Treatment of Nausea and Vomiting

Question 1

Suffix serotonin receptor antagonists

Answer 1

-setron

Question 2

suffix neurokinin receptor antagonists

Answer 2

-pitant

Question 3

Suffix some histamine (H1)/ dopamine (D2) receptor antagonists

Answer 3

-zine

Question 4

Serotonin receptor antagonist only indicated for IBS-D

Answer 4

alosetron

Question 5

most worrisome adverse effect of serotonin receptor antagonists

Answer 5

dose-dependent QT prolongation (Torsade’s)

Question 6

drug interactions serotonin receptor antagonists

Answer 6

• QT-prolonging agents

- antiarrhythmics

Question 7

prodrug of aprepitant

Answer 7

fosaprepitant

Question 8

prodrug of netupitant

Answer 8

fosnetupitant

Question 9

given for prophylaxis of post-operative N/V

Answer 9

aprepitant

*given up to 3 hours prior to anesthesia

Question 10

initial therapy for N/V in pregnancy

Answer 10

doxylamine (w/ pyridoxine [B6])

Question 11

anticholinergic effects of histamine receptor antagonists

Answer 11

• drowsiness
• dry mouth
• constipation
• urinary retention
• blurred vision
• decreased BP

Question 12

Describe histamine receptor antagonists

Answer 12

• block H1 receptors in vestibular system

- agents exhibit varying levels of CENTRAL ANTICHOLINERGIC properties at the level of the chemoreceptor trigger zone

Question 13

what is the only indication for H1 antagonists meclizine and cyclizine?

Answer 13

motion sickness/vertigo

Question 14

Important use metoclopramide

Answer 14

stimulates ACh actions in GI tract, enhancing GI motility (good for gastroparesis)

Question 15

Adverse effects dopamine receptor antagonists

Answer 15

classic anticholinergic effects!

• drowsiness
• dry mouth
• constipation
• urinary retention
• blurred vision
• decreased BP

Question 16

scopolamine: class, use

Answer 16

• M1 receptor blocker
• most commonly used for motion sickness
• transdermal patch; worn for 72 hours

Question 17

adverse effects muscarinic receptor blockers

Answer 17

classic anticholinergic effects!

• drowsiness
• dry mouth
• constipation
• urinary retention
• blurred vision
• decreased BP

Question 18

cannabinoid receptor agonists (two drugs)

Answer 18

1) dronabinol

2) nabilone

Question 19

use for cannabinoid receptor agonists

Answer 19

strong antiemetic agents reserved for treatment-resistant chemotherapy induced N/V (due to FDA scheduling)

Question 20

interactions cannabinoid receptor agonists

Answer 20

• other CNS depressants
• cardiovascular agents
• sympathomimetics

Question 21

focus of proper therapy for chemotherapy induced nausea and vomiting

Answer 21

prevention!

Question 22

high emetogenic regimen for chemotherapy induced N/V

Answer 22

1) NK1 receptor antagonist
2) 5-HT3 receptor antagonist
3) corticosteroid (Dexamethasone)

• given regimen day of (prior to) chemotherapy and for 3 days after chemotherapy

Question 23

moderate emetogenic regimen for chemotherapy induced N/V

Answer 23

1) 5-HT3 receptor antagonist
2) corticosteroid (Dexamethasone)

• given regimen day of (prior to) chemotherapy and for 2 days after chemotherapy

Question 24

low emetogenic regimen for chemotherapy induced N/V

Answer 24

1) corticosteroid (dexamethasone) -OR-
2) 5-HT3 receptor antagonist -OR-
3) metoclopramide -OR-
4) prochlorperazine

• given regimen day of (prior to) chemotherapy

Question 25

minimal-emetogenic regimen

Answer 25

• no routine prophylaxis therapy needed

- provide breakthrough/ anticipatory therapy

Question 26

general principle of breakthrough treatment

Answer 26

add one agent from a different drug class to the current regimen

Question 27

drugs for motion sickness

Answer 27

• scopalamine (patch)
• dimenhydrinate
• meclizine

Question 28

drugs for vertigo

Answer 28

• meclizine

- cyclizine

Question 29

drugs for diabetic gastroparesis

Answer 29

metoclopramide

Question 30

drugs for pregnancy-induced N/V

Answer 30

1) histamine antagonist w/ B6 or 5-HT3 antagonist
2) dopamine antagonist
3) steroid or different dopamine antagonist