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GI II Exam I AP > Drugs - Treatment of NVDC (Kinder) > Flashcards

Drugs - Treatment of NVDC (Kinder) Flashcards

(62 cards)

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1
Q

ondansetron

A

Zofran

5-HT3 antagonist

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2
Q

Metoclopromide

A

Reglan

Substitued Benzamide
D2 receptor antagonist

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3
Q

Prochloperazine (Compazine)

A

Penothiazines

D2 receptor Antagonist

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4
Q

Diphenhydramine (Benadryl)

A

Antihistamine

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5
Q

Promethazine (Phenergen)

A

Antihistamine

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6
Q

Dronabinol

A

Cannabinoids

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7
Q

MOA of Serotonin 5 HT3 receptor antagonists

A

ondansetron is prototype

blocks central 5HT3 receptors (vomiting center and CTZ) and peripheral receptors (GI tract -viscera)

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8
Q

Therapeutice use of ondansetron

A

***Acute CINV
(chemo induced n/v)

(little or no efficacy in delayed CINV)

PONV and post-radiation NV

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9
Q

when do you dose adjust ondansetron

A

hepatic insufficiency

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10
Q

ADR’s of ondansetron

A

well tolerated; headache, dizziness, constipation

QT prolongation

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11
Q

MOA of D2 receptor antagonists (metoclopramide)

A

inhibits D2-like (D2, D3, D4) dopamine receptors in the CTZ and solitary tract nucleus

Additional actions: 5-HT3 antagonism & prokinetic (nausea and vomiting peripherally)

prokinetic- results in peristalsis

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12
Q

therpeutic use of metoclopramide

A

CINV

diabetic gastroparesis

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13
Q

ADR’s of metoclopramide

A

Crosses BBB; extrapyramidal symptoms

-restless, dystonia (immature muscle contractions), parkinsonian symptoms

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14
Q

MOA of prochlorperazine

D2 receptor antagonist

A

inhibits D2-like (D2, D3, D4) dopamine receptors in the CTZ and solitary tract nucleus

Additional actions: antihistaminic and anticholinergic

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15
Q

therapeutic use of D2 receptor antagonist prochlorperazine

A

“General purpose” antiemetics

Motion sickness

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16
Q

what are the ADR’s of prochlorperazine

A

Hypotension, sedation, extrapyramidal symptoms
(don’t use post-operatively b/c you don’t want to make them more sedated)

hyperprolactinemia

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17
Q

MOA of diphenhydramine and promethazine

A

histamine, H1 receptor antagonists

Additional actions: anticholinergic and some antidopaminergic

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18
Q

Therapeutic use of diphenhydramine and promethazine

A

Motion sickness
PONV (post-op)
Vertigo

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19
Q

what are the ADR’s of antihistamines

A

dizziness,
sedation
dry mouth
urinary retention

*anticholinergic effects

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20
Q

MOA of scopalamine

A

MOA: muscarinic cholinergic receptor antagonist

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21
Q

therapeutic use of Scopalamine

A

motion sickness

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22
Q

ADR’s of scopalamine

A

better tolerated as a patch (behind ear)

often used for fisherman, people on boats

don’t use PO

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23
Q

MOA of cannabinoids (dronabinol)

and therapeutic use

A

stimulation of central CB1 receptors

therapeutic use:

  • appetite stimulant
  • antiemetic
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24
Q

what are the drug drug interactions of cannabinoids (dronabinol)

A

DDIs: potentiate effects of other psychoactive agents

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25
what are the ADR's of cannabinoids (dronabinol)
euphoria, dysphoria, sedation, hallucinations autonomic- tachy, orthostatic hypotensino
26
NK1 receptor antagonists (aprepitant, fosaprepitant) MOA
inhibits binding of substance P acute phase of CINV is believed to be mediated by 5HT and substance P while delayed CINV primarily due to substance P
27
therapeutic use of NK1 receptor antagonists
acute and delayed CINV
28
what drug do NK1 receptor antagonist decreased effectiveness
warfarin--- can lead to clotting
29
what are therapeutic uses of corticosteroids in N/V
dexamethasone increases the efficacy of 5-HT2 antagonists for acute and dealayed CINV PONV
30
treatment combination for acute CINV
5HT3 receptor antagonist + NK1 receptor antagonist + glucocorticoid
31
what is the treatment for anticapatory n/v
benzodiazepine -> sedative properties reduce anxiety
32
what are the drugs used in PONV
5-HT3 receptor antagonist + dexamethasone dimenhydrinate (if sedation desired) prochlorperazine- less sedation metaclopramide if above don't work
33
what drugs are used for motion sickness
dimenhydrinate promethazine scopalamine
34
gastroparesis treatment
metoclopramide (D2 receptor antagonist)
35
pyridoxine use
pregnancy N/V
36
Loperamide
opioid anti-diarrheal
37
bismuth subsalicylate
mucosal protective agent anti-diarrheal
38
what are the osmotic laxatives
saline laxatives polyethylene glycol
39
MOA of loperamide
stimulates μ-opioid receptors; increase transit time, increase fecal water absorption, decrease motility non-prescription opioid does not cross BBB (no CNS side effects) no analgesic properties no potential for addiction
40
Therapeutic use of Opioid agonists (Loperamide)
Nonspecific treatment of diarrhea Traveler’s diarrhea Adjunct in chronic diarrhea
41
ADR"s of loperamide
well tolerated CNS effects at high doses (so use atropine added to discourage abuse) CI in C. diff and active IBD due to risk of toxic megacolon
42
Psyllium MOA
bulk forming laxative indigestible, hydrophilic colloids which absorb water. Bulky emollient gel distends colon promoting peristalsis. used for long term prevention
43
ADR's of psyllium
bloating and flatulence
44
stool surfactant (softeners) Docusate** MOA:
allows water and lipids to penetrate stool which softens it Ineffective for treatment but useful for prevention helpful to prevent straining -- > MI, after rectal surgery, etc.
45
MOA of osmotic laxatives ``` saline (mag citrate) polyethylene glycol (sugar) ```
soluble, non-absorbable, increase stool liquidity due to increase in fecal fluid
46
when do you not use anti-diarrheal agents
bloody diarrhea high fever systemic toxicity
47
Senna (Stimulant Laxative) MOA
MOA: direct stimulation of enteric nervous system
48
therapeutic use of Stimulant laxatives
Not 1st line, recommended for intermittent use Administer in lowest effective dose for shortest period of time Long-term in neurologically impaired, bed-bound in long-term care facilities *** Severe constipation with non-modifiable risk factors
49
Metoclopramide (Prokinetic) MOA and therapeutic use
central and peripheral dopamine (D2) receptor antagonist; a serotonin (5-HT4) agonist; a serotonin (5-HT3) antagonist (at high doses); and a cholinesterase inhibitor ↑ motility of upper GI tract & ↑ gastric emptying; antiemetic Treats gastroparesis and GERD
50
lactulose used for what
hepatic encephalopathy
51
what is used for bowel prep for colonoscopy
polyethylene glycol mag citrate
52
Softens stool is 1-3 days
Bulk forming laxatives Stool softeners Osmotic laxatives - lactulose - polyethylene glycol
53
softening of semi-fluid stool in 6-12 hrs
Senna Mag sulfate
54
watery evacuation in 1-6 hrs
mag citrate | polyethylene glycol
55
MOA of Methylnatltrexone
selective inhibition of mu (opioid) receptors does not cross BBB inhibits peripheral receptors without affecting analgesia therapeutic use -opioid induced constipation in pt's receiving palliative care for advanced illness CI: GI obstruction
56
in pt's with chronic renal disease and HTN problems , what drug do you want to avoid
sodium phosphate oral solution (osmotic laxative)
57
serotonin
binding in the periphery of 5HT3--> N/V
58
what is first line treatment for constipation prevention
bulk forming laxatives docusates (Stool softeners)
59
what are sorbitol, lactulose, and magnesium hydroxide
osmotic laxatives
60
how long does it take for osmotic active agents to cause bowel evacuation
1-3 hrs
61
sodium phosphate type of drug ADR's
osmotic laxative frequently causes hyperphosphatemia, hypocalcemia, hypernatremia, and hypokalemia can lead to cardiac arrythmias or acute renal failure don't use in frail or elderly, renal insufficiency , cardiac disease, or those unable to maintain adequate hydration
62
in comparison to sorbitol and lactulose what does polyethylene glycol not do
does not produce significant cramps or flatus also designed so no significant intravascular fluid or electrolyte shifts occur

GI II Exam I AP (8 decks)

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