Exam 4 - GI Nausea and Vomiting

Question 1

Causes of N/V?

Answer 1

CNS-related, infection, GI disorders, meds, radiation

Question 2

What and where is the Chemoreceptor Trigger Zone?

Answer 2

Area in the brain which receives signals from brain and GI tract. Stimulates brain’s vomiting center via NTs.

Question 3

Who gets Chemo-Induced NV (CINV) most often?

Answer 3

Young people and women.

Question 4

What causes CINV? What is the intensity based on?

Answer 4

Chemo agents, based on potency of chemo agent.

Question 5

3 risk factors for CINV?

Answer 5

Hx of prior CINV
Hx of motion sickness
Hx of morning sickness

Question 6

Acute CINV in what time frame?

Answer 6

0-24h after chemo

Question 7

Delayed CINV in what time frame? Mostly due do?

Answer 7

More than 24h after chemo.

Mostly due to high emetogenic chemo agents

Question 8

What is Anticipated CINV?

Answer 8

Conditioned response to prior N/V from chemo.

Question 9

Tx for High Emetic Risk?

Answer 9

1. NK-1 Antagonist
2. 5-HT3 Antagonist
3. Corticosteroid
   combo of all three

Question 10

What percent is high emetic risk? Which two chemo agents cause it most?

Answer 10

Over 90%. Cisplatin and Cyclophodoid.

Question 11

What percent range in Moderate Emetic Risk? Which agent causes it most?

Answer 11

30-90%. Doxarubicin.

Question 12

Tx for Moderate Emetic Risk?

Answer 12

1. Dopamine-antagonist
2. Corticosteroid
   combo of the two

Question 13

What is range for Low Emetic Risk? Which chemo agent often causes?

Answer 13

10-30%. Roxtinamib

Question 14

Tx for Low Emetic Risk?

Answer 14

Corticosterois

Question 15

Percent range for Minimal Emetic Risk?

Answer 15

0-10%

Question 16

Tx for Minimal Emetic Risk?

Answer 16

May or may not need treatment

Question 17

MOA and indications for Serotonin 5-HT3 Antagonist?

Answer 17

Blocks 5-HT3 receptors centrally and peripherally.

CINV (acute better than delayed), PONV, RINV. Give before chemo!

Question 18

5HT3 route, SE, and name?

Answer 18

PO or IV.

Constipation, mild HA, possible QT prolongation.
“-setron”

Question 19

NK-1 Antagonist MOA and indications?

Answer 19

Antagonized NK-1 receptors.

Strongest available! Prevent acute and delayed CINV. Give with 5HTP or steroid.

Question 20

When to give 5HT3 Antagonist?

Answer 20

Before chemo

Question 21

Give NK-1 Antagonist with what other meds?

Answer 21

Give with 5HTP or steroid.

Question 22

NK-1 routes, SE, and name?

Answer 22

PO or IV.

Diarrhea, dizzy, fatigue, CYP3A4, CYP2C9.
“-itant”

Question 23

NK-1 regimen? Routes during regimen?

Answer 23

3 day regimen.
Day 1=IV
Day 2-3=PO

Question 24

Dopamine Antagonist MOA and indications?

Answer 24

Dopamine-antagonist.

Delayed CINV w/moderate to low emetogenic chemo.

Question 25

Dopamine-antagonist SE, name, and potency?

Answer 25

"-azine" Low potency. An older drug.

Question 26

Corticosteroid MOA and indications?

Answer 26

MOA unknown. Acute and delayed CINV. Given with 5HT3 to increase efficacy.

Question 27

Corticosteroid route, SE, and name?

Answer 27

PO and IV. Insomnia, jittery, fluid retention, check BGL in DM. "-one"

Question 28

Corticosteroids given with what? Why?

Answer 28

Given with 5HT3 Antagonists to improve effectiveness.

Question 29

Benzo MOA and use?

Answer 29

Anoxiolytic activity. Anticipatory CINV to allow to sleep through.

Question 30

Benzo name? Does it have antiemetic properties?

Answer 30

"-zepam" No antiemetic properties

Question 31

Cannabinoid MOA and use?

Answer 31

Interacts with cannabinoid receptors. Poorly understood MOA. Refractory and delayed CINV.

Question 32

Cannabinoid names?

Answer 32

Dronabinol (Marinol) | Nabilone (Cesamet)

Question 33

Dronabinol and Nabilone in what class? Use?

Answer 33

Cannabinoid receptors. Refractory and delayed CINV.

Question 34

Two classes for Motion Sickness?

Answer 34

1. Antihistamines | 2. Anticholinergics

Question 35

Antihistamine for Motion Sickness MOA and use?

Answer 35

Blocks H1-receptors. Crosses BBB and sedates. Prevent or treat motion sickness for short trips!

Question 36

Which class to use for short trips?

Answer 36

Antihistamines

Question 37

Antihistamine for Motion Sickness SE?

Answer 37

Weak cholinergic activity. Dry mouth, sedation, constipation, urinary retention, blurry vision

Question 38

Names of Antihistamines or Motion Sickness?

Answer 38

Dimenhydrate (Dramamine), Meclizine (Antivert)

Question 39

Anticholinergic use for motion sickness?

Answer 39

Travel sickness. Apply patch behind ear 3h before starting trip. Reapply q3d. Long trips.

Question 40

Length of trip Anticholinergic patch used for?

Answer 40

Long trips! Apply patch behind ear 3h before trip, reapply q3d.

Question 41

Anticholinergic SE? Name?

Answer 41

Dry mouth, sedation, constipation, urinary retention, blurry vision Scopolamine patch.

Question 42

Which med for Acute CINV, PONV, and RINV?

Answer 42

5HT3 Antagonist. "-setron"

Question 43

Which med to prevent acute and delayed CINV?

Answer 43

NK-1 | "-itant"

Question 44

Which med for delayed CINV from moderate to low emetogenic chemo?

Answer 44

Dopamine Antagonist | "-azine"

Question 45

Which med for Anticipatory CINV?

Answer 45

Benzo | "-zepam"

Question 46

Med class for Scopolamine patch?

Answer 46

Anticholinergic