Pharm: Vertigo

Question 1

antihistamines/anticholinergics

Answer 1

H1 block and M1 block
Tx: vertigo
CYP2D6 substrates
caution with other anti-muscarinics and sedatives
AE: drowsy, dizzy, confusion

Question 2

benzodiazepine

Answer 2

Tx: psychosomatic vertigo

Question 3

corticosteroids

Answer 3

act on solitary tract

give with 5HT3 antagonist for chemo induced N/V and post operative N/V prophylaxis

Question 4

D2 antagonists

Answer 4

act on CTZ
also antihistamine and anticholinergic effects
Tx: nausea (not for chemo induced N/V)
AE: bone marrow suppression, blood dyscrasia, QT PROLONGATION: torsades
DI: antipsychotics (increase CNS AE)

Question 5

5HT3 antagonists

Answer 5

act on chemo-trigger zone and solitary tract nucleus
CYP
Tx: N/V; chemo induced N/V and post operative N/V prophylaxis with corticosteroids
AE: QT prolongations, constipation/diarrhea, anaphylaxis

Question 6

NK1 antagonists

Answer 6

substance P/neurokinin-1 receptor antagonist
central: act on solitary tract
peripheral: vagal terminals in GI tract
CYP3A4 inhibitor
Tx: prophylaxis against acute emesis in chemo induced N/V
AE: headache, constipation/diarrhea

Question 7

cannabinoid receptor agonist

Answer 7

1. decreased activity in medullary vomiting center and solitary tract
2. oppose 5HT3 mediated stimulation from vagal afferents
   Tx: N/V
   AE: increased appetite (CB receptor in lateral hypothalamus), elation, heightened awareness
   caution in people with substance abuse

Question 8

meclizine hydrochloride

Answer 8

H1 and M1 blocker

Question 9

diphenhydramine

Answer 9

H1 and M1 blocker

CYP2D6 inhibitor

Question 10

scopolamine

Answer 10

transdermal patch
M1 blocker ONLY
LONG duration 
NOT CYP2D6 substrate
AE: xerostomia, ocular effects if touch eye

Question 11

promethazine HCl

Answer 11

H1 and M1 blocker
CYP2D6 inhibitor
BBW for injection use
AE: RESPIRATORY DEPRESSION in children less than 2 y/o

Question 12

diazepam

Answer 12

benzodiazepine

Question 13

dexamethasone

Answer 13

corticosteroids

Question 14

methylprednisolone

Answer 14

corticosteroids

Question 15

prochlorperazine

Answer 15

D2 antagonist

Question 16

chlorpromazine

Answer 16

D2 antagonist

Question 17

dolasteron

Answer 17

5HT3 antagonist

Question 18

granisetron

Answer 18

5HT3 antagonist

Question 19

ondansetron

Answer 19

5HT3 antagonist

dose adjust in hepatic dysfunction

Question 20

palonosteron

Answer 20

5HT3 antagonist

Question 21

aprepitant

Answer 21

pro-drug

NK1 antagonist

Question 22

fosaprepitant

Answer 22

NK1 antagonist

Question 23

dronabinol

Answer 23

cannabinoid receptor agonist

Question 24

THC

Answer 24

cannabinoid receptor agonist

Question 25

aminoglycosides

Answer 25

IRREVERSIBLE ototoxicity: dose dependent
improvement with N-acetylcysteine
caspase dependent and independent

Question 26

cisplatin

Answer 26

IRREVERSIBLE ototoxicity: dose dependent

CASPASE dependent

Question 27

loop diuretics

Answer 27

ototoxicity: dose dependent

possibly reversible

Question 28

What are some drugs that cause REVERSIBLE ototoxicity?

Answer 28

NOT dose dependent 
antimalarials
erythromycin
minocycline
fluoroquinilones
NSAIDs, salicylates (dose dependent)

Question 29

MoA for aminoglycoside and cisplatin ototoxicity

Answer 29

entry into hair cells

AG: AG-Fe
CP: CP-MHC activates NOX-3

in common

1. ROS
2. JNK to nucleus
3. mitochondria release cytochrome C
4. caspase
5. apoptosis

Question 30

MoA of loop diuretics ototoxicity

Answer 30

inhibition of Na/K/2Cl co-transporter in inner ear STRIA VASCULARIS that maintains endolymph: edema and loss of function

also in loop of Henle