Upper GI & Anti-emetics Flashcards
Promethazine: MOA (2)
MOA: D2 antagonist with some-anti-muscarinic
Promethazine: uses (2)
Motion sickenss
Migraines
Metoclopramide: MOA (2)
D2 antagonist
high dose = 5HT- antagonist
Metoclopramide: uses (2)
gastroparesis (prokinetic)
nausea
Metoclopramide: ADEs (4)
- causes Extrapyramidal sx (Neuroleptic Malignant Syndrome)
- Sedation/drowsiness
- prolactinemia (gynecomastia, galactorrhea)
- QTc prolongation
Promethazine ADE
causes Extrapyramidal sx
Metoclopramide: Cix? why?
Do not use in small bowel obstruction - can increase risk of perforation
Aprepitant: MOA (where it acts in brain, receptor, and how)
- Antagonists at neurokinin1 (NK 1) receptors in the CTZ/ Area postrema
- substance P antagonist
Aprepitant: how is it dosed
used with a steroid and another anti-emetic
Aprepitant use?
Post-operative nausea.
Aprepitant ADE and why?
may decrease effects of warfarin
-it is an inducer of CYP2C9 (which metabolizes warfarin)
Odansetron: MOA
5HT3 antagonist
Odansetron: use
chemo-therapy induced nausea
Odansetron ADEs (2)
QTc prolongation Serotonin syndrome (when used with other drugs that increase serotonin)
SX of serotonin syndrome (4)
rigidity, tremor, hyperthermia, confusion
ADE: Magnesium, Aluminum respectively
Mg = diarrhea Aluminum = constipation
1st Gen H1 blocker that is combined with vitmain B6 to prevent morning sickness
Doxylamine
Haloperidol: MOA, uses (2),
D2 receptor antagonist,
Uses: antipsychotic, motion sickness
Haloperidol ADE
sedation
prolactinemia
1st Gen H1 blocker good for vestibular nausea
Meclizine:
Aprepitant: MOA,
NK1 receptor/ substance P blocker
Aprepitant: Use with what for what
used with steroids for chemotherapy nausea prevention
Aprepitant ADE
drug-drug effects (via CYP)
Methylprenisolone: What is it, use?
Glucocorticoid
combo with anti-emetics for chemotherapy-nausea prevention
PPIs: first line for what? (3)
PUD,
Zollinger-Ellison syndrome
NSAID gastritis
PPIs: ADEs (3)
increased risk for osteoporosis, C. diff colitis, nosocomial PNA
WHat do PPIs end in? anti-fungal ending?
anti-fungal = -azole PPI = -prazole
dimenhydramine MOA, use, ADE and mechanism
H1 blocker, motion sickness, dry mouth etc (via muscarinic antagonism)
Which is the longer-acting benzo and what is it used for
Diazepam - anti-anxiety effects are used for anticipatory nausea (chemo)
Misoprostol MOA-
Prostaglandin E1 agonist that inhibits gastric acid secretion and stimulates secretion of mucus and bicarbonate by epithelial cells. –> cytoprotective!
Misoprostol: uses
PUD and also for prevention of gastric ulcers for patients that are on long-term NSAIDs. (NSAIDs block PGE1 production)
Misoprostol: ADE and cix
diarrhea, cix in pregnancy (abortifactant)
Scopolamine: MOA (exact receptor), use
anti-muscarinic (M1 receptor), treats vestibular nausea
scopolamine ADEs, administration (3)
dry mouth, blurred vision, drowsiness,
administered: oral, IV, patch
Calcium carbonate MOA, ADE (2)
neutralizes stomach acid, hypercalcemia, rebound acid production
Octerotide uses (4) administered (2)
VIPomas gastrinomas carcinoid tumors esophageal varices administered: IV, SQ
octreotide MOA
inhibits gastrin release (from G cells)
inhibits Histamine release from ECL cells
dronabinol: MOA
THC analog.
Dronabinol ADEs. Worse in what pop? Paired with what to help
dry mouth, vertigo, dizziness, disorientation,
worse in elderly
paired with Haldol
Ranitidine, dosing, 2nd line for what (3)
2x/day
2nd line for NSAID-induced gastritis, gastrinomas, PUD
Sulcrafate MOA, ADE
coats stomach to protect from acid
ADE: prevents medication absorption
What merits a biopsy: signs of an ulcer or GERD
signs of an ulcer
What is the treatment for H. Pylori infx
PPI plus 2 ABX
H2 blockers treat what (2)
Treat dyspepsia and GERD
Vagus nerve releases what?
GRP, ACh
GRP has what effect
acts directly on G cells to release gastrin
Gastrin has what effects?
stimulates ECL cells to release histamine
acts directly on parietal cell CCKb receptor