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CPT > Anti-emetics > Flashcards

Anti-emetics Flashcards

1
Q

Which drugs act on the vestibular nuclei?

A

Muscarinic receptor antagonists

H1 receptor antagonists

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2
Q

What is an example of a muscarinic receptor antagonist?

A

Hyoscine hydrobromide

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3
Q

What are muscarinic receptor antagonists recommended for?

A

Motion sickness
People who can’t take tablets (patch)
Bowel obstruction

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4
Q

What are some side effects of muscarinic receptor antagonists?

A

Sedation
Memory problems
Glaucoma
Dry mouth and constipation

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5
Q

What are some examples of H1 receptor antagonists?

A

Cyclizine
Levomepromazine
Promethazine

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6
Q

How do H1 antagonists act as anti-emetics?

A

Inhibit histaminergic signals from the vestibular system to CTZ

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7
Q

What are H1 receptor antagonists used for (anti-emetic)?

A

Motion sickness - long plane journeys

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8
Q

What can cyclizine be used for?

A

Morning sickness

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9
Q

What are some side effects of H1 receptor antagonists?

A

Sedation
Excitation
Dry mouth, constipation, urinary retention
Cardiac toxicity - long QT syndrome

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10
Q

What are examples of 5HT3 receptor antagonists?

A

Ondansetron
Granesitron
Palonosetron

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11
Q

How do 5HT3 receptor antagonists act as anti-emetics?

A

Act on visceral afferents in the gut

Peripherally:
Reduce GI motility
Reduce GI secretions

Centrally:
Inhibit CTZ

Often 1st line treatment

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12
Q

What are some side effects of 5HT3 antagonists?

A 
Constipation 
Headache 
Elevated liver enzymes 
Long QT syndrome 
Extra-pyramidal effects; dystonia, Parkinsonism

Side effects are uncommon

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13
Q

What are some D2 receptor antagonists?

A

Metacloperamide

Domperidone

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14
Q

How does metaclopramide (D2 receptor antagonist) act as an anti-emetic?

A

Increase AcH at muscarinic receptors in the gut

Promotes gastric emptying
Increase tone of lower oesophageal sphincter
Increase peristalsis
Decrease tone of pyloric sphincter

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15
Q

What are some side effects of metacloperamide?

A

Galactorrhoea

Extra-pyramidal effects; dystonia, Parkinsonism

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16
Q

What is domperidone good for? (Most an anti-emetic use)

A

Improving lactation in mothers

However used selectively bc can cause sudden cardiac death - long QT

17
Q

What D2 receptor antagonists act on the CTZ?

A 
Metacloperamide 
Domperidone 
Prochlorperazine 
Chlorpromazine 
Levomepromazine 
Haloperidol
18
Q

What are D2 receptor antagonists used for?

A

Motion sickness, vertigo

Prochlorperazine used in pregnancy

19
Q

What are some side effects of D2 receptor antagonists?

A

Extra-pyramidal effects; dystonia, Parkinsonism
Sedation
Hypotension

20
Q

What corticosteroids are used as anti-emetics?

A

Dexamethasone

Methylprednisolone

21
Q

How do corticosteroids act as anti-emetics?

A

Assumed to act on CTZ
May also have properties of D2 receptors

Used for peri-operative nausea and vomiting, chemo and palliation

22
Q

How are cannabinoids used as anti-emetics?

A

Assumed to act on the CTZ
Last line for chemo

Side effects:
Dizziness, drowsiness

23
Q

How do neurokinin-1 receptor antagonists act as anti-emetics?

A

Prevent action of substance P at CTZ and in peripheral nerves
Also boosts effects of 5HT3 receptor antagonists

Good for chemo, esp delayed emesis

24
Q

How is motion sickness treated?

A

Prevention is better than cure

Hyoscine hydrobromide- 1st line
Selective, good for long plane journeys

Cinnirazine - fewer side effects

25
Q

What are prokinetics? And what are they used for?

A

Increase peristalsis of the gut
Used for GORD, and paralytic ileus

Don’t use w/ bowel obstruction as there is a risk of perforation

26
Q

What causes hyperemesis gravidarum? And what is the treatment?

A

Rapid rise in βhCG

1) promethazine or prochlorperazine
2) metacloperamide
3) ondansetron

27
Q

What’s the order of anti-emetics used for chemo?

A

1) dexamethasone
2) dexamethasone and ondansetron
3) dexamethasone and ondansetron and aprepitant

28
Q

What are some risk factors for post-op nausea and vomiting?

A

Female, younger age, non-smoker

GA, post-op opioids

Longer surgery

CPT (21 decks)

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