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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
What is the MOA of proton pump inhibitors?
Inhibits the gastric proton pump which inhibits **transport of hydrogen atoms** into the stomach and inhibits the **hepatic cytochrome p-450** system
26
How do antiemetics work?
Block or compete with neurotransmission at the **receptor sites** associated with emesis
27
Name the 6 categories of antiemetic drugs
Phenothiazines Anticholinergics NK-1 receptor inhibitors Dopamine antagonists Antihistamines Serotonin antagonists **PANDAS!**
28
Scopalamine, Phenothiazines, Propantheline, and Isopropamide are all drugs in this category used in the tx of vomiting
M1-Cholinergic Receptor Antagonists
29
Which M1 Cholinergic Receptor antagonist can cause excitement in cats and can cross the BBB?
Scopalamine
30
Diphenhydramine, Meclizine, Cryptoheptadine are all drugs in this category used in the tx of vomiting
Antihistamines
31
T/F: Histamine antagonists are great to use in cats to prevent vomiting
FALSE! Histamine antagonists are not helpful in cats because they **do not have histamine receptors in the CRTZ**
32
Metoclopramide is a drug in this category used in the tx of vomiting
D2-Dopaminergic Antagonist
33
What is the MOA of Metoclopramine (D2-Dopaminergic Receptor Antagonist) in CATS?
Stimulates movement of the distal esophagus but not as much of an antiemetic effect because **cats have** **fewer CNS dopamine receptors**
34
What is the MOA of Metoclopramine (D2-Dopaminergic Receptor Antagonist) in DOGS?
Antiemetic
35
T/F: Metoclopramide is a 5-HT**3** **antagonist** and a 5-HT**4** **agonist**
TRUE
36
What are some side effects of Metoclopramide?
Constipation, mentation change
37
Dolasetron (Anzemet) and Odansetron (Zofran) are both drugs in this category used in the tx of vomiting
5-HT**3** Serotonin Antagonists
38
Where do Dolasetron and Zofran (Ondansetron) have an effect?
Works in the GIT and CRTZ
39
What are the side effects associated with Dolasetron and Ondansetron?
Constipation, Fatigue, Dry Mouth
40
Maropitant and Cerenia are both drugs in this category used in the tx of vomiting
NK-1 Receptor Antagonists
41
What is the mechanism of action of Maropitant and Cerenia?
Competes with **substance-P** (peripherally and centrally)
42
What is the best drug to use in the treatment of motion sickness?
Cerenia (Maropitant can see bradycardia with high doses, which are required to tx motion sickness)
43
T/F: You can only use Maropitant for 5 days before you must discontinue use
FALSE! It is only labeled for use for 5 days, but it is SAFE LONGER!
44
What kind of drug is Sucralfate (Carafate)?
Gastric Mucosal Protectants
45
What is the MOA of Sucralfate (Carafate)?
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
Which 2 drugs are used in advanced cases of vomiting?
**Misoprostal** and **Octreotide**
47
What is the MOA of **Misoprostol**, a prostaglandin analog?
Treats and prevents gastric ulcers by enhancing mucosal defense systems via **direct action on parietal cell secretion of gastric acid**
48
What is the MOA of **Octreotide**, a **somatostatin analog**?
Treats **insulinomas and gastrinomas** via inhibition of gastric, pancreatic, and biliary **secretions**, prolonging **transit time**, decreasing **jejunal** secretions, and stimulating **GI water absorption**
49
What somatostatin analog is used to treat gastrinomas and insulinomas?
**Octreotide**
50
Metoclopramide, Cisapride, Ranitidine, and Erythromycin are all ________ drugs, used in the tx of vomiting
prokinetic
51
Which 2 drugs **activate 5-HT4 Receptors**?
Cisapride and Metoclopramide
52
What is the MOA of 5-HT**4** Receptor Activators Cisapride and Metoclopramide?
Gastric emptying and GI motility stimulates release of ACh into enteric NS in the **LES, Stomach, and Colon**
53
What is the most important side effect associated with Cisapride?
While it can cause vomiting and diarrhea, the most important side effect is **QT interval prolongation**
54
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)
Erythromycin
55
What Rx diets can be used in the tx of acute vomiting?
Hill's I/D Royal Canin LF
56
T/F: Withholding food should be your first step in treating chronic vomiting
FALSE! NEVER withhold food in chronic vomiting (only acute cases less than 1 week)
57
Which 2 drugs are used for appetite stimulation?
Cyproheptadine and Mirtazapine
58
What is the MOA of the appetite stimulant **Cyproheptadine**?
H1-receptor blocker Serotonin antagonists
59
What is the MOA of Tetracyclic Antidepressants like **Mirtazapine**?
**Increases NE** and thus appetite, 5-HT**3** antagonism, **H1-histamine** antagonism

Preeti: SAM II (6 decks)

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