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GII Exam 1 [Path, Pharm, Immuno, CLMD] > [Pharm] Treatment of Nausea and Vomiting > Flashcards

[Pharm] Treatment of Nausea and Vomiting Flashcards

1
Q

Due to the diversity of receptors in the brain and GI tract that stimulate N/V, what is the best way to combat N/V?

A

Combinations of agents w/ different MOAs

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2
Q

What are the (6) major receptors involved in N/V?

A

Serotonin (5-HT3)

Neurokinin (NK1)

Histamine (H1)

Dopamine (D2)

Muscarinic (M1)

Cannabinoid

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3
Q

What are the (5) antagonist category drugs for treating N/V?

A

Serotonin receptor antagonists

Neurokinin receptor antagonists

Histamine receptor antagonists

Dopamine receptor antagonists

Muscarinic receptor antagonists

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4
Q

What is the (1) agonist drug class used to treat N/V?

A

Cannabinoid receptor agonist

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5
Q

All the drugs within the serotonin receptor antagonists end in…

A

-Setron

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6
Q

What are the (5) serotonin receptor antagonists?

A

Dolasetron

Granisetron

Ondansetron

Palonosetron

Alosetron

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7
Q

What is the ONLY serotonin receptor antagonist that is only indicated for IBS-D?

A

Alosetron

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8
Q

What is the MOA of serotonin receptor antagonists?

A

Blcok serotonin type-3 receptors at the vagal nerve terminals

Blocks signal transmission to chemoreceptor trigger zone

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9
Q

What are the most common AE of serotonin receptor antagonists?

A
  • CNS (headache)
  • GI (constipation/Diarrhea)
  • Serotonin syndrome

-Dose-dependent QT prolongation (Torsades)

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10
Q

What are the major drug interactions with serotonin receptor antagonists?

A

QT prolonging agents

Antiarrhythmics

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11
Q

All of the serotonin receptor antagonists have short half lives EXCEPT for…

A

Palonosetron

and

Sustained release formulation of Granisetron

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12
Q

What do all neurokinin receptor antagonists end with? (suffix)

A

-PITANT

Aprepitant

Fosaprepitant

Netupitant

Fosnetupitant

Rolapitant

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13
Q

What are neurokinin receptor antagonists used for?

A

Chemotherapy induced N/V

Prophylaxis of post operative N/V

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14
Q

When are neurokinin receptor antagonists most effective?

A

When used in combination with a glucocorticosteroid and 5-HT3 antagonist

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15
Q

What are the AE of neurokinin receptor antagonists?

A

GI (dyspepsia/constipation/diarrhea)

CNS (dizziness/fatigue/somnolence)

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16
Q

What is the one histamine receptor antagonist that has the SPECIFIC indication for use as nausea/vomiting in pregnancy?

A

Doxylamine

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17
Q

What are the (7) histamine receptor antagonists?

A

Diphenhydramine

Doxylamine

Dimenhydrinate

Hydroxyzine

Promethazine

Meclizine

Cyclizine

18
Q

What is one of the major issues with using histamine receptor antagonists?

A

Anticholinergic properties

19
Q

What is typically used for pts with motion sickness/vertigo?

A

Meclizine

Cyclizine

20
Q

What are the common AE of histamine receptor antagonists?

A

Classic anticholinergic effects

  • Drowsiness
  • Dry mouth
  • Constipation
  • Urinary retention
  • Blurred vision
21
Q

What is the major family of dopamine receptor antagonists?

A

Phenothiazines

-azine

22
Q

What are the 3 phenothiazines?

A

Chlorpromazine

Perphenazine

Prochlorperazine

23
Q

What is the “other” dopamine receptor antagonist?

A

Metoclopramide

24
Q

What is a unique dual action of metoclopramide?

A

In addition to suppressing N/V, it also stimulates ACh actions in GI which enhances GI motility

25
Q

What are the AE of dopamine receptor antagonists?

A

Classic Anticholinergic effects

  • Drowsiness
  • Dry mouth
  • Constipation
  • Urinary retention
  • Blurred vision
26
Q

What is the muscarinic receptor blocker?

A

Scopolamine

27
Q

What is scopolamine typically used for?

A

Motion sickness

28
Q

AE of scopolamine?

A

Classic Anticholinergic effects

  • Drowsiness
  • Dry mouth
  • Constipation
  • Urinary retention
  • Blurred vision
29
Q

What are the two cannabinoid receptor agonists?

A

Dronabinol

Nabilone

30
Q

Who are cannabinoids typically indicated for?

A

Treatment resistent chemotherapy induced n/v

31
Q

How many active metabolites?

Dronabinol

Nabilone

A

Dronabinol = ONE active metabolite

Nabilone = SEVERAL active metabolites

32
Q

Define:

Acute N/V

Chronic N/V

Anticipatory N/V

A

Acute N/V = occurs <24 hours after chemo given

Chronic N/V = occurs >24 hours after chemo given

Anticipatory N/V = occurs before chemo given

33
Q

Proper therapy focuses on _______

A

Proper therapy focuses on prevention

34
Q

For HIGH Emetogenic potential, what is the drug regimen you’d prescribe?

A
  1. NK1 receptor antagonist
  2. 5-HT3 receptor antagonist
  3. Corticosteroid (Dexamethasone)
35
Q

For HIGH Emetogenic potential, how many drugs, and how many days do you prescribe?

A

3

36
Q

For MODERATE emetogenic regimen, what drugs would you prescribe?

A
  1. 5-HT3 receptor antagonist
  2. Corticosteroid (Dexamethasone)
37
Q

For MODERATE emetogenic regimen, how many drugs, and how many days to you give drugs?

A

2

38
Q

For LOW emetogenic regimen, what do you prescribe?

A

1 drug regimen

Corticosteroid (Dexamethasone) OR 5-HT3 receptor antagonist

39
Q

Drug you’d prescribe:

Motion sickness

A

Scopolamine

or

Dimenhydrinate

or

Meclizine

40
Q

Drug you’d prescribe:

Vertigo

A

Meclizine

or

Cyclizine

41
Q

Drug you’d prescribe:

Diabetic gastroparesis

A

Metoclopramide

42
Q

Drug you’d prescribe:

Pregnancy-induced N/V

A
  1. VItamin B6 OR Histamine Antagonist
  2. Dopamine Antagonist
  3. Steroid OR different dopamine antagonist

GII Exam 1 [Path, Pharm, Immuno, CLMD] (16 decks)

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