Tx of N/V

Question 1

N/V receptors include

Answer 1

serotonin 5-HT (setron) 
Neurokinin (pitant) 
Histamine H1 
Dopamine D2 
Muscarinic M1 (scopalamine) 
cannabinoid receptors (dronabinol nabilone)

Question 2

in addition to antagonists/agonists to a bunch of receptors, what agents are used in the tx of N/V

Answer 2

glucocorticoids such as dexamethasone

benzodiazepines such a alprazolam/lorazepam

Question 3

serotonin receptor antagonsists

Answer 3

setron
dolasetron
granisetron
ondansetron
palonosetron

Question 4

IV only 5-ht antagonist

Answer 4

palonosetron (all others have PO/IV)

Question 5

unique 5-ht antagonist in its indicaiton

Answer 5

alosetron is only indicated for IBS-D

Question 6

5-ht receptor antagonists are indicated for

Answer 6

CINV
RINV
PONV
NVP 
STRONG antiemetic agents 
block 5-HT receptors at CTZ from intestinal enterochromaffin cells

Question 7

AE of 5-ht antagonists

Answer 7

CNS -HA
GI - constipation/diarrhea (Serotonin syndrome)
WORST POSSIBLE AE
Dose-dependent QT prolongation and Torsade’s
use extreme caution when using with other QT prolonging agents

Question 8

longest lasting 5-HT antagonists

Answer 8

palonosetron and sutstained SQ granisetron

effective for delayed CINV as a single dose

Question 9

drug interactinos for 5-HT receptor antagonsits

Answer 9

QT prolonging agents

Antiarrhythmics

Question 10

NK1 receptor antagonists include

Answer 10

aprepitant (and fosaprepitant)
netupitant (and fosnetupitant)
rolapitant

Question 11

MoA of NK 1 receptor antagonists

Answer 11

block substance p (neurokinin 1) receptors in CTZ/VC
peripheral blockade of NK1 receptors located on vagal terminals in gut maybe too
moderate antiemetic agents

Question 12

unique indication of aprepitant

Answer 12

PONV

given up the 3 hours prior to anesthesia

Question 13

-pitants are most effective when given with

Answer 13

a glucocorticosteroid and 5-ht3 antagonist

Question 14

AE of NK1 antagonsits

Answer 14

gi - dyspepsia/constipation/diarrhea

cns - dizziness/fatigue/somnolence

Question 15

H1 receptor antagonists

Answer 15

diphenhydramine
dimenhydrinate
hydroxyzine
promethazine
meclizine
cyclizine

Question 16

unique indication for doxylamine (h1 receptor antagonist)

Answer 16

prepared with b6 (pyridoxine)

INITIAL THERAPY FOR NVP

Question 17

PO only h1 receptor antagonists

Answer 17

meclizine
cyclizine
dramamine (dimenhydrinate, generic is IV/IM as well)

Question 18

indications for H1 receptor antagonists as it relates to N/V

Answer 18

PONV

block histamine type 1 receptors in VC and vestibular system

Question 19

huge consideration for h1 blockers

Answer 19

exhibit anticholinergic effects 
drowsiness
dry mouth
constipation
urinary retention
blurred vision
decreased BP

Question 20

therapeutic uses of h1 receptor antagonsits

Answer 20

idiopathic/mild n/v 
PONV
NVP
motion sickness/vertigo (meclizine and cyclizine) 
CINV/RINV add on therapy

Question 21

unique indication for meclizine and cyclizine

Answer 21

motion sickness/vertigo

Question 22

D2 receptor antagonists

Answer 22

phenothiazines (chlorpromazine, perphenazine, prochlorperazine)
other (metoclopramide, haloperidol, olanzapine, trimethobenzamide)

Question 23

D2 receptor antagonist MoA

Answer 23

weak-moderate antiemtic agents

block dopamine 2 recpetors in CTZ

Question 24

unique MoA of metoclopramide

Answer 24

stimulates Ach actions in GI, enhancing GI motility and increasing LES tone
no impact on GI secretion

Question 25

gastroparesis/dysmotility indicates

Answer 25

metoclopramide

Question 26

AE of d2 receptor antagonists

Answer 26

``` anticholinergic effects drowsiness dry mouth constipation urinary retention blurred vision hypotension ```

Question 27

m3 receptor antagonist name and use

Answer 27

scopalamine used for motion sickness SIGNIFICANT ANTICHOLINERGIC PROPERTIES AVOID USE WITH OTHER ANTICHOLINERGICS

Question 28

cannabinoid receptor AGONISTS

Answer 28

dronabinol | nabilone

Question 29

indicatinos for cannabinoids

Answer 29

TREATMENT RESISTANT CINV | reserved for the big bad cases d/t scheduling

Question 30

MoA of cannibinoid agoinsts

Answer 30

sitmulate CB1 and CB2 receptors in VC/CTZ | results in decreased excitability of neurons and reducing serotonin release from vagal afferents

Question 31

AE of cannabinoids

Answer 31

``` euphoria/irritability (emotional lability) vertigo sedation/drowsiness impaired cognition/memory alterations in perception of reality (distortions in perception and sense of time; hallucinations) xerostomia sympathomimetic appetite stimulation ```

Question 32

interactions of cannabinoids

Answer 32

other CNS depressants | CV agents and sympathomimetics

Question 33

what guidelines are followed for tx of CINV

Answer 33

national comprehensive cancer network (NCCN) guidelines

Question 34

high emetogenic regimen

Answer 34

NK1 receptor antagonist 5-HT3 receptor antagonist corticosteroid (dexamethasone) a. may add olanzapine (D2 antagonist --> 4 drug regimen) b. may add cannabinonid if tx-resistant c. provide therapy for breakthrough n/v d. provide therapy for anticipatory n/v as needed

Question 35

moderate emetogenic regimen

Answer 35

2 drug 5-ht recpetor antagonist (palonos/granis SQ) corticosteroid (dexamethasone) may bump up as needed

Question 36

low emetogenic regimen

Answer 36

``` 1 drug corticosteroid or 5-ht receptor antagonist or metoclopramide or prochlorperazine ```

Question 37

breakthrough emesis regimen

Answer 37

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