Seegars - Drugs for Nausea & Vomiting Flashcards
drug endings of serotonin receptor agonists
-setron
drug endings of neurokinin receptor agonists
-pitant
only 5-HT receptor agonist that is not an antiemetic
alosetron
most worrisome AE of 5-HT receptor agonists
QT prolongation & torsades
5-HT RA with longest T1/2
Palonsetron (40h)
only NK1 RA that can be given IV
fosaprepitant
NK1 RAs are used with what other drugs for CINV
- glucocorticosteroids
- 5-HT RAs
therapeudic uses of NK1 RAs
- CINV
- prophylaxis for PONV (3 hrs prior to induction)
H1 RAs
- diphenhyramine
- dimenhydrinate
- hydroxyzine
- promethazine
- meclizine
- cyclizine
AEs of blocking H1 receptors
varying levels of anticholinergic properties
only indication for meclizine & cyclizine
motion sickness/vertigo
promethazine black box warnings
-resp distress in kid
D2 RAs
- chlorpromazine
- perphenazine
- prochlorperazine
- haloperidol
- trimethobenzamine
- metoclopramide
D2 RA that is off-lable/2nd line tx for CINV
haloperidol
D2 RA that enhances GI motility and increases LES tone
metoclopramide
AEs of D2 RAs
- classic anticholingergic effects
- extrapyramidal side effects (dyskinesias)
drug interactions of D2 RAs
- other drugs with anticholinergic effects
- antiarrhythmics
- antiHTNs
muscarinic (M1) receptor antagonists
scopolamine
unique mode of delivery of scopolamine
patch > worn for 72 h
drug used for motion sickness
scopolamine
AEs of M1 RAs
classic anticholinergic effects
cannabinoid receptor agonists
- droabinol
- nabilone
cannabinoid RAs are reserved for tx of what?
CINV that doesn’t respond to other drugs (its a scheduled drug!)
MOA: cannabinoid RAs
-stim central (CB1) and peripheral (CB2) cannabinoid receptors in VC/CTZ
pharmicokinetics of cannabinoid RAs
- short onset time
- long DOA (24h)
highly emetogenic 3 drug regimen (ASCO guidelines)
- 5-HT RA
- NK1 RA
- corticosteroid (dexamethazone/methyorednisolone)
when do you give the 3 drug ASCO guideline therapy?
- prior to chemo
- up to 3-5 days post chemo
moderately emetogenic 2 drug regimen (ASCO guidelines)
- 5-HT receptor antagonist
- corticosteroid
mild emetogenic 1 drug regimen (ASCO guidelines)
corticosteroid
3 MC drugs given for PINV
- any 5-HT RA
- metoclopramide
- diphenhydramine