Antivomitive

Question 1

Cauze de varsatura

Answer 1

Anomalii ale tubului digestiv - obstructive sau non-obstructive
DZ, uremie, ICSR
Migrena, anorexia nervoasa
Medicamente (chimioterapice anticanceroase)
Sarcina
Kinetoze, sdr Meniere

Question 2

Stimuli care pot declansa varsatura

Answer 2

Substante chimice (medicamente/toxice) din sg
Aferente nv de la TGI, ap vestibular sau SNC

Question 3

Mediatori si receptori ai reflexului de voma

Answer 3

Serotonina -> R 5HT3, r 5ht4
Dopamina -> R D2
His -> R H1
Ach -> R M
Endocanabinoizii -> R CB1
Substanta P -> R NK1

Question 4

Vomitive - utilizare, reprezentant, CI

Answer 4

IPECA - in intoxicatii

CI: pacienti inconstienti, convulsii, ingestie de subst caustice sau corozive

Question 5

Utilizarile clinice ale antivomitivelor

Answer 5

Adjuvant in chimio si radioterapie - combate voma indusa de medicamentele citotoxice
Varsaturi post-op
Kinetoze, afect vestib
Disgravidie precoce - DOAR atunci cand sunt neaparat necesare
Altele - diskinezii biliare, dispepsii

Question 6

Setroni - mecanism de actiune

Answer 6

Blocarea R 5HT3 de la niv aferentelor vagale, NTS, area postrema si CV

Question 7

Setroni - reprezentanti

Answer 7

Ondansetron
Granisetron
Palonosetron

Question 8

Setroni - indicatii

Answer 8

voma produsa de citostatice, radioterapie
varsaturi de sarcina
varsaturi postoperatorii
NU este eficient in kinetoze

Question 9

Setroni - farmacocinetica

Answer 9

efecte de lunga durata (1 doza/zi)
abs buna din TGI
metabolizare hep extensiva - !ajustarea dozelor in IH
eliminare urinara

Question 10

Setroni - administrare

Answer 10

iv in perfuzie cu 30 min inaintea administrarii chimioterapicelor

Question 11

Setroni - RA

Answer 11

dureri musculare, sedare/anxietate, prelungirea intervalului QT

Question 12

Antagonistii R D2 - clase

Answer 12

Fenotiazine
Butirofenone
Benzamide

Question 13

Fenotiazine - reprezentanti

Answer 13

Clorpromazina

Proclorperazina

Question 14

Fenotiazine - indicatii

Answer 14

Varsaturi post-op
Uremie
ELECTIE - gastroenterite virale
Varsaturi induse de medicamente
Sarcina
Preventiv in kinetoze
Varsaturi post-chimioterapie de intensit moderata (eficacit < setronii)

Question 15

Fenotiazine - RA

Answer 15

Somnolenta
hTA ortostatica
Tulburari extrapiramidale

Question 16

Fenotiazine - CI

Answer 16

IH, IR, epilepsie, asocierea cu alcool

Question 17

Butirofenone - reprezentanti

Answer 17

Haloperidol

Droperidol

Question 18

Benzamide - reprezentanti

Answer 18

Metoclopramid

Domperidon

Question 19

Metoclopramid - actiune

Answer 19

antagonist al R D2 de la niv TV -> ef antivomitiv

actiune perif -> ef prokinetic mai ales in portiunea sup a TGI

Question 20

Metoclopramid - farmacocinetica

Answer 20

A rapida dupa admin orala
sufera primul pasaj hepatic
E urinara

Question 21

Metoclopramid - indicatii

Answer 21

Boala de iradiere
Uremie
Gastrita, UGD, BRGE, tulb motilitate digestive
Cancer gastric/intest
Varsatura post anestezica/medicamente
Varsatura post chimio si radioterapie

Question 22

Metoclopramid - RA

Answer 22

Somnolenta, nervozitate
Distonii acute, tulb extrapiramidale
Tulb de menstruatie
Galactoree
MetHb la nn

Question 23

Metoclopramid - CI

Answer 23

Obstructie mecanica TGI, hemoragii digestive, feocromocitom

Question 24

M-colinolitice - reprezentant si indicatie

Answer 24

Scopolamina

I: kinetoze - po. sau TTS retroauricular

Question 25

Antihistaminice H1 - reprezentanti

Answer 25

``` GENERATIA I Ciclizina, cinarizina Prometazina Difenhidramina, dimenhidrinat Betahistina ```

Question 26

Antihistaminice H1 - indicatii

Answer 26

Kinetoze Iritatia directa a stomacului Varsaturi post-op

Question 27

Canabinoizi - reprezentanti

Answer 27

Dronabinol | Nabilona

Question 28

Canabinoizi - farmacocinetica

Answer 28

Admin orala Leg extensiva de P plasmatice M hep E biliar

Question 29

Canabinoizi - indicatii

Answer 29

Varsaturi post-chimioterapie | Anorexia pacientilor cu SIDA - dronabinol

Question 30

Dronabinol - RA

Answer 30

Stimulare Sy (tk, palpitatii, hTA) Congestie conjunctivala Potential addictiv

Question 31

Nabilona - RA

Answer 31

``` Somnolenta, ameteala Palpitatii hTA ortostatica xerostomie euforie, anxietate, tulb de gandire, reactii psihotice ```

Question 32

Canabinoizi - CI

Answer 32

persoane cu istoric de dependenta de subst de abuz

Question 33

Steroizii

Answer 33

Potenteaza efectul altor antivomitive | Dexametazona, metilprednisolon, prednison

Question 34

Benzodiazepinele

Answer 34

Nu au ef antivomitiv propriu-zis Voma anticipatorie - datorita ef anxiolitic, sedativ, amnezic Lorazepam, alprazolam

Question 35

Antagonistii R pentru subst P

Answer 35

I: varsaturile tardive post-chimioterapie Reprezentanti: Aprepitant, Fosaprepitant

Question 36

Prevenirea varsaturilor precoce si tardive post chimioterapie

Answer 36

Ondansetron + dexametazona iv in perfuzie cu 30 min inainte de inceperea cisplatinului Aprepitant 125 mg po cu 30 de min inaintea admin cisplatin Aprepitant 80 mg po dimineata in Z2-3 post-chimioterapie

Question 37

Combaterea varsaturilor din disgravidia precoce - masuri non-farmacologice

Answer 37

Mese frecvente, reduse cant, bogate in P Hidratare Lichide reci Cola

Question 38

Combaterea varsaturilor din disgravidia precoce - masuri farmacologice

Answer 38

Prometazina/ Metoclopramid | ! doar dupa evaluarea raportului risc/beneficiu