Agents for Nausea and Vomiting - specific applications

Question 1

What Serotonin Receptor Antagonist is used to treat IBS-D?

Answer 1

Alosetron

Question 2

Adverse effects of Serotonin Receptor Antagonists?

Answer 2

Serotonin Syndrome - occurs with other 5HT drugs

Dose-Dependent QT prolongation (Torsades)

Question 3

What is the most worrisome Serotonin Receptor Antagonist adverse effect and when should you used extra caution?

Answer 3

Dose-Dependent QT prolongation (Torsades)

- When patients are taking other antiarrhythmic drugs or have hypokalemia/hypomagnesemia

Question 4

When should you use extra caution with Serotonin Receptor Antagonists to avoid Dose-Dependent QT prolongation?

Answer 4

When patients are taking other antiarrhythmic drugs or have hypokalemia/hypomagnesemia

Question 5

What Serotonin Receptor Antagonist drug specifically, has the highest risk to cause QT prolongation?

Answer 5

Dolasetron

Question 6

Which Serotonin Receptor Antagonists are effective SINGLE dose agents for delayed chemo N/V?

Answer 6

Palonosetron

Granisetron

Question 7

When are Neurokinin1 Receptor Antagonists the most effective?

Answer 7

When used in combination with other agents to treat chemo-induced N/V

Question 8

When are Neurokinin1 Receptor Antagonists the most effective?

Answer 8

When used in combination with other agents to treat chemo-induced N/V

Question 9

Which NK1 Receptor Antagonists have the most active metabolites and longer half lives?

Answer 9

Netupitant

Rolapitant

Question 10

Initial pregnancy N/V treatment?

Answer 10

Doxylamine + B6

H1 receptor antagonist

Question 11

Initial pregnancy N/V treatment?

Answer 11

Doxylamine + B6

H1 receptor antagonist

Question 12

Adverse effects of Histamine1 Receptor Antagonists?

Answer 12

Anticholinergic:

• Drowsy, blurred vision, low BP
• Constipation and urinary retention

Question 13

Adverse effects of Histamine1 Receptor Antagonists?

Answer 13

Anticholinergic:

• Drowsy, blurred vision, low BP
• Urinary retention, constipation

Question 14

What is the only indication to use Meclizine and Cyclizine?

Answer 14

Motion sickness/vertigo

Question 15

What is the only indication to use Meclizine and Cyclizine?

Answer 15

Motion sickness/vertigo

Question 16

Which Histamine1 Receptor Antagonists are used to treat motion sickness/vertigo?

Answer 16

Meclizine

Cyclizine

Question 17

What Dopamine (D2) Receptor Antagonist is used ONLY for Post-op N/V?

Answer 17

Amisulpride

Question 18

Amisulpride is only used for?

Answer 18

Post-op N/V

D2 receptor antagonist

Question 19

Amisulpride is only used for?

Answer 19

Post-op N/V

D2 receptor antagonist

Question 20

What Dopamine (D2) Receptor Antagonist can also enhance GI motility/treat gastroparesis?

Answer 20

Metoclopramide

Question 21

Metoclopramide can also treat?

Answer 21

GI dysmotility

Gastroparesis

Question 22

Metoclopramide can also treat?

Answer 22

GI dysmotility

Gastroparesis

Question 23

Adverse effect of ALL of the D2 Receptor Antagonists?

Answer 23

Drowsy

Question 24

Adverse effect of ALL of the D2 Receptor Antagonists?

Answer 24

Drowsy

Question 25

Adverse effects of Prochlorperazine?

Answer 25

- urinary retention and constipation | - dry mouth and blurred vision

Question 26

Adverse effects of Amisulpride?

Answer 26

Chills, hypokalemia, hyperprolactinemia

Question 27

Which drug/class is a patch that can be worn for 72 hours?

Answer 27

Scopolamine | - Muscarinic1 Receptor Antagonist

Question 28

When is Scopolamine most commonly used?

Answer 28

Motion sickness | End-of-life care for excessive secretions

Question 29

When is Scopolamine most commonly used?

Answer 29

Motion sickness | End-of-life care for excessive secretions

Question 30

Adverse effects of Scopolamine?

Answer 30

Anticholinergic: - Drowsy and blurred vision - Urinary retention and constipation - Dry mouth

Question 31

What drug class is FDA-scheduled (controlled) due to abuse potential?

Answer 31

Cannabinoid (CB) Receptor Agonists

Question 32

Cannabinoid receptor agonists (+) which receptors?

Answer 32

Central (CB1) and Peripheral (CB2)

Question 33

Once the CB1/2 receptors are activated, what does that do?

Answer 33

Decreases excitability of neurons

Question 34

When are CB receptor agonists used?

Answer 34

TREATMENT-RESISTANT scenarios

Question 35

When are CB receptor agonists used?

Answer 35

Treatment - Resistant scenarios

Question 36

Adverse effects of CB receptor agonists usually effect?

Answer 36

CNS

Question 37

The proper focus of therapy from Chemo-induced N/V is on?

Answer 37

Prevention

Question 38

Acute chemo-induced N/V

Answer 38

Less than 24 hours after chemo

Question 39

Chronic chemo-induced N/V

Answer 39

More than 24 hours after chemo

Question 40

Anticipatory chemo-induced N/V

Answer 40

BEFORE chemo

Question 41

HIGH-ematogenic regimen involves how many drugs?

Answer 41

4

Question 42

What 4 drug classes are chosen for HIGH-ematogenic regimens?

Answer 42

1. D2 receptor antagonist 2. NK1 antagonist 3. 5HT antagonist 4. Corticosteroid (Dexamethasone)

Question 43

4 drugs are given the day of chemo for HIGH-ematogenic regimens. For 3 days after, what 3 drugs are given?

Answer 43

1. D2 receptor antagonist 2. NK1 antagonist 3. Corticosteroid (Dexamethasone)

Question 44

MODERATE-ematogenic regimen involves how many drugs?

Answer 44

3

Question 45

What 3 drug classes are chosen for MODERATE-ematogenic regimens?

Answer 45

1. NK1 antagonist 2. 5HT antagonist 3. Corticosteroid (Dexamethasone)

Question 46

3 drugs are given the day of chemo for MODERATE-ematogenic regimens. For 2 days after, what 2 drugs are given?

Answer 46

1. NK1 antagonist | 2. Corticosteroid (Dexamethasone)

Question 47

LOW-ematogenic regimens involve how many drugs?

Answer 47

1

Question 48

Minimal-ematogenic regimens involve how many drugs?

Answer 48

0

Question 49

For Breakthrough Emesis, what drug do you give?

Answer 49

ANY in this lecture

Question 50

For Breakthrough Emesis, what drug do you give?

Answer 50

ANY in this lecture