Exam 1 Pharm: Nausea & Vomiting

Question 1

Suffix for Serotonin (5-HT3) Receptor antagonists

Answer 1

-setron

Dolasetron
Granisetron
Ondansetron
Palonosetron

Question 2

Suffix for Neurokinin (NK1) Receptor Antagonists

Answer 2

-pitant

Aprepinant (prodrug Fosaprepitant)
Netupitant (prodrug Fosnetupitant)
Rolapitant

Question 3

Diphenhydramine drug class

Answer 3

Histamine (H1) receptor antagonist

Diphenhydramine (Dimenhydrinate metabolizes to Diphenhydramine)
Hydroxyzine
Promethazine
Meclizine
Cyclizine
Doxylamine/B6

Question 4

Dimenhydrinate drug class

Answer 4

Histamine (H1) receptor antagonist

Diphenhydramine (Dimenhydrinate metabolizes to Diphenhydramine)
Hydroxyzine
Promethazine
Meclizine
Cyclizine
Doxylamine/B6

Question 5

Hydroxyzine drug class

Answer 5

Histamine (H1) receptor antagonist

Diphenhydramine (Dimenhydrinate metabolizes to Diphenhydramine)
Hydroxyzine
Promethazine
Meclizine
Cyclizine
Doxylamine/B6

Question 6

Promethazine drug class

Answer 6

Histamine (H1) receptor antagonist

Diphenhydramine (Dimenhydrinate metabolizes to Diphenhydramine)
Hydroxyzine
Promethazine
Meclizine
Cyclizine
Doxylamine/B6

Question 7

Meclazine drug class

Answer 7

Histamine (H1) receptor antagonist

Diphenhydramine (Dimenhydrinate metabolizes to Diphenhydramine)
Hydroxyzine
Promethazine
Meclizine
Cyclizine
Doxylamine/B6

Question 8

Cyclizine drug class

Answer 8

Histamine (H1) receptor antagonist

Diphenhydramine (Dimenhydrinate metabolizes to Diphenhydramine)
Hydroxyzine
Promethazine
Meclizine
Cyclizine
Doxylamine/B6

Question 9

Prochlorperazine drug class

Answer 9

Dopamine (D2) Receptor Antagonist

Prochloreperazine
Olanzapine
Metoclopramide
Amisulpride

Question 10

Olanzapine drug class

Answer 10

Dopamine (D2) Receptor Antagonist

Prochloreperazine
Olanzapine
Metoclopramide
Amisulpride

Question 11

Metoclopramide drug class

Answer 11

Dopamine (D2) Receptor Antagonist

Prochloreperazine
Olanzapine
Metoclopramide
Amisulpride

Question 12

Amisulpride drug class

Answer 12

Dopamine (D2) Receptor Antagonist

Prochloreperazine
Olanzapine
Metoclopramide
Amisulpride

Question 13

Scopolamine drug class

Answer 13

Muscarinic (M1) Receptor Antagonist

Question 14

Dronabinol drug class

Answer 14

Cannabinoid (CB) Receptor Agonist***

only antiemetic class that is a receptor agonist

Dronabinol
Nabilone

Question 15

Nabilone drug class

Answer 15

Cannabinoid (CB) Receptor Agonist***

only antiemetic class that is a receptor agonist

Dronabinol
Nabilone

Question 16

Serotonin (5-HT3) Receptor Antagonist indications

Answer 16

multiple etiologies of N/V

Question 17

*Most worrisome adverse effect in serotonin receptor antagonist use

Answer 17

Dose dependent QT prolongation (Dolasteron highest risk)

*extreme caution required for use in pts on other QT prolonging agents

Question 18

Longest lasting serotonin receptor antagonists

Answer 18

Palonosetron and Granisetron

Question 19

Neurokinin-1 Receptor Antagonist indication

Answer 19

Most effective in combination therapy for N/V in chemotherapy pts

Question 20

*Histamine (H1) receptor antagonist adverse effects

Answer 20

Classic Anticholenergic Effects

CNS depression
Dry mouth
Constipation
Urinary retention
Blurred vision
Decreased BP

Question 21

Histamine receptor (H1) Antagonist therapeutic uses

Answer 21

multiple etiologies of N/V

• Doxylamine/B6 1st line for pregnancy N/V
• Meclizine or Cyclizine only indicated for motion sickness/vertigo

Question 22

Dopamine receptor (D2) Antagonist therapeutic uses

Answer 22

multiple etiologies of N/V

• Amisulpride only for postoperative N/V after other treatments have failed (expensive)
• Metoclopramide in pts with N/V and GI dysmotility

Question 23

Drug to treat N/V in pt who gets motion sickness while fishing on a boat and doesnt want to be taking tons of pills

Answer 23

Scopolamine (M1 Receptor Antagonist)

• patch worn for 72 hours
• treat motion sickness in deep sea fisherman

Question 24

M1 Receptor Antagonist (Scopolamine) adverse effects

Answer 24

Classic Anticholenergic Effects

CNS depression
Dry mouth
Constipation
Urinary retention
Blurred vision

*decreased BP not on slide for this one

Question 25

Cannabinoid (Dronabinol/Nabilone) MOA

Answer 25

STIMULATES cannabinoid receptors (mostly C1), GPCR signal transduction decreases excitability of neurons, minimizes serotonin release

Question 26

*Cannabinoid (Dronabinol/Nabilone) indications

Answer 26

FDA scheduled drug, commonly reserved for treatment resistant N/V in chemotherapy patients

Question 27

*Treatment regimen for N/V in patient on HIGH-EMETOGENIC chemotherapy regimen

Answer 27

1. D2 receptor antagonist 2. NK1 receptor antagonist 3. Serotonin receptor antagonist 4. Corticosteroid (Dexamethazone) Ex: 1. Olanzapine 2. -pitant 3. -setron 4. Dexamethazone

Question 28

*Treatment regimen for N/V in patient on MODERATE-EMETOGENIC chemotherapy regimen

Answer 28

1. NK1 receptor antagonist 2. Serotonin receptor antagonist 3. Corticosteroid (Dexamethazone) Ex: 1. -pitant 2. -setron 3. Dexamethazone *just drop the D2 antagonist

Question 29

*1st line treatment for N/V in pregnancy

Answer 29

Doxylamine/B6 (H1) 1st line for pregnancy N/V

Question 30

*Treatment for vertigo

Answer 30

Meclizine (H1) or Cyclizine (H1) (Vertigo)

Question 31

*Treatment for motion sickness

Answer 31

Scopolamine patch (M1) Dimenhydrinate (H1) or Meclazine (H1) for motion sickness

Question 32

Treatment for patient w/ postoperative N/V after other treatments have failed

Answer 32

Amisulpride only for postoperative N/V after other treatments have failed (expensive)

Question 33

Treatment for diabetic patient w/ N/V and gastroparesis/GI dysmotility

Answer 33

Metoclopramide in pts with N/V and GI dysmotility