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SUM '20 - Pharm II > week 2 antiemetics gi motility- 4 of 4 > Flashcards

week 2 antiemetics gi motility- 4 of 4 Flashcards

1
Q

T/F

pushing rapid IV raglan less than 3 minutes will cause abdominal cramping

A

true!

this is a side effect of rapid administration of IV reglan

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2
Q

this side effect of reglan hammon talked about in class- his patients in the er would just jump up and leave

A

akathisia (feeling of unease an restlessness in lower extremities) This may result in canceling surgery or may manifest in PACU

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3
Q

what are the cardiac side effects seen with reglan

A

hypotension, tachycardia, bradycardia, cardiac arrythmias

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4
Q

these side effects of reglan are rarely seen after a single dose

A 
sedation
dysphoria
agitation
dry mouth
glossal or periorbital edema
hirsutism
urticarial
maculopapular rash
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5
Q

patients with breast cancer should not be treated chronically with what medication

A

reglan

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6
Q

reglan rapidly crosses the placenta - do we see adverse fetal effects with single dose

A

no- not observed

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7
Q

for a patient on chronic therapy of reglan that develops peripheral edema what should we assess?

A

sodium retention and hypokalemia.

*This is due to that fact reglan inhibits dopamine-

dopamine normally inhibits aldosterone-

BUT reglan inhibits dopamine=elevated aldosterone=hypokalemia and sodium retention

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8
Q

reglan

May increase sedative actions of CNS depressants and the incidence of extrapyramidal reactions cause by certain drugs: Should avoid administering in combination with

A

Phenothiazine (prochlorperazine, promethazine, chlorpromazine)

Butyrophenone drugs (Doperidol and haldol)

Patients with preexisting extrapyramidal symptoms

Seizure disorders

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9
Q

these two medication classes should be avoided in patients taking reglan

A

MOAI or Tricyclic antidepressants

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10
Q

reglan decreases bioavailability of orally administered cimetidine by what percent

A

25-50%

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11
Q

what type of gastric issues do we avoid giving reglan to

A

suspected or known mechanical obstruction to gastric emptying

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12
Q

what GI surgery do we avoid administering reglan to?

why do we avoid reglan in these patients

A

pyloroplasty or intestinal anastomosis - it stimulates gastric motility and may delay healing

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13
Q

what are the effects of reglan on ester LA

A

metabolism of ester LA could be slowed by reglan induced decreases in plasma cholinesterase activity.

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14
Q

reglan inhibits plasma cholinesterase activity- which may prolong what two drugs

A

may cause prolonged responses to succinylcholine and mivacurium

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15
Q

who is at an especially increased risk for developing this prolonged responses of inhibiting effect of plasma cholinesterase activity when administering reglan

A

Parturients may be at increased risk for developing this response, considering the already decreased plasma cholinesterase activity associated with pregnancy.

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16
Q

BENZODIAZEPINES- ponv

A

May decrease PONV by decreasing synthesis and release of dopamine within the CRTZ.

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17
Q

If using a benzo for PONV therapy like versed when do you administered it

A

toward the end of the surgical procedure

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18
Q

if the patient is going to be ventilated in the ICU how can you administer the Versed for PONV

A

administer by continuous infusion

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19
Q

Droperidol prophylactic dose

A

0.625-1.25mg IV PONV

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20
Q

what was the primary reason droperidol was listed for a black box warning

A

the doses were MUCH higher than that necessary to treat PONV

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21
Q

what is the dose of haloperidol that does not cause sedation but has antiemetic properties

A

0.5-2mg IV

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22
Q

all meds that involve dopamine receptor blockade in the brain have a risk of “These” symptoms

A

extrapyramidal symptoms

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23
Q

due to the extrapyramidal symptoms caused from dopamine receptor blockade in the brain- caution should be used for what 3 disease types

A

parkinsons disease

RLS

Disease R/T dopaminergic activity

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24
Q

what type of drug is dexamethasone

A

corticosteroids

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25
Q

what is the mechanism of action for the use of dexamethasone as an antiemetic

A

unclear MOA

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26
Q

what has been proposed as the moa for dexamethasone for the use as an antiemetic

A

centrally inhibit prostaglandin synthesis and control endorphin release

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27
Q 
one time use of dexamethasone will produce ...
-minimal?
-moderate?
-maximum?
side effects
A

minimal side effects

28
Q

these two patient populations are at risk for perioperative hyperglycemia when they receive a single dose of dexamethasone

A

Diabetics (brittle/labile) and Obese

29
Q

antagonism of 5-HT3 receptors=

A

antiemetic effect

30
Q

which antiemetic receptor is an Excitatory ligand-gated nonselective cation.

A

5-HT3 Receptor Antagonists

31
Q

5ht3 receptors are extensively distributed on enteric neurons in what two places

A

Gi and brain

32
Q

what stimulates the vagal Afferents through 5-HT3 receptor and initiates the vomiting reflex

A

serotonin which is release from the enterochromaffin cells of the small intestines

33
Q

T/F

5-HT3 receptor antagonist are highly specific and have minimal side effects

A

True

34
Q

this drug class has been proven to be effective in prevention and treatment of PONV

A

5HT3 receptor antagonist

35
Q

in addition to 5HT3 receptor antagonist being proven to be effective in prevention and treatment of PONV- what other types of N/V situation are they useful for as prophylaxis.

A

prophylaxis and treatment of chemotherapy and radiation therapy induced N/V

36
Q

% protein bound - 5HT3 receptor antagonist

A

moderate

60-70%

37
Q

metabolism of 5HT-3 receptor antagonist

A

different subtypes of the cytochrome P450

38
Q

metabolites of 5HT3 receptor antagonist are excreted by what organ

A

primarly renal excretion

39
Q

5HT3 receptor antagonist are readily absorbed - do they cross the BBB

A

yes they readily cross the BBB

IV administration=max brain concentration quickly

40
Q

ondansetron 4mg
dexamethasone 4mg
droperidol 1.2mg

these drugs administered prophylactically before induction of general anesthesia are equally effective in decreasing PONV by what percent

A

26%

41
Q

ondansetron - name the two most common side effect

A

headache

diarrhea

42
Q

ondansetron therapeutic blood concentrations are achieved in how many minutes

A

30-60 minutes

43
Q

how is ondansetron metabolized ?

what is the elimination half time

A

metabolized by liver

elimination half time is 3-4 hours

44
Q

ondansetron is derived from _______ and structurally related to ________

A

carbazalone

serotonin

45
Q

ondansetron possess specific 5-HT3 subtype receptor antagonist properties without altering what 4 receptor activity

A

dopamine, histamine, adrenergic or cholinergic receptor activity

46
Q

what cardiac issues have been reported after IV zofran and reglan

A

cardiac arrhythmia and conduction disturbances (Atrioventricular block)

47
Q

T/F

ondansetron can cause QT interval prolongation but not to the extent as droperidol

A

true

48
Q

for every 100 patients receiving ondansetron for prevention of PONV 20 will not vomit who would have vomited without treatment- what will 3 of those 100 patients develop who would not have this adverse effect without the drug

A

3 - headache?

why do we have to know this?

49
Q

ondansetron significant feature

A

free of side effects

50
Q

zofran 4-8mg IV over 2-5 minutes immediately before the induction of anesthesia is highly effective in decreasing the incidence of ponv in susceptible pt population such as..

A

ambulatory gyno surgery, middle ear surgery

51
Q

oral zofran for pre adolescent children dose

A
  1. 15mg/kg-PO

0. 05-0.15mg/kg- IV

52
Q

what surgeries do we want to especially pre medicate children for

A

tonsillectomy and strabismus surgery ambulatory surgery

53
Q

Name the drug that is almost as effective as ondansetron in preventing PONV 19-26%

A

propofol

54
Q

dimenhydrinate (dramamine) dose for adult

decreases vomiting after

A

20mg IV

outpatient surgery

55
Q

dimenhydrinate (dramamine) dose for children

decreases incidence of vomiting after?

A

0.5mg/kg IV

strabismus surgery

56
Q

name the 4 medications Nonspecific antihistamines likely acting on H1 receptors include:

A

Diphenhydramine
Dimenhydrinate
Cyclizine
promethazine

57
Q

what are the 3 subtypes of histamine

A

H1-H2-H3

58
Q

Histamine acting through H1 receptors and inositol phospholipid hydrolysis evokes

A

smooth muscle contraction in GI tract

59
Q

compared to ondansetron- what is the benefit of tropisetron

A

tropisetron has the benefit of a longer elimination half time- 7.3hr vs. 3.5hr

60
Q

what disease process is tropisetron effective in treating symptoms of

A

carcinoid syndrome

61
Q

what additional properties does tropisetron treat

A

gastrokinetic properties

62
Q

compared to ondansetron: tell me about granisetron

A

it is more selective than ondansetron

63
Q

what can be administered with granisetron to siginificantly improve the acute antiemetic efficacy

A

dexamethasone

64
Q

name the 5ht3 antagonist that increases appetite

A

dolasetron

65
Q

which 5ht3 antagonist medication is highly potent

A

dolasetron

66
Q

explain the antiemetic effect of dolasetron

A

dolasetron is rapidly metabolized to hydrodolasetron- which is responsible for the antiemetic effect

SUM '20 - Pharm II (30 decks)

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