Anti-Emetics

Question 1

SCOPOLAMINE (Transderm Scop) Class

Answer 1

Anticholinergic; anti-emetic and anti-vertigo (dermal patch)

Question 2

SCOPOLAMINE (Transderm Scop) MOA

Answer 2

blocks activity of acetylcholine at PSNS sites in smooth muscle, secretory glands, and CNS

Question 3

SCOPOLAMINE (Transderm Scop) Indications

Answer 3

nausea, vertigo

Question 4

SCOPOLAMINE (Transderm Scop) S/E

Answer 4

sedation, dry mouth, pupillary dilatation, constipation; confusion, urinary retention

Question 5

MECLIZINE (Antivert) Class

Answer 5

antiemetic, H1 antagonist

Question 6

MECLIZINE (Antivert) Indication

Answer 6

prevention and treatment of motion sickness

Question 7

MECLIZINE (Antivert) MOA

Answer 7

central anticholinergic blockage in chemoreceptor trigger zone and decreases excitability of vestibular-cerebellar pathways which reduces motion sickness

Question 8

MECLIZINE (Antivert) S/E

Answer 8

sedation, fatigue, vomiting, blurred vision

Question 9

PROMETHAZINE (Phenergen) Class

Answer 9

Phenothiazine

Question 10

PROMETHAZINE (Phenergen) Indication

Answer 10

Antiemetic, motion sickness, sedative

Question 11

PROMETHAZINE (Phenergen) MOA

Answer 11

blocks CNS dopamine receptors (D2); competes for H1 receptors

Question 12

PROMETHAZINE (Phenergen) S/E

Answer 12

VERY SEDATIN, confusion, delirium, extrapyramidal symptoms; cardiac arrhythmias, orthostatic hypotension, urinary retention

Question 13

HALOPERIDOL (Haldol) Class

Answer 13

Butyrophenones; typical antipsychotic

Question 14

HALOPERIDOL (Haldol) Indication

Answer 14

antiemetic; schizophrenia, Tourette’s disorder; emergency sedation of agitated-aggressive patients (off label)

Question 15

HALOPERIDOL (Haldol) MOA

Answer 15

blocks postsynaptic mesolimbic D1 and D2 receptors; also suppresses the reticular activating system (RAS) thereby reducing emesis

Question 16

HALOPERIDOL (Haldol) S/E

Answer 16

agitation, akithesia, alteration of temp regulation, confusion; QT prolongation, EPS (tardive dyskinesia), NMS, anticholinergic effects

Question 17

METOCLOPROMIDE (Reglan) Class

Answer 17

Benzamide; anti-emetic; prokinetic

Question 18

METOCLOPROMIDE (Reglan) Indication

Answer 18

anti-emetic; diabetic gastroparesis, GERD

Question 19

METOCLOPROMIDE (Reglan) MOA

Answer 19

blocks D and 5-HT receptors in CRTZ

Question 20

METOCLOPROMIDE (Reglan) S/E

Answer 20

AV block, drowsiness, fatigue, diarrhea; Tardive dyskinesia, EPS (esp acute dystonic reactions initial 24-48h); pseudoparkinsonism; rarely NMS

Question 21

DEXAMETHASONE (Maxidex) Class

Answer 21

corticosteroid

Question 22

DEXAMETHASONE (Maxidex) Indication

Answer 22

anti-emetic; immune modulation

Question 23

DEXAMETHASONE (Maxidex) MOA

Answer 23

enhance effect of 5-HT3-receptor antagonists CRTZ

Question 24

DEXAMETHASONE (Maxidex) S/E

Answer 24

single dose regimen so minimal

Question 25

DRONABINOL (Marinol) class

Answer 25

Tetrahydrocannabinol (THC)

Question 26

DRONABINOL (Marinol) Indication

Answer 26

appetite stimulant; anti-emetic (chemo related)

Question 27

DRONABINOL (Marinol) MOA

Answer 27

unknown

Question 28

DRONABINOL (Marinol) S/E

Answer 28

euphoria, dysphoria, sedation, dry mouth; tachycardia, orthostatic hypotension Contra: hx schizophrenia, seizure disorders, hepatic disease

Question 29

ONDANESTRON (Zofran) Class

Answer 29

serotonin antagonist

Question 30

ONDANESTRON (Zofran) Indication

Answer 30

post-op, radiation and chemotherapy induced N/V

Question 31

ONDANESTRON (Zofran) MOA

Answer 31

peripheral and CRTZ 5-HT3 receptor blockade

Question 32

ONDANESTRON (Zofran) S/E

Answer 32

headache, dizziness, constipation, malaise, fatigue; QT prolongation, hypoxia Contra: hypersensitivity; cardiac arrhythmias

Question 33

If we blockade central and peripheral 5-HT3 receptors, where are they located?

Answer 33

Intestinal vagal & spinal afferent nerves

Question 34

When is Odanestron most effective?

Answer 34

When pretreated, and on a scheduled bases.

Question 35

APREPITANT (Emend) Class

Answer 35

neurokinin-1 antagonist

Question 36

APREPITANT (Emend) Indicaiton

Answer 36

prevention chemo induced N/V; post-op N/V

Question 37

APREPITANT (Emend) MOA

Answer 37

blocks central NK1 receptors; augments anti-emetic effect of 5-HT3 receptor antagonism and corticosteroids

Question 38

APREPITANT (Emend) S/E

Answer 38

fatigue, nausea, constipation, muscle weakness, diarrhea

Question 39

Can we combine Aprepitant with anything else to prevent chemo induced N/V?

Answer 39

5-HT3 & corticosteroids

Question 40

LORCASERIN (Belviq) Class

Answer 40

peripherally-acting opioid antagonist

Question 41

LORCASERIN (Belviq) Indicaiton

Answer 41

opioid-induced constipation

Question 42

LORCASERIN (Belviq) MOA

Answer 42

Mu-opioid receptor antagonist (conjugated with PEG reducing its ability to cross BBB) so acts peripherally in GI tract

Question 43

LORCASERIN (Belviq) S/E

Answer 43

abdominal pain, headache, N/V/D