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Melissa's Pharm 2 > T2-Vomitting > Flashcards

T2-Vomitting Flashcards

1
Q

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.

A

Vomiting center

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2
Q

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

A

Serotonin (5HT 3) and dopamine (D2)

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3
Q

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

A

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

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4
Q

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

A

CTZ, vomiting center

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5
Q

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?

A

Balance, vomiting center, Ach and H1

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6
Q

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

A

We block the vomiting/nausea signal

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7
Q

What does antiemetics mean?

A

Antinausea

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8
Q

What are the 4 antiemetics?

A

Ondansetron
Promethazine
Prochlorperazine
Metoclopramide

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9
Q

T/F. Ondansetron is very popular.

A

True

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10
Q

What patients use ondansetron?

A

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

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11
Q

What receptor does ondansetron block?

A

5-HT 3

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12
Q

5-HT 3 is specifically involved in ____.

A

N/V

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13
Q

Is Ondansetron a clean or dirty drug?

A

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

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14
Q

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

A

No

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15
Q

What are the most common side effects of Ondansetron?

A

Headache
Diarrhea
Dizziness
Some report constipation

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16
Q

What is the big issue with Ondansetron?

A

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

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17
Q

When taking Ondansetron, is a prolonged QT interval common?

A

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

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18
Q

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

A

Chemo patients

19
Q

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

A

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

20
Q

Can you give Ondansetron before severe nausea occurs?

A

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

21
Q

Promethazine is also a ____.

A

First generation anti-histamine

22
Q

Promethazine blocks 3 receptors. What are they?

A

D2, H1, and alpha 1

23
Q

What is the major receptor Promethazine blocks?

A

H1

24
Q

Is Promethazine a clean or dirty drug?

A

Dirty

25
Q

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

A

Extrapyramidal (acute dystonia, akathisia, parkinsonism)

26
Q

Promethazine blocks D2, H1, and alpha 1

What happens when you block H1?

A

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

27
Q

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

A

Orthostatic hypotension

28
Q

What age group cannot take promethazine and why?

A

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

29
Q

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

A

Gangrene and amputations

30
Q

Promethazine biggest effects are on _____.

A

H1

31
Q

Prochlorperazines biggest effects are on ____.

A

D2

32
Q

Prochlorperazine also blocks what other receptors besides D2?

A

H1 and alpha 1!

33
Q

What is Prochlorperazine also approved for?

A

Schizophrenia (but better ones out there)

34
Q

Prochlorperazine is mainly given for ____ too.

A

Nausea

35
Q

What are the main side effects for prochlorperazine?

A

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

36
Q

Is Metoclopramide a common medication to give?

A

Yes

37
Q

What receptor does Metoclopramide block?

A

Dopamine

38
Q

What is a nice side benefit of Metoclopramide?

A

Increases gastric motility – helps you become more “regular”

39
Q

What diabetes issues is metoclopramide good for?

A

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!!

40
Q

What is the big adverse effect with Metoclopramide?

A

It blocks dopamine receptors so extrapyramidal side effects!!!

41
Q

Metoclopramide has a BBW. What for?

A

BBB for TARDIVE DYSKINESIA

42
Q

How long can you take metoclopramide for?

A

NO MORE THAN 12 weeks!!!

43
Q

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

A

Increase with duration of treatment and total cumulative dose

44
Q

Who uses scopolamine patches?

A

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

Melissa's Pharm 2 (32 decks)

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