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Pediatric Pharm Exam 3 > Nausea/Vomiting > Flashcards

Nausea/Vomiting Flashcards

1
Q

Pathophysiology of Chemoreceptor Trigger Zone (CTZ)

3

A
  1. Area postrema located at the end of the 4th ventricle
  2. Outside the BBB & influenced by triggers in the blood or CSF
  3. Receptors involved – DA2, M1, H1, NK1, and opioid
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2
Q

Pathophysiology - Vagal afferent System (2)

A
  1. Triggers: chemotherapy, radiation, acute infectious gastroenteritis
  2. Receptors involved – 5-HT3
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3
Q

Pathophysiology - Vestibular System (3)

A
  1. Cranial nerve VIII
  2. Motion sickness
  3. Receptors involved –M1 and H1
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4
Q

5-HT3 Receptor Antagonists MOA (2)

A
  1. Effects occur at CTZ (potentially at peripheral sites as well)
  2. Block binding of serotonin
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5
Q

5-HT3 Receptor Antagonists Use in Therapy (4)

A
  1. Chemotherapy
  2. Post-operative N/v
  3. Cyclic vomiting
  4. Gastroenteritis
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6
Q

5-HT3 Receptor Antagonists Side effects (4)

A
  • Headache
  • QT prolongation
  • Dizziness
  • Constipation
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7
Q

5-HT3 Receptor Antagonists Available Agents (4)

A
  1. Ondansetron (Zofran®)
  2. Granisetron (Kytril®) — Longer half-life, Same QT prolongation, Anecdotal improved efficacy
  3. Palonosetron
  4. Dolasetron
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8
Q

Antihistamine and Anticholinergic Agents MOA

A

Weak anti-emetic properties but work by competing with histamine on H1-receptors or M1 (scopolamine)

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9
Q

Antihistamine & Anticholinergic Agents Use in Therapy (2)

A
  1. Additive agent

2. Motion sickness

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10
Q

Antihistamine and Anticholinergic Agents Side Effects (4)

A
  1. Dry mouth
  2. Sedation, dizziness
  3. Blurred vision
  4. Urinary retention
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11
Q

Antihistamine and Anticholinergic Agents Available Agents (5)

A
  1. Diphenhydramine (Benadryl®) – Oral tablet and liquid
  2. Hydroxyzine (Vistiril®)
  3. Meclizine (Dramamine®)
  4. Dimenhydrinate (Gravasol®)
  5. Scopolamine – Only available as patch, Long acting but takes time to work, Best for motion sickness

ALL AVAILABLE OTC

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12
Q

Dopamine Receptor Antagonists MOA

A

Work primarily affecting DA receptors but also bind to M1 and H1

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13
Q

Dopamine Receptor Antagonists Side Effects (3)

A
  1. Drowsiness (H1 effects)
  2. EPS: restlessness, dystonias
  3. QT prolongation
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14
Q

Dopamine Receptor Antagonists Available Agents (3)

A
  1. Prochlorperazine
  2. Promethazine
  3. Metoclopramide
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15
Q

Dronabinol (Marinol®) Overview (3)

A
  1. Synthetic delta-9-tetrahydrocannabinol (delta-9-THC)
  2. Natural occurring component ofCannabis sativa L.(marijuana), activates cannabinoid receptors CB1to stimulate appetite
  3. CIII
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16
Q

Dronabinol (Marinol®) Drug-Drug interaction

A

No Drug-drug interactions except with highly protein bound drugs (ie warfarin)

17
Q

Dronabinol (Marinol®) ADE (6)

A
  1. Flushing
  2. tachycardia
  3. vasodilation
  4. CNS effects (hallucinations, ephoria, anxiety
  5. N/V
  6. abdominal pain
18
Q

Dronabinol (Marinol®) Clinical Pearl

A

Not your “go-to anti-emetic” but something to consider especially if kids are not eating

19
Q

Antiemetic Options Serotonin Antagonists (2)

A
  1. Ondansetron (Zofran®)

2. Granisetron (Kytril®)

20
Q

Antiemetic Options Antihistamines (2)

A
  1. Diphenydramine (Benadryl®)

2. Hydroxyzine (Atarax®)

21
Q

Antiemetic Options NK-1 Receptor Antagonists (1)

A

Aprepitant (Emend®)

22
Q

Antiemetic Options Benzo Agent

A

Lorazepam (Ativan)

23
Q

Antiemetic Options - Other (3)

A
  1. Prochlorperazine (Compazine®)
  2. Promethazine (Phenergan®)
  3. Metoclopramide (Reglan®)
24
Q

Antiemetic Options “BAD” infusions

A

Benadryl-Lorazepam-Dexamethasone

25
Q

Antiemetic Options - Corticosteroids information

A

Not recommended for leukemia, lymphoma, and brain tumor regimens. Also, contraindicated with some immunologic and biologic agents

Helpful with delayed nausea/vomiting

26
Q

Most common type of nausea; starts immediately after chemotherapy up to 24 hrs post-dose

A

Acute Nausea and Vomiting Associated with Chemotherapy

27
Q

Treatment Options for Nausea with Chemo (5)

A
  1. 5-HT3 receptor antagonists
  2. NK-1 receptor antagonists
  3. Corticosteroids
  4. Benzodiazepines
  5. Benadryl-Dexamethasone-Lorazepam “BAD” infusions
28
Q

Anticipatory Treatment (3)

A
  1. Behavioral
  2. Holistic (i.e. Accupuncture)
  3. Pharmacologic
    Benzodiazepines: One study recommended 0.04 – 0.08 mg/kg the night before and morning of chemotherapy for children with anticipatory (Duprius 2014)

Pediatric Pharm Exam 3 (11 decks)

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