Sketchy Pharm: Antiemetic Agents Flashcards

1
Q

The nucleus solitarius receives input from the ______________.

A

GI tract, vestibular system, and area postrema

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2
Q

The nucleus solitarius sends out what?

A

Axons to other areas to coordinate the vomiting response

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3
Q

What nerve mediates the vomiting response?

A

The vagus nerve (think of the neon sign in the stomach-shaped dirt area advertising fabulous Las Vagus)

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4
Q

By what molecular/nerve mechanism does GI irritation lead to the vomiting response?

A

Stomach irritation induces release of serotonin by gastric cells onto the 5HT-3 receptors of the vagal afferents. (Think of the athlete releasing the smiley face by the 1-2-3 Hammer Throw sign.)

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5
Q

Which system is responsible for motion sickness and vertigo?

A

The vestibular system (think of the rower with the orange VEST vomiting)

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6
Q

Where is the area postrema located?

A

The area postrema (also called the chemoreceptor-trigger zone) is next to the nucleus solitarius in the 4th ventricle –it is not protected by the BBB.

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7
Q

Ondansetron blocks ____________.

A

5HT-3 receptors on the vagal nerve

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8
Q

Although ondansetron is generally well tolerated, what are the most common side effects?

A

Constipation (think of the runner with the serotonin cord wrapped around the runners gut); headache (think of the serotonin ball hitting the other runner); QT prolongation; and serotonin syndrome (with concomitant SSRI use).

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9
Q

What part of the vomiting response do antihistamines block?

A

The vestibular response (H1 receptors –Gq receptors)

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10
Q

Which muscarinic receptor isotype do antimuscarinics act on when they counteract the dizziness response?

A

M1 (the M1 motorcycle) in the vestibular system

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11
Q

__________ receptors are also on the area postrema.

A

D2 receptors

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12
Q

Which drugs block the D2 receptors of the area postrema?

A

Metoclopramide (think of the guy TiCkLing the gymnast on the rings)

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13
Q

What is a potentially useful side effect of metoclopramide?

A

Treatment of non-obstructive ileus due to prokinetic effect on the GI tract (think of the gymnast falling on the stomach pad)

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14
Q

The non-useful side effects of metoclopramide include _________________.

A

extrapyramidal side effects, depression, neuroleptic malignant syndrome, prolactinemia, and somnolence (from central D2 blockade)

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15
Q

Those with neuroleptic malignant syndrome can have elevated levels of ________________.

A

creatine kinase

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16
Q

The area postrema contains what receptors other than D2 receptors?

A

NK1 (neurokinin 1) –think of the guy plaNKing

17
Q

What ligand binds to the NK1 receptor?

A

Substance P (think of the team checking the urine for SUBSTANCEs near the guy plaNKing)

18
Q

The drug _______________ blocks NK1 receptors.

A

Aprepitant (“All PaRticiPANTs must undergo urine screening”)