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pharm test 6 > 33 Drugs used to treat nausea and vomiting > Flashcards

33 Drugs used to treat nausea and vomiting Flashcards

1
Q

Regurgitation

A

gastric or esophageal contents rise to the pharynx because of greater pressure (gas bubbles, tight clothing, body position)

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2
Q

Postoperative nausea and vomiting (PONV)

A

pt-related, anesthesia-related, and surgery-related. Potential for PONV increases with the number of risk factors present in a particular pt. Increased risk for tearing sutures, excess pressure on organs, and increase in cranial pressure

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3
Q

hyperemesis gravidarum

A

electrolytes and fluids become imbalanced; recurring emesis during pregnancy can lead to this- harmful to mother and baby; elderly and very young at risk

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4
Q

psychogenic vomiting

A
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5
Q

chemotherapy-induced nausea and vomiting (CINV)

A
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6
Q

anticipatory nausea and vomiting

A
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7
Q

emetogenicity

A
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8
Q

delayed emesis

A
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9
Q

radiation-induced nausea and vomiting (RINV)

A
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10
Q

Vomiting can be either…

A

self-induced/ voluntary (bulimia) or involuntary with a wide variety of reasons

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11
Q

Etiology

A

chemo-induced, anesthetics, disease process, organ damage, harmful substances

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12
Q

Ongoing emesis can lead to

A

alkalosis due to loss of acid from vomiting

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13
Q

prolonged diarrhea likely to lead to

A

acidosis due to excessive loss of bicarbonate ions in feces. (bicarb ions made by pancreas and secreted into the lumen of the small intestine to neutralize stomach acid)

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14
Q

Control centers for N/V (2); location

A

Chemoreceptor trigger zone and the Vomiting center; brainstem

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15
Q

Two systems receive afferent information from

A

vestibular system of inner ear, GI tract and cerebral cortex

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16
Q

When (inner ear, gi tract, cerebral cortex) systems become activated they release 5 main neurotransmitters that bring about n/v

A

dopamine, serotonin, histamine, acetylcholine, substance p

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17
Q

Medications used to treat n/v used to block what

A

used to block the elevated 5 neurotransmitters; dopamine, serotonin, histamine, acetylcholine, substance p

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18
Q

Anticholinergics block; examples

A

effects of acetylcholine; scoplamine (Transderm-Scop; patch used for motion sickness), trimethobenzamide (Tigan)

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19
Q

Seratonin antagonist SHT-3 antagonists block what neurotransmitter and where

A

ondansetron (Zofran), granisetron (Kytril), palonosetron (Aloxi) (gen. names end in setron); block serotonin receptors in the gastrointestinal mucosa, vomiting center (VC) and chemoreceptor zone (CTZ) in medulla oblongota

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20
Q

indications for SHT-3 antagonists; even more effective when administered with

A

cancer treatment, radiation therapy, PONV; dexamethasone and aprepitant (Emend)

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21
Q

Unlabeled uses for ondansetron

A

bulimia, alcoholism, hyperemisis gravidarum

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22
Q

Seratonin antagonist SHT-3 antagonists; block what neurotransmitter and where

A

ondansetron (Zofran), granisetron (Kytril), palonosetron (Aloxi) (gen. names end in setron); block serotonin receptors in the gastrointestinal mucosa, vomiting center (VC), and chemoreceptor zone (CTZ) in medulla oblongata

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23
Q

Antihistamines

A

diphenhydramine (Benadryl), dimehydrinate (Dramanine), meclizine (Antivert)

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24
Q

Antihistamines use related to n/v

A

motion sickness

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25
Q

Other properties antihistamines have; to block what

A

anticholinergic properties; to block acetylcholine

26
Q

Substance P

A

aprepitant (Emend)

27
Q

Many NK-1 receptors located in CTZ and VC- aprepitant is selective to the NK-1 receptor and block this; use

A

substance-P; cancer treatment, PONV

28
Q

Antidopaminergic

A

prochlorperazine (Compazine), promethazine (Phenergan), chorpromazine (Thorazine)

29
Q

Antidopaminergic uses; dosage form; Other properties antidopaminergic have

A

n/v, psychiatric disorders, intractable hiccups; suppositories; anticholinergic properties

30
Q

Metoclopramide; which property promotes gastric emptying into the duodenum; use

A

antidopaminergic, antiemetic, anticholinergic, prokinetic; prokinetic promotes gastric emptying into the duodenum;use for reflux/regurgitation

31
Q

long term use of metoclopramide can lead to

A

tardive dyskinesia

32
Q

dronabinol (Marinol) receptor agonist

A

CB-1 receptor in the brainstem and GI tract

33
Q

dronabinol (Marinol) additional use

A

appetite stimulant in cancer and aids pts

34
Q

OTC; active ingredients

A

Emetrol and Nausea relief; dextrose/fructose w/ phosphoric acid

35
Q

how otc medications work

A

delay gastric emptying by reducing smooth muscle contraction in the GI tract

36
Q

Sites of action: Inner ear- antiemetic

A

antihistamines, anticholinergics, prokinetics, antidopaminergics

37
Q

Sites of action: GI tract- antiemetic

A

SHT-3 antagonists, prokinetics, dextrose/fructose w/ phosphoric acid

38
Q

Sites of action: CTZ- antiemetic

A

SHT-3 antagonists, prokinetics, antidopaminergics, NK-1 antagonists

39
Q

Sites of action: VC- antiemetic

A

NK-1 antagonists, SHT-3 antagonists

40
Q

Sites of action: Cerebral cortex- antiemetic

A

CB-1 agonist

41
Q

Important funtion of CTZ

A

sample blood and spinal fluid for potentially toxic substances and when detected to initiate the vomiting reflux.

42
Q

Can CTZ initiate vomiting independently

A

no, only by stimulating the VC

43
Q

Prior to vomiting these symptoms of pallor, sweating, and tachycardia cause additional discomfort associated with vomiting

A

autonomic symptoms

44
Q

N/V in preg: V is more common in (5)

A

primigravidas, younger women, nonsmokers, African Americans, obese women

45
Q

CINV

A

chemotherapy-induced nausea and vomiting

46
Q

CINV: conditioned response triggered by the sight or smell of the clinic or hospital or by the knowledge that treatment is imminent

A

anticipatory nausea and vomiting

47
Q

CINV: onset of anticipatory n/v is usually

A

2-4 hrs before treatment and most severe at time of chemo administration

48
Q

CINV: delayed emesis starts when

A

more than 24 after treatment, lasts up to a few days

49
Q

Control of v is important for:

A

relieving the obvious distress associated with it, preventing aspiration of gastric contents into lungs, dehydration, and electrolyte imbalance

50
Q

Primary treatment of n/v should be directed where; because this is not always possible, treatment with what measures is appropriate

A

at underlying cause; nondrug and drug

51
Q

PONV drugs

A

dopamine antagonists, anticholinergic agents, serotonin antagonists, and histamine-2 antagonists

52
Q

PONV therapy may include these options

A

-hydration
-supplemental O2
-a benzodiazepine for anxiolysis
-a combination of antiemetics that work by different mechanisms
-IV anesthesia induction agents
-analgesia with an NSAID rather than an opioid

53
Q

IV anesthesia induction agents

A

propofol
remifentanil

54
Q

N/V in preg: why would ondansetron and metoclopramide be prescribed

A

to treat hyperemesis gravidarum w/o teratogenic effects

55
Q

Seratonin antagonists: ex; used to prevent __

A

ondansetron, granisetron, palonosetron; prevent CINV

56
Q

Anticholinergic agents: uses; how to determine which drug to use

A

-scopolamine and antihistamines (diphenhydramine, dimenhydrinate, meclizine), and promethazine; used to treat motion sickness.
-antihistamines used in preg for n/v;

-depends on both the period for which antinausea protection is needed and the adverse effects

57
Q

Which anticholinergic agent is used for short periods of motion; which is used for longer periods

A

scopolamine; antihistamine

58
Q

Corticosteroids use

A

efficacy and lack of adverse effect due to only a few doses being administered

59
Q

Benzodiazepines (am’s) (3)

A

lorazepam, midazolam, diazepam

60
Q

Benzodiazepines are effective in the frequency of n/v but also in this

A

the anxiety associated with chemotherapy

61
Q

This serotonin antagonist is given 30 min - 1 hr before chemo and routinely for the next 3-4 days

A

ondansetron

62
Q

Drugs that increase toxic effects of cannabinoids; what to monitor for

A

antihistamines, alcohol, analgesics, benzodiazepines, phenobarbital, antidepressants, muscle relaxants, and sedative-hypnotics;
monitor for excessive sedation and reduce the dosage of the other sedative agents

pharm test 6 (4 decks)

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