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Preeti: SAM II > Vomiting > Flashcards

Vomiting Flashcards

1
Q

T/F:

Vomiting is a reflex

A

TRUE

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2
Q

What are the 3 phases of vomiting?

A

Nausea (Prodromal) Phase

Retching Phase

Expulsion Phase

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3
Q

T/F:

The stomach is responsible for actively expelling contents

in vomiting

A

FALSE!

The force that expels is from the contraction of the

diaphragm and abdominal muscles

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4
Q

Stomach, esophagus, and sphincters are all

______ during vomiting

A

relaxed

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5
Q

Fill in the blanks for the pathway of vomiting:

Stimuli → Afferent pathways → Higher brain →

___________→ CRTZ →______→Efferent motor signals→ VOMIT

A

Stimuli→ Afferent pathways → Higher brain →

Vestibular Apparatus→CRTZ→Emetic Center→

Efferent motor signals→ VOMIT

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6
Q

Which receptors are found in the

Vestibular Nuclei?

A

H1, AChM

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7
Q

Which receptors are found in the

Visceral Afferents?

A

5-HT3

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8
Q

Which receptors are found in the

CRTZ?

A

D2

5-HT3

NK-1

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9
Q

Which receptors are found in the

Vomiting Center?

A

AChM

NK-1

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10
Q

Which receptor is found in the Stomach and SI?

A

NK-1

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11
Q

Where is the CRTZ located?

A

The medulla oblongata

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12
Q

The CRTZ is stimulated by the ________ system

A

vestibular

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13
Q

Motion Sickness is also known as

A

Kinetosis

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14
Q

Describe the mechanism of motion sickness:

_______ stimulation→ Dopamine and Serotonin released

from ______ activation→______ released from emetic center

A

Inner ear/labyrinth stimulation→ Dopamine and Serotonin released

from CRTZ activation→ACh released from emetic center

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15
Q

How do drugs like chemo agents stimulate vomiting?

A

5HT-serotonergic receptors and CRTZ

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16
Q

How does intestinal inflammation stimulate vomiting?

A

Direct afferent input to the vomiting center

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17
Q

How do opioids stimulate vomiting?

A

Stimulation of the CRTZ, increased vestibular sensitivity,

gastric stasis, or impaired intestinal motility/constipation

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18
Q

What are 3 ways that uremia can cause vomiting?

A

Decreased gastric clearance→ulcers,gastritis

Toxins cross BBB→stimulate central and peripheral receptors

D2-dopaminergic receptors→ activates CRTZ

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19
Q

Acute vomiting is <____week

Chronic is >_____week

A

Acute- < 1 week

Chronic- > 1 week

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20
Q

T/F:

A foreign body can cause either acute or chronic vomiting

A

TRUE!

chronic- ball moving in and out of the pylorus intermittently

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21
Q

Normosol

Plasmalyte

LRS

Sodium Chloride

Are all examples of this type of fluid

A

maintenance

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22
Q

Famotidine, Ranitidine, and Cimetidine

are all drugs in this category

used in the tx of vomiting

A

H2-receptor antagonists

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23
Q

What is the MOA of H2-receptor antagonists?

A

Affects gastric parietal cell receptors resulting in

reducing acid secretion with only a mild effect on pH

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24
Q

Omeprazole and Pantoprazole

are drugs in this category

used in the tx of vomiting

A

Proton Pump Inhibitors (PPIs)

25
Q

What is the MOA of proton pump inhibitors?

A

Inhibits the gastric proton pump which

inhibits transport of hydrogen atoms into the stomach

and inhibits the hepatic cytochrome p-450 system

26
Q

How do antiemetics work?

A

Block or compete with neurotransmission

at the receptor sites associated with emesis

27
Q

Name the 6 categories of antiemetic drugs

A

Phenothiazines

Anticholinergics

NK-1 receptor inhibitors

Dopamine antagonists

Antihistamines

Serotonin antagonists

PANDAS!

28
Q

Scopalamine, Phenothiazines, Propantheline, and Isopropamide

are all drugs in this category

used in the tx of vomiting

A

M1-Cholinergic Receptor Antagonists

29
Q

Which M1 Cholinergic Receptor antagonist

can cause excitement in cats

and can cross the BBB?

A

Scopalamine

30
Q

Diphenhydramine, Meclizine, Cryptoheptadine

are all drugs in this category

used in the tx of vomiting

A

Antihistamines

31
Q

T/F:

Histamine antagonists are great to use in cats

to prevent vomiting

A

FALSE!

Histamine antagonists are not helpful in cats because

they do not have histamine receptors in the CRTZ

32
Q

Metoclopramide

is a drug in this category

used in the tx of vomiting

A

D2-Dopaminergic Antagonist

33
Q

What is the MOA of Metoclopramine

(D2-Dopaminergic Receptor Antagonist)

in CATS?

A

Stimulates movement of the distal esophagus

but not as much of an antiemetic effect because cats have

fewer CNS dopamine receptors

34
Q

What is the MOA of Metoclopramine

(D2-Dopaminergic Receptor Antagonist)

in DOGS?

A

Antiemetic

35
Q

T/F:

Metoclopramide is a 5-HT3 antagonist

and a 5-HT4 agonist

36
Q

What are some side effects of Metoclopramide?

A

Constipation, mentation change

37
Q

Dolasetron (Anzemet) and Odansetron (Zofran)

are both drugs in this category

used in the tx of vomiting

A

5-HT3 Serotonin Antagonists

38
Q

Where do Dolasetron and Zofran (Ondansetron) have an effect?

A

Works in the GIT and CRTZ

39
Q

What are the side effects associated with Dolasetron and Ondansetron?

A

Constipation, Fatigue, Dry Mouth

40
Q

Maropitant and Cerenia

are both drugs in this category

used in the tx of vomiting

A

NK-1 Receptor Antagonists

41
Q

What is the mechanism of action

of Maropitant and Cerenia?

A

Competes with substance-P (peripherally and centrally)

42
Q

What is the best drug to use in the treatment of motion sickness?

A

Cerenia

(Maropitant can see bradycardia with high doses, which are required

to tx motion sickness)

43
Q

T/F:

You can only use Maropitant for 5 days before you must discontinue use

A

FALSE!

It is only labeled for use for 5 days, but it is SAFE LONGER!

44
Q

What kind of drug is Sucralfate (Carafate)?

A

Gastric Mucosal Protectants

45
Q

What is the MOA of Sucralfate (Carafate)?

A

Stimulates PGE-2 and I-1 which are cytoprotective

Reacts with HCl to form a paste which sticks to ulcers

Inactivates pepsin and

binds bile acids and gastrointestinal phosphorus

46
Q

Which 2 drugs are used in advanced cases of vomiting?

A

Misoprostal

and

Octreotide

47
Q

What is the MOA of Misoprostol, a prostaglandin analog?

A

Treats and prevents gastric ulcers by enhancing mucosal defense systems

via direct action on parietal cell secretion of gastric acid

48
Q

What is the MOA of Octreotide, a somatostatin analog?

A

Treats insulinomas and gastrinomas

via

inhibition of gastric, pancreatic, and biliary secretions, prolonging transit time, decreasing jejunal secretions, and stimulating GI water absorption

49
Q

What somatostatin analog is used to treat

gastrinomas and insulinomas?

A

Octreotide

50
Q

Metoclopramide, Cisapride, Ranitidine, and Erythromycin

are all ________ drugs, used in the tx of vomiting

A

prokinetic

51
Q

Which 2 drugs activate 5-HT4 Receptors?

A

Cisapride and Metoclopramide

52
Q

What is the MOA of 5-HT4 Receptor Activators Cisapride and Metoclopramide?

A

Gastric emptying and GI motility stimulates release of ACh into enteric NS

in the LES, Stomach, and Colon

53
Q

What is the most important side effect associated with Cisapride?

A

While it can cause vomiting and diarrhea, the most important

side effect is QT interval prolongation

54
Q

This macrolide Abx stimulates motilin which promotes

intestinal motility and initiates phase 3 of the migrating myoelectric complex

which propels ingesta (and can treat vomiting)

A

Erythromycin

55
Q

What Rx diets can be used in the tx of acute vomiting?

A

Hill’s I/D

Royal Canin LF

56
Q

T/F:

Withholding food should be your first step in treating chronic vomiting

A

FALSE!

NEVER withhold food in chronic vomiting

(only acute cases less than 1 week)

57
Q

Which 2 drugs are used for appetite stimulation?

A

Cyproheptadine and Mirtazapine

58
Q

What is the MOA of the appetite stimulant Cyproheptadine?

A

H1-receptor blocker

Serotonin antagonists

59
Q

What is the MOA of Tetracyclic Antidepressants like Mirtazapine?

A

Increases NE and thus appetite,

5-HT3 antagonism,

H1-histamine antagonism

Preeti: SAM II (6 decks)

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