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Pharm 2.4 PONV etc > PONV > Flashcards

PONV Flashcards

1
Q

Epigastric and throat sensation associated with the urge to vomit, an autonomic response

A

Nausea

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2
Q

Endogenous endocannabinoids (anandamine and 2 AG) act at CB1 receptors send important emetic signals in afferent pathways from?

2

A

The vomiting center AKA nucleus tractus solitarius

Chemo trigger zone/area postrema

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3
Q

There is no blood brain barrier here, accessible to emetogenic stimuli in blood or CSF, (D2, 5HT3, M1, CB1 receptors located here)

A

Chemo trigger zone/area postrema

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4
Q

name 2 neurokinin NK1 receptor antagonist

A

aprepitant (emend)

rolapitant/varubi

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5
Q

Adverse effects of headache with increased risk factors of headache attributed to personal family history of migraine, concurrent use of propofol or fentanyl, and higher doses

A

Ondansetron/Zofran

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6
Q

Histamine acting at H1 receptors important emetic signals in afferent pathways from?

2

A

The vomiting center AKA nucleus tractus solitarius

vestibular system

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7
Q

what happens when a ligand binds to serotonin 5HT3 receptors?

A

rapid depolarization via sodium and calcium influx

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8
Q

Selective D2 receptor antagonist acts as a prokinetic and antiemetic

A

domperidone

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9
Q

how do dopamine D2 receptors help regulate gastric motility

3

A

Inhibition of gastric motility
relaxation of upper portion of the stomach
delayed gastric emptying in response to gastric distention

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10
Q

Useful in treatment of chemotherapy induced nausea and vomiting in patients that don’t respond to conventional antiemetics

A

Marinol/dronabinol

Nabilone/cesamet

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11
Q

what is neuroleptic malignant syndrome

A

fever,
muscular rigidity,
alter mental status,
autonomic instability

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12
Q

5HT3 receptors send important emetic signals in afferent pathways from?
The 3 places these receptors are located in RT vomiting.

A

The vomiting center AKA nucleus tractus solitarius
Chemo trigger zone/area postrema
GI tract (stomach, small intestine)

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13
Q

anti-emetic, side effects including euphoria solemness detachment anxiety panic etc etc and side effects related to withdrawal

A

Marinol/dronabinol

Nabilone/cesamet

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14
Q

What are some strategies to reduce baseline risk of PONV

6

A 
use a multimodal approach to decrease the use of perioperative opioids
regional anesthesia
propofol TIVA
Avoid volatile anesthetics
adequate hydration
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15
Q

a competitive H1 receptor inverse agonist that readily crosses the blood brain barrier

A

Benadryl

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16
Q

A relatively selective D2 receptor antagonist that doesn’t cross the blood brain barrier so it doesn’t cause extra pyramidal side effects?

A

domperidone

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17
Q

The most effective drugs for treatment of PONV and chemotherapy induced nausea and vomiting in adults and children, non sedating, well tolerated, no extra pyramidal side effects, no significant drug interactions noted

A

Ondansetron/Zofran consider first generation drugs

Palonosteron/aloxi second generation

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18
Q

Adverse effects include muscarinic receptor blockade, dry mouth, blurred vision, drowsiness, urinary retention, and sedation

A

Benadryl

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19
Q

This PONV treatment may result in unwanted pregnancy for up to 28 days?
2 drugs

A

aprepitant (emend)

rolapitant/varubi

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20
Q

How do mu opioid receptors help with regulation of gastric motility

3

A

decrease lower sausages sphincter tone
reduce gastrointestinal motility
suppress forward peristalsis

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21
Q

Blocks three types of receptors, D2, alpha Adrenergic, H1 receptors, risk of QT prolongation(black box)

A

Droperidol D2 receptor antagonist

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22
Q

Name the only selective dopamine D2 receptor antagonist

A

domperidone

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23
Q

What are the four risk predictors of postoperative nausea and vomiting

A

history of motion sickness or PONV
female sex
non-smoking status
the use of opioids for postoperative analgesia

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24
Q

Associated with perennial burning slash itching when given IV.
this drug’s most effective when administered when

A

dexamethasone

most effective when given at the beginning rather than the end of surgery

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25
Q

expulsion of upper GI contents due to contraction of abdominal muscles

26
Q

the only monoamine neurotransmitter receptor known to function as a ligand gated ion channel

A

serotonin 5HT3 receptors

27
Q

somatic response, Efferent motor nerves from the vomiting emetic center in the medulla

28
Q

the cannabinoid B1 receptor is what type of G?

29
Q

Postoperative nausea and vomiting can result in an increased risk of incidence of
5 negative things/side effects

A 
wound dehiscence,
 esophageal rupture, 
pulmonary aspiration
 dehydration, 
increased intracranial pressure
30
Q

Excluding the four risk predictors, what are some other causes for increased incidence of PONV

8

A 
high preoperative anxiety
obesity
delayed gastric emptying
younger patient
long surgery
nitrous oxide 
volatile anesthetic use
opioids
31
Q

The vomiting center AKA nucleus tractus solitarius, what receptors located here? 6

A

5HT3, D2, CB1, NK1, M1, H1

32
Q

What’s unique about the transmission Endogenous endocannabinoids (anandamine and 2 AG)

A

Retrograde transmission, synthesize in the postsynaptic neuron, but activate presynaptic cannabinoid receptors

33
Q

antihistamine that’s also a d2 receptor antagonist, not used an anti psychotic, crosses blood brain barrier, can treat motion sickness and PONV?
What are its adverse effects?

A

Promethazine

Adverse effects HOTN, extra pyramidal syndrome, sedation, respiratory depression in children

34
Q

Acetylcholine acting on the M1 receptors important emetic signals in afferent pathways from?
3

A

The vomiting center AKA nucleus tractus solitarius
Chemo trigger zone/area postrema
vestibular system

35
Q

Substance P (neurokinin NK1) receptors important emetic signals from afferent pathways from?

A

The vomiting center AKA nucleus tractus solitarius

36
Q

Substance P (neurokinin NK1) receptors what G?

37
Q

Adverse effects include extra pyramidal syndrome and neuroleptic malignant syndrome

A

Droperidol

38
Q

Rhythmic activity of respiratory and abdominal muscles, a somatic response

39
Q

Important in motion sickness via cranial nerve number 8, H1 and M1 receptors here

A

Vestibular system

40
Q

Name two CB1 receptor agonist

A

Marinol/dronabinol

Nabilone/cesamet

41
Q

blocks three types of receptors, D2 M1 and H1

A

promethazine

42
Q

what two drugs come to mind when you think about CYP2D6?

A

Metoclopramide

Zofran

43
Q

M1 is what G?

44
Q

Vomiting due to psychiatric disorders, stress, anticipatory vomiting would be initiated here

A

the cortical structures/central nervous system/cortex, thalamus, hypothalamus, meninges

45
Q

What two receptors are located in the gastrointestinal tract RT to PONV?

A

D2 and 5HT3

46
Q

This drug produces a high incidence of dystonia to include oculogyric crisis, D2 receptor antagonist

A

Prochlorperazine/Compazine

47
Q

name the two 5HT3 receptor antagonist?

A

Ondansetron/Zofran

Palonosteron/aloxi

48
Q

Peripheral acting anti emetic drugs that do not cross the blood brain barrier will still bind to targets in the chemo receptor trigger zone. true or false

49
Q

Nonselective antihistamine, blocks M1, H1, alpha adrenergic, And serotonin receptors

50
Q

Second generation 5HT3 receptor antagonist with 100 fold affinity 5HT3 and a long duration of action( 72 hours)
how does it bind?

A

Palonosteron/aloxi second generation

Allosteric binding, positive cooperatively and 5HT3 receptor internalization

51
Q

dopamine D2 receptors are what type of G ?

what happens?

A

GI
inhibition of adenylyl cyclase
closing of calcium channels
opening k channels

52
Q

use of this drug is limited due to large doses causing sedation and extrapyramidal syndrome

A

promethazine

53
Q

A D2 receptor antagonist and at higher doses 5HT3, with prokinetic properties

A

Metoclopramide

54
Q

Name the drug affected by cyp polymorphism and ABCB1(drug efflux transporter) polymorphism?

A

Ondansetron/Zofran

55
Q

Dopamine D2 receptors send important emetic signals in afferent pathways from?
3

A

The vomiting center AKA nucleus tractus solitarius
Chemo trigger zone/area postrema
GI tract (stomach, small intestine)

56
Q

H1 is what G?

57
Q

Use caution in pediatric and elderly patients because of excessive sedation and delirium, side effects include dry mouth, blurred vision, drowsiness, urinary retention

A

sounds like an SRNA, but probably scopolamine

58
Q

alvimopan entereg is what?

A

Peripheral acting in the gastrointestinal system, opioid antagonist, prevents mu receptor mediated inhibition of acetylcholine, reducing delayed gastric emptying and slowing of peristalsis, basically opposite action of what happens when you take opioids

opioids equal reduce gastrointestinal motility and delayed gastric emptying

59
Q

Prokinetic/antiemetic D2 receptor antagonist with adverse effects of extrapyramidal syndrome and tardive dyskinesia that you should probably consult surgery before giving in a GI case?

A

Metoclopramide

60
Q

Name four D2 receptor antagonist

A

promethazine
droperidol
metoclopramide
domperidone

61
Q

M1 receptor antagonist that crosses the blood brain barrier, nonselective competitive antagonist, tertiary, used to treat motion sickness and ponv

A

Scopolamine

62
Q

name 2 neurokinin NK1 receptor antagonist

A

aprepitant (emend)

rolapitant/varubi

Pharm 2.4 PONV etc (3 decks)

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