T2-Vomitting

Question 1

We have this part in our brain called the _____. When this is activated, you become nauseas and/or vomit. There are 3 major things that can trigger this center.

Answer 1

Vomiting center

Question 2

First major thing that can trigger the vomiting center: Chemoreceptor trigger zone (CTZ). What synapses do these use?

Answer 2

Serotonin (5HT 3) and dopamine (D2)

Question 3

Second major thing that can trigger the vomiting center: GI tract. The neurons that originate here utilize several neurotransmitters. What are they?

Answer 3

Serotonin (5HT-3), Dopamine (D2), ACh, and Histamine 1 (H1)

Question 4

When the neurotransmitters in the GI tract is activated, it triggers the ___, which then triggers the ____.

Answer 4

CTZ, vomiting center

Question 5

Thing major thing that can trigger the vomiting center: The inner ear (vestibular system). This system regulates ____. When we become motion sick, neurons that arise from here also active the _____ of the brain. What neurotransmitters are utilized here?

Answer 5

Balance, vomiting center, Ach and H1

Question 6

These neurons in these systems utilize several different neurotransmitters. If we block one or more of these neurotransmitters, what happens?

Answer 6

We block the vomiting/nausea signal

Question 7

What does antiemetics mean?

Answer 7

Antinausea

Question 8

What are the 4 antiemetics?

Answer 8

Ondansetron
Promethazine
Prochlorperazine
Metoclopramide

Question 9

T/F. Ondansetron is very popular.

Answer 9

True

Question 10

What patients use ondansetron?

Answer 10

People recovering from surgery/anesthesia, chemo patients, preg mothers, etc

Question 11

What receptor does ondansetron block?

Answer 11

5-HT 3

Question 12

5-HT 3 is specifically involved in ____.

Answer 12

N/V

Question 13

Is Ondansetron a clean or dirty drug?

Answer 13

CLEAN; it only works on 5-HT 3 receptors!

Question 14

Since ondansetron is a clean drug, does it have a lot of side effects?

Answer 14

No

Question 15

What are the most common side effects of Ondansetron?

Answer 15

Headache
Diarrhea
Dizziness
Some report constipation

Question 16

What is the big issue with Ondansetron?

Answer 16

It can prolong the QT interval!!! (which can lead to Torsades de Pointes, which can lead to V-fib, which can lead to death)

Question 17

When taking Ondansetron, is a prolonged QT interval common?

Answer 17

NO! This is just associated with VERY, very high doses

EX: Normal dose= 8 mg BID
You may see prolonged QT with a 30 mg BID dose

Question 18

What kind of patients might have a 30 mg BID dose when taking Ondansetron?

Answer 18

Chemo patients

Question 19

Ondansetron comes in lots of forms (IV, PO, Sublingual, oral film). Why is this a good thing?

Answer 19

Sometimes when people are really nauseas they can’t keep anything down, so having other options besides PO only is good bc they may just vomit it back out

Question 20

Can you give Ondansetron before severe nausea occurs?

Answer 20

Yes, they work WAY better if you give them before severe nausea! (sort of like narcotics in this regard)

Question 21

Promethazine is also a ____.

Answer 21

First generation anti-histamine

Question 22

Promethazine blocks 3 receptors. What are they?

Answer 22

D2, H1, and alpha 1

Question 23

What is the major receptor Promethazine blocks?

Answer 23

H1

Question 24

Is Promethazine a clean or dirty drug?

Answer 24

Dirty

Question 25

Promethazine blocks D2, H1, and alpha 1. What are the adverse effects seen when it blocks D2?

Answer 25

Extrapyramidal (acute dystonia, akathisia, parkinsonism)

Question 26

Promethazine blocks D2, H1, and alpha 1 | What happens when you block H1?

Answer 26

Same things that happen when you take Benadryl (drowsiness, dizziness, constipation, dry mouth)

Question 27

Promethazine blocks D2, H1, and alpha 1. What happens when you block alpha-1?

Answer 27

Orthostatic hypotension

Question 28

What age group cannot take promethazine and why?

Answer 28

Children under the age of 2; can cause profound respiratory depression--> deaths have occurred

Question 29

If PhenerGAN (promethazine) infiltrates, nobody will be grinning. This can lead to ____ & _____. Thats why we don't call it PhenerGRIN.

Answer 29

Gangrene and amputations

Question 30

Promethazine biggest effects are on _____.

Answer 30

H1

Question 31

Prochlorperazines biggest effects are on ____.

Answer 31

D2

Question 32

Prochlorperazine also blocks what other receptors besides D2?

Answer 32

H1 and alpha 1!

Question 33

What is Prochlorperazine also approved for?

Answer 33

Schizophrenia (but better ones out there)

Question 34

Prochlorperazine is mainly given for ____ too.

Answer 34

Nausea

Question 35

What are the main side effects for prochlorperazine?

Answer 35

Blocking D2- extrapyramidal Blocking H1-same effects as Benadryl (drowsiness, dizziness, constipation, dry mouth) Blocking alpha 1- orthostatic hypotension

Question 36

Is Metoclopramide a common medication to give?

Answer 36

Yes

Question 37

What receptor does Metoclopramide block?

Answer 37

Dopamine

Question 38

What is a nice side benefit of Metoclopramide?

Answer 38

Increases gastric motility -- helps you become more "regular"

Question 39

What diabetes issues is metoclopramide good for?

Answer 39

Gastroparesis (long term, microvascular) because gastroparesis (delayed stomach emptying) causes nausea. This drug increases gastric motility (moves food along) and can help with nausea associated with it!!

Question 40

What is the big adverse effect with Metoclopramide?

Answer 40

It blocks dopamine receptors so extrapyramidal side effects!!!

Question 41

Metoclopramide has a BBW. What for?

Answer 41

BBB for TARDIVE DYSKINESIA

Question 42

How long can you take metoclopramide for?

Answer 42

NO MORE THAN 12 weeks!!!

Question 43

BBW for Metoclopramide: The risk of developing tradive dyskinesia increases with _____ and total ____.

Answer 43

Increase with duration of treatment and total cumulative dose

Question 44

Who uses scopolamine patches?

Answer 44

Scopolamine is an anti-cholinergic drug; most effective for prevention and treatment of motion sickness