Antiemetic Agents Flashcards Preview

Pharm II Exam 4 > Antiemetic Agents > Flashcards

Flashcards in Antiemetic Agents Deck (31):
1

Describe the brainstem "vomiting center"

Coordinates the act of vomiting through CN VIII, X, & networks in the nucleus tractus solitarius

High concentrations of M1, H1, NK1, D2, GABA, & sertonin (5-HT3) receptors

2

What are the 4 sources of afferent input to the vomiting center?

1. "Chemoreceptor trigger zone" (D2, opioid, NK1, & 5-HT receptors)
2. Vestibular system (M1 & H1 receptors)
3. Vagal & spinal afferent nerves (5-HT receptors)
4. CNS

3

What drug classes are used to relieve vomiting? (6)

Antihistamine-anticholinergics

Benzos

Corticosteroids

5 HT receptor antagonists

Phenothiazines

Substance P/Neurokinin 1 receptor antagonist

4

What do all 4 of the serotonin 5-HT3 antagonists end in?

"setron"

5

Do you need to reduce the dose of serotonin 5-HT3 antagonists in geriatric patients or patients w/ renal insufficiency?

Nope!

6

Which serotonin 5-HT3 antagonist may require dose reduction in patients w/ hepatic insufficiency?

Ondansetron

7

What is an action of serotonin 5-HT3 antagonists?

May slow colonic transit

8

Describe the efficacy of serotonin 5-HT3 antagonists for the prevention of delayed N/V (> 24hr after chemo) when used alone

Little to none

9

How is the efficacy of serotonin 5-HT3 antagonists enhanced?

By combining w/ a corticosteroid & NK-receptor antagonist

10

What are ADEs of serotonin 5-HT3 antagonists?

HA, dizziness, constipation

QT prolongation (most pronounced w/ dolasetron)

11

What can other drugs do to the 5-HT3 receptor antagonists?

Reduce hepatic clearance --> increased 1/2 life

12

What are the actions of substance P/neurokinin 1 receptor antagonists?

Provide relief from delayed emesis a/w emetogenic meds

Possess antidepressant, anxiolytic, & antiemetic properties

13

What are ADEs of dimenhydrinate (Dramamine - an antihistaminic/anticholinergic)?

Drowsiness, confusion, blurred vision, dry mouth, urinary retention

14

What are examples of phenothiazines?

Prochlorperazine

Promethazine

Chlorpromazine

15

What are ADEs of prochlorperazine?

QT prolongation
Sedation
Tardive dyskinesia

16

What is the MOA of chlorpromazine (a phenothiazine)?

Dopaminergic blocker

Strong alpha-adrenergic blocker

Hypothalamic depression affecting body temp

17

What do the substance P/NK1 receptor antagonists end in?

"pitant"

18

Why is dimenhydrinate (an antihistaminic/anticholinergic) problematic in the elderly?

Risk of complications in patients w/ BPH, glaucoma, or asthma

19

What are examples of butyrophenones?

Haloperidol

Droperidol

20

What are ADEs of haloperidol?

Sedation

Constipation

Hypotension

21

What are ADEs of droperidol?

QT prolongation &/or torsade de pointes

*Need 12 lead EKG prior to administration, followed by cardiac monitor for 2-3 hrs after administration

22

What are examples of benzos?

Alprazolam

Lorazepam

23

What are benzos used for?

Anticipatory N/V, chemo

24

What are ADEs of alprazolam?

Dizziness
Sedation
Appetite changes
Memory impairment

25

What is the MOA of dexamethasone (a corticosteroid)?

Enhance 5-HT3 receptor antagonists

26

What are ADEs of dexamethasone?

Insomnia
GI sx
Agitation
Appetite stimulation

27

What are examples of cannabinoids?

Dronabinol

Nabilone

28

What are the ADEs of cannabinoids?

Somnolence
Xerostomia
Vertigo (Nabilone)
Euphoria (Dronabinol)

29

What are ADEs of metoclopramide?

Asthenia, HA, somnolence

30

What is an ADE of olanzapine?

Sedation

Caution in elderly

31

What is 1st line pharmacologic therapy for N/V in pregnancy?

Pyridoxine w/ or w/out doxylamine