Time course of drug therapies- what causes watery evacuation in 1-6 horus?
``` magnesium citrate magnesium hydroxide magnesium sulfate (high dose) sodium phosphates bisacodyl (PR) Polyethylene glycol (bowel prep) ```
48
methylnaltrexone MOA, use, CI
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
Guy ate raw oysters and has watery, non-bloody diarrhea
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
docusate therapeutic class?
stool softener
51
loperamide therapeutic class?
opioid agonist
52
octreotide therapeutic class?
somatostatin analog
53
ondansetron therapeutic class?
antiemetic
54
Senna therapeutic class?
stimulant laxative
55
what do we reserve octreotide for?
endocrine tumors
56
Best choices for acute chemotehrapy-induced nasuea and vomiting
(within 24 hours of chemotherapy administration) COMBINATIONS: 5-HT3 receptor antagonist, NK1 receptor antagonist, dexamethasone, olanzapine, prochlorperazine, metoclopramide, diphenhydramine, lorazepam
57
Best choices for delayed CINV?
Delayed (more than 24 hours after chemotherapy received) | Best management = prevent acute CINV
58
Best choice for anticipatory (prior to chemotherapy) CINV?
benzodiazepine night before and morning of chemotherapy
59
agents for Postoperative Nausea & Vomiting (PONV)
5-HT3 receptor antagonist + dexamethasone Dimenhydrinate Prochlorperazine Metoclopramide
60
agents for motion sickness
Scopolamine, dimenhydrinate, promethazine
61
agents for pregnancy
pyridoxine
62
agents for gastroparesis
metoclopramide
63
Diarrhea- acute vs severe
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
treating constipation
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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