Treatment of Nausea and Vomiting Flashcards
What drug classes are useful in the treatment of nausea and vomiting?
- 5HT3 receptor antagonists
- Neurokinin (NK1) receptor antagonists
- H1 receptor antagonists
- D2 receptor antagonists
- M1 receptor antagonists
- Cannabinoid receptor agonist
- glucocorticoids (dexamethasone)
- benzodiazepines (alprazolam/lorazepam)
Which drugs are 5HT3 receptor antagonists?
“-setron”
- dolasetron
- ondansetron
- granisetron
- palonosetron
Which drugs are NK1 receptor antagonists?
“-pitant”
- aprepitant
- fosaprepitant
- netupitant
- fosnetupitant
- rolapitant
Which drugs are H1 receptor antagonists?
- diphenhydramine
- dimenhydrinate
- hydroxyzine
- promethazine
- meclizine
- cyclizine
Which drugs are D2 receptor antagonists?
- chlorpromazine
- perphenazine
- prochlorperazine
- metoclopramide
- haloperidol
- olanzapine
- trimethobenzamide
Which drugs are M1 receptor antagonists?
- scopolamine
Which drugs are cannabinoid receptor agonists?
- dronabinol
- nabilone
Adverse effects with 5HT3 receptor antagonists?
- serotonin syndrome
- dose-dependent QT prolongation (Torsades)
Which 5HT3 receptor antagonists have the longest half-lives (24+ hrs)?
- palonosetron
- granisetron
Which drugs do 5HT3 receptor antagonists interact with?
- anti-arrhythmics/QT-prolonging agents
What are NK1 receptor antagonists indicated for?
- chemotherapy-induced N/V
- post-operative N/V (only give aprepitant for this, and give 3 hrs before anesthesia)
Which NK1 receptor antagonists have the longest half-lives?
- netupitant
- rolapitant
Which H1 receptor antagonist is administered with pyridoxine (B6) for n/v associated with pregnancy?
doxylamine
What is special about the H1 receptor antagonists?
exhibit CENTRAL anticholinergic properties at chemoreceptor trigger zone
- block H1 receptors in vomiting center and vestibular system
What are the adverse effects associated with H1 receptor antagonists?
- classic anticholinergic effects
What drugs are indicated for motion sickness/vertigo from the H1 receptor antagonists?
- meclizine
- cyclizine
Which D2 receptor antagonist also stimulates ACh in the GI system?
metoclopramide
What are the adverse effects associated with D2 receptor antagonists?
- classic anticholinergic effects
Scopolamine (indications, how to administer/for how long)
indications:
- motion sickness
- end of life care for excessive secretions
Transdermal patch - worn for 72 hrs
Cannabinoids are reserved for treatment of what?
treatment-resistant chemotherapy-induced N/V
A strong emetogenic regimen entails what?
3 drug regimen
- NK1 receptor antagonist
- 5HT3 receptor antagonist
- corticosteroid (dexamethazone)
given day of chemo and for 3 days after you finish chemo
A moderate emetogenic regimen entails what?
2 drug regimen
- 5HT3 receptor antagonist
- corticosteroid (dexamethasone)
give day of chemo and for 2 days after chemo
A low emetogenic regimen entails what?
1 drug regimen
- corticosteroid (dexamethasone)
- or 5HT3 receptor antagonist, metoclopramide, prochlorperazine
give day of chemo
