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Pharm II Exam 4 > GI Agents: Diarrhea, Constipation, N/V, GERD > Flashcards

GI Agents: Diarrhea, Constipation, N/V, GERD Flashcards

1
Q

Causes of constipation?

A

Low fiber diet, Low fluid intake, Inactivity, Aging, Diseases (IBS, DM, Hypothyroidism, MS, Parkinson’s, Anxiety, Depression, Cancer), Meds

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2
Q

Meds that can cause constipation?

A

Opioids, CCBs, Anticholinergics (TCAs, diphenhydramine, atypical antipsychotics), Paroxetine, Calcium supplements, Antacids w/ aluminum or calcium, Thiazides, NSAIDs

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3
Q

Goals of therapy for constipation?

A

-Increase frequency of BMs
-Titrate dose to soften stool
-Prevent recurrence

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4
Q

Non-pharmalogical tx for constipation?

A

-Hydration (8-12 glasses/day)
-Balanced diet (soluble fiber in food): apples, oranges, peas
-Exercise (walking, swimming)
-D/C meds that cause constipation

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5
Q

1st line treatment for constipation?

A

OTC laxatives

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6
Q

Targeted constipation therapy can be specific to which diagnoses?

A

Chronic idiopathic constipation, IBS-C, Opioid induced

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7
Q

Laxatives for constipation?

A

Stool softeners, Lubricants, Fiber/Bulk agents, Osmotics, Stimulants

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8
Q

Stool softeners for constipation?

A

Docusate sodium (Colace)

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9
Q

Libricants for constipation?

A

Mineral oil

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10
Q

Fiber/Bulk agents for constipation?

A

Psyllium (Metamucil), Methylcellulose (Citrucel)

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11
Q

Osmotics for constipation?

A

Glycerin, Lactulose, Sorbitol, Polyethylene glycol (PEG) (Miralax), Saline laxatives

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12
Q

Stimulants for constipation?

A

Bisacodyl (Dulcolax), Senna (Senokot)

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13
Q

MOA of Docusate?

A

Surfactant that lowers surface tension of stool (water penetrates, hydrates, and softens stool)

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14
Q

ROA of Docusate?

A

PO

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15
Q

Onset of Docusate?

A

1-3 days

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16
Q

Use for Docusate?

A

Avoid strain, preventative
Post-MI, surgery, hemorrhoids flare, combo w/ other meds for opioid induced

*doesn’t get bowels moving if already constipated

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17
Q

Precautions w/ using Docusate?

A

Efficacy is questionable (evidence low)

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18
Q

Special populations for Docusate use?

A

Popular w/ older adults, pregnancy, kids

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19
Q

Contraindications of Docusate?

A

Mineral oil (docusate inc. mineral oil absorption)

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20
Q

Mineral oil MOA?

A

Softens stool/lubricates lining of gut to facilitate defecation

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21
Q

ROA of Mineral oil?

A

PO

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22
Q

Onset of Mineral oil?

A

6-8 hrs

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23
Q

Use for Mineral oil?

A

Occasional constipation

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24
Q

Precautions with Mineral oil?

A

Avoid long-term use, bedridden pts (aspiration pneumonia), decreases absorption of fat-soluble vitamins
AVOID IN: kids, elderly, pregnacy

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25
Q

Contraindications of Mineral oil?

A

Docusate (increases absorption of mineral oil)

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26
Q

MOA of fiber/bulk agents for constipation?

A

Holds water in stool, adds bulk, promotes peristalsis

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27
Q

ROA for fiber/bulk agents?

A

PO

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28
Q

Onset of fiber/bulk agents?

A

1-3 days

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29
Q

Use of fiber/bulk agents?

A

Daily, dietary

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30
Q

Precautions w/ fiber/bulk agents?

A

Need a lot of fluids & movement (Do not use if bedridden/fluid limitations)

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31
Q

Side effects of fiber/bulk agents?

A

Bloating/cramps

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32
Q

Drug interactions w/ fiber/bulk agents?

A

Separate other meds by 1-2hrs

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33
Q

Special populations use of fiber/bulk agents?

A

Older adults must continue to drink & move around, pregnancy needs plenty of water, limited role for opioid induced

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34
Q

MOA of glycerin?

A

Local rectal stimulation: induces evacuation

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35
Q

ROA of glycerin?

A

Rectal suppository

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36
Q

Onset of glycerin?

A

quick action

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37
Q

Special populations use of glycerin?

A

Suppository sizes for kids/infants/adults, common use in children, can be used in pregnancy

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38
Q

MOA of lactulose, sorbitol (osmotic laxatives)?

A

Non-absorbable sugars that pull water into colon lumen & promote peristalsis

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39
Q

ROA of lactulose, sorbitol (osmotic laxatives)?

A

Oral, rectal

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40
Q

Onset of lactulose, sorbitol (osmotic laxatives)?

A

12hrs to 3 days

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41
Q

Use of lactulose, sorbitol (osmotic laxatives)?

A

Prevent & treat chronic constipation, daily use not recommended

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42
Q

Precautions with lactulose, sorbitol (osmotic laxatives)?

A

Electrolyte imbalance, DM (high amnt of lactose)

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43
Q

Frequency of osmotic laxatives?

A

Daily

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44
Q

MOA of Polyethylene glycol (Miralax) and PEG 3350 (GoLYTELY) (osmotic laxatives)?

A

Non-absorbable osmotic sugar that draws water into colon lumen but also contains electrolytes (prevents electrolyte shifts into colon)

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45
Q

ROA of Polyethylene glycol (Miralax) and PEG 3350 (GoLYTELY) (osmotic laxatives)?

A

PO

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46
Q

Use for Polyethylene glycol (Miralax) and PEG 3350 (GoLYTELY) (osmotic laxatives)?

A

Prevention/tx post MI, surgery, opioid induced (mix w water)
onset 1-3 days

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47
Q

Which laxative is used for colonic cleansing prior to diagnostics?

A

GoLYTELY (1 gallon jug) w/ watery evacuation in 1-6 hrs

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48
Q

Precautions w/ Polyethylene glycol (Miralax) and PEG 3350 (GoLYTELY) (osmotic laxatives)?

A

Cramping, diarrhea (but less than other laxatives)

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49
Q

Special populations use of Polyethylene glycol (Miralax) and PEG 3350 (GoLYTELY) (osmotic laxatives)?

A

Use in all ages, 1st line in hospitals for pregnancy

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50
Q

Saline laxatives?

A

Magnesium hydroxide (milk of mag), Magnesium citrate, Sodium phosphate

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51
Q

MOA of saline laxatives?

A

Non-absorbable salts that pull fluid into colon to promote peristalsis

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52
Q

ROA for saline laxatives?

A

PO
(sodium phosphate is also an enema)

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53
Q

Onset of MOM?

A

30 min - 8 hr

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54
Q

Onset of Mag. citrate?

A

30 min - 6 hr

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55
Q

Onset of PO Sodium phos.?

A

1-3 hr

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56
Q

Onset of Sodium phos. enema (Fleets enema)?

A

1-5 min

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57
Q

Use of saline laxatives?

A

Occasional use (every few weeks), avoid use on regular basis

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58
Q

Precautions w/ saline laxatives?

A

Cramps, dehydration, diarrhea, electrolyte imbalance

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59
Q

Special populations use of saline laxatives?

A

Caution dehydration, renal, cardiac

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60
Q

Stimulant laxatives?

A

Bisacodyl (Dulcolax) and Senna (Senokot)

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61
Q

MOA of stimulant laxatives?

A

Local mucosal irritation directly stimulates GI tract

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62
Q

Onset of stimulant laxatives?

A

PO: 6-12 hrs
Rectal: 15-60 min

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63
Q

Use of stimulant laxatives?

A

Tx and prevention: quick action
-can be used for opioid induced

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64
Q

Precautions w/ stimulant laxatives?

A

Cramping

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65
Q

Special populations use w/ stimulant laxatives?

A

Pts on chronic constipation meds, safe for older adults, no evidence that long-term use is harmful

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66
Q

Opioid induced constipation prevalence (cancer pts and non cancer pts w/ pain)?

A

Cancer pain 95%
Nonmalignant pain 80%

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67
Q

Which opioids can be constipating?

A

All

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68
Q

Does tolerance to opioid constipation develop?

A

Rarely

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69
Q

Laxatives for opioid induced constipation?

A

Senna, PEG

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70
Q

Pathophysiology of opioid induced constipation (OIC)?

A

Decrease Gi motility, increase absorption of fluid in gut, decrease intestinal excretions, decrease defecation reflex
(Result of u-opioid R’s in GI tract)

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71
Q

Target therapy recommendations by the AGA for OIC?

A

Recommended: Peripherally acting mu-opioid R antagonists (PAMORAs)
No recommendations: Intestinal secretagogues, Selective 5-HT agonists

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72
Q

Recommendations for PAMORAs?

A

Naldemedine (Symporic) PO: Strong rec.
Naloxegol (Movantik) PO: Strong rec.
Methylnatrexone (Relistor) PO or SubQ: conditional rec.

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73
Q

MOA for PAMORAs?

A

Block opioid from binding at mu R’s in GI tract –> inhibits delay in GI transit time, decreasing constipation effects of opioids

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74
Q

2nd line for OIC after laxatives fail?

A

PAMORAs

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75
Q

Administration of Naloxegol (Movantik)?

A

Empty stomach (1-2 hrs after first meal)
D/c all other laxatives (may re-initiate if suboptimal response after 3 days)

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76
Q

Onset of Naloxegol (Movantik)?

A

6-12 hrs up to 3 days

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77
Q

Avoid what food with Naloxegol (Movantik)?

A

Grapefruit (and juice)

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78
Q

Use of Naloxegol (Movantik)?

A

OIC in adults w/ noncancer pain
(off label for cancer pain OIC)

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79
Q

Caution w/ use of Naloxegol (Movantik)?

A

Severe abdominal pain, diarrhea (may result in hosp)

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80
Q

Dose adjustments for Naloxegol (Movantik)?

A

Renal dose adjustment
Avoid use in hepatic impairment

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81
Q

Metabolism of Naloxegol (Movantik)?

A

CYP3A4 (many d/d interactions)

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82
Q

Administration of Naldemedine (Symproic)?

A

w/ or w/o food

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83
Q

Onset of Naloxegol (Movantik)?

A

w/in 24 hrs

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84
Q

Use of Naloxegol (Movantik)?

A

OIC in adults w/ noncancer pain

85
Q

Avoid use of Naloxegol (Movantik) with what?

A

Severe hepatic impairment

86
Q

Metabolism of Naloxegol (Movantik)?

A

CYP3A4 (many d/d interactions)

87
Q

Administration of Methylnatrexone (Relistor)?

A

PO empty stomach
SubQ rotate between upper arm, abdomen, thigh

88
Q

Use of Methylnatrexone (Relistor)?

A

PO: OIC in noncancer pts
SubQ: OIC in both cancer/noncancer

89
Q

Onset of Methylnatrexone (Relistor)?

A

w/in 4 hrs

90
Q

What causes diarrhea?

A

Imbalance between water absorption/secretion in GI tract

91
Q

3 types of diarrhea?

A

Acute: resolves in 14 days (mostly aquired: viral or travelers: bacterial/viral)
Persistent: 14-30 days
Chronic: >30 days (IBD, IBs-D, Diabetic neuropathy)

92
Q

Oral rehydration in community acquired diarrhea?

A

Water, juice, sports drinks, soups, salty crackers, pedialyte

93
Q

Are probiotics recommended in community acquired diarrhea?

A

Not unless post-abx diarrhea

94
Q

Meds for community acquired diarrhea?

A

Bismuth subsalicylate and Loperamide

95
Q

Travelers diarrhea prophylaxis?

A

Bismuth, Abx, Probiotics

96
Q

Tx of travelers diarrhea?

A

Rehydration, Bismuth, Loperamide, Abx

97
Q

Meds that may cause diarrhea?

A

Acid-reducing agents (PPIs, cimetidine), Misoprostol, Antacids w/ Mg, Colchicine, Digoxin, NSAIDs, Quinidine, Antiretroviral, Abx (Clindamycin, Erythromycin, Augmentin), Chemo (5FU), AntiHTN (ACEis), Laxatives

98
Q

Goals of tx for diarrhea?

A

Identify causes, Sx relief, Correct fluid-electrolyte loss, Manage diet,

**stopping diarrhea not necessarily goal (esp C. diff) –> need to rid pathogens or toxin

99
Q

Non-pharmacologic tx for diarrhea?

A

-Diet: low residue if tolerable, avoid salty/spicy/caffeine/dairy, replenish fluids/electrolytes, inc. diet as tolerable
-BRAT diet (banana, rice, applesauce, toast): low cal/protein/fat
-Hold laxatives/other contributing meds

100
Q

Agents for diarrhea?

A

Antimotility, Antispasmodics, Antisecretory/Adsorbents, Probiotics

101
Q

Antimotility agents for diarrhea?

A

Loperamide (Imodium) OTC, Diphenoxylate w/ atropine (Lomotil) Rx

102
Q

MOA of antimotility agents for diarrhea?

A

Stimulate mu R’s on intestinal muscles, reduce intestinal motility, inc. intestinal absorption, reduce fecal volume

103
Q

Use of antimotility agents for diarrhea?

A

Most effective in acute diarrhea

104
Q

Precautions w/ antimotility agents for diarrhea?

A

C/I in bloody & infectious diarrhea
High doses cross BBB
Addiction potential (atropine in Lomotil is to reduce risk of abuse)

105
Q

Special population use of antimotility agents for diarrhea?

A

Not for kids <2y/o, weight-based dosing in kids up to 12y/o

106
Q

US boxed warning in antimotility agents for diarrhea?

A

QT prolongation

107
Q

Antispasmodic agent for diarrhea?

A

Dicyclomine (Bentyl)

108
Q

MOA of Dicyclomine (Bentyl) for diarrhea?

A

Anticholinergic- blocks action of ACh at sites in GI smooth muscle (reduces spasms)

109
Q

Use of Dicyclomine (Bentyl) for diarrhea?

A

IBS-D or abdominal pain

110
Q

Side effects of Dicyclomine (Bentyl) for diarrhea?

A

Constipation, drowsiness, blurred vision, anti SLUD: salivation, lacrimation, urination, defecation (Anticholinergic)

111
Q

Antisecretory/Adsorbent agent for diarrhea?

A

Bismuth subsalicylate (Pepto)

112
Q

MOA of Bismuth subsalicylate (Pepto) for diarrhea?

A

Dec. secretions, absorbs bacteria/toxins/fluids, dec. stool liquidity and frequency

113
Q

Use of subsalicylate (Pepto) for diarrhea?

A

Acute diarrhea, traveler’s diarrhea

114
Q

Precautions w/ subsalicylate (Pepto) for diarrhea?

A

Can blacken tongue and stool (harmless), may reduce absorption of some meds

115
Q

Probiotic bacteria for diarrhea?

A

Lactic-acid producing bacteria (bifidobacteria & lactobacilli, yeast- Saccharomyces)

116
Q

Which probiotics have bifidobacteria?

A

Activia yogurt, Align

117
Q

Which probiotics have lactobacilli?

A

Culturelle, Kefir, Lactinex

118
Q

Which probiotics have Saccharomyces (yeast)?

A

Florastor

119
Q

MOA of probiotics for diarrhea?

A

Recolonize gut w beneficial microbes

120
Q

Use of probiotics for diarrhea?

A

Possible prevention/tx of abx associated diarrhea/ C. diff
Possible prevention of travelers, daycare diarrhea

121
Q

Which cells in the stomach secrete gastric acid?

A

Parietal cells

122
Q

What are the 3 R’s on the parietal cell that are stimulated by smell or ingestion of food?

A

Histamine**, Gastrin, Acetylcholine R’s

123
Q

Stimulation of histamine, gastrin, and ACh R’s results in what?

A

Activation of cAMP, stimulating acid secretion by H+/K+ ATPase pump (Proton pump)

124
Q

H+ and Cl- combine in the blood to form what?

A

Hydrochloric acid (HCl)

125
Q

What is GERD?

A

Retrograde passage of gastric contents from stomach into esophagus (primarily d/t LES relaxation, also inc. gastric pressure and delayed gastric emptying time)

*inflammation results from chronic exposure of mucosa to gastric acid

126
Q

GERD Risk Factors?

A

Alc, Smoking, Caffeine, Obesity, Pregnancy, Drugs, Foods (chocolate, peppermint, high fat, citric acid, tomato, spicy, large meals)

127
Q

Meds that are risk factors of GERD?

A

Bisphosphonates, CCBs, Iron, Potassium, NSAIDs

128
Q

Sx of GERD?

A

Heartburn (common at night, certain foods, may radiate to neck), Belching, Chronic cough, Hoarseness, Dental erosion, Angina

129
Q

Self care for GERD (occasional sx)?

A

Antacids, OTC H2’s or PPI’s

130
Q

Tx for persistent sx w/ diagnosed GERD?

A

PPI’s, H2 antagonists, Antacids

131
Q

Antacids for GERD?

A

Ca, Mg, Aluminum based (Mylanta, Maalox, Tums, Rolaids)

132
Q

MOA of antacids for GERD?

A

Neutralize acid, raises intragastric pH

133
Q

Onset of antacids?

A

10 min, short duration (1-2 hr)

134
Q

Adverse effects of antacids?

A

Ca and aluminum: constipation
Mg: diarrhea

135
Q

D/d interactions of antacids?

A

Chelation (binding) to fluoroquinolones, Increase of pH and reduction of absorption of Itraconazole and Iron

136
Q

H2 blockers for GERD?

A

Cimetidine, Ranitidine, Nizatidine, Famotidine (most potent)

137
Q

MOA od H2 blockers for GERD?

A

Compete w/ H2 R’s on parietal cells (suppress acid secretion)

138
Q

ROA of H2 blockers for GERD?

A

PO (PRN)

139
Q

Use of H2 blockers for GERD?

A

Good for sx relief/prevention of: GERD, PUD (not H-pylori related), Dyspepsia, Stress related gastritis
*most effective in reducing nocturnal acid

140
Q

Drug interactions of H2 blockers for GERD?

A

Inhibits 2C9, 2D6, 3A4
Increases levels of: Warfarin, Phenytoin, Diazepam, Propanolol

**Cimetidine most

141
Q

Minimal adverse effects of H2 blockers for GERD?

A

Headache, dizzy, diarrhea, constipation

142
Q

Special populations use of H2 blockers for GERD?

A

Require dose adjustment in mod-severe renal impairment
Avoid if high risk of delirium (beers)

143
Q

Limitations of H2 blockers for GERD?

A

Tolerance may develop, not effective w/ H. pylori, Less potent than PPIs

144
Q

PPIs for GERD?

A

OTC: Omeprazole, Pantoprazole, Lansoprazole, Esomeprazole
Rx: Dexlansoprazole, Rabeprazole

145
Q

MOA of PPIs?

A

Prodrug, pass into parietal cells, protonated and inhibit protein pump

146
Q

ROA of PPIs for GERD?

A

IV (pantoprazole), PO (all) - most 30-60 min before food

147
Q

Use of PPIs for GERD?

A

More effective than H2 blockers for suppression of acid secretion: GERD, PUD (H. pylori), Dyspepsia, Stress ulcer prophylaxis

148
Q

Precautions of PPIs?

A

-May inc. risk of osteoporosis/fractures if chronic use
-May dec oral absorption of Mg and B12 if chronic use
-May inc. risk of infections (disrupt acid barrier, C.diff, beers list)
-Respiratory CAP
-Difficult to d/c (suggest taper over few wks, reduce dose, every other day)

149
Q

Adverse effects of PPIs?

A

Diarrhea, abd pain, nausea, headache

150
Q

Drug interactions w/ PPIs?

A

Inhibits CYP2C19: (strong-Omeprazole/Esomeprazole) will convert Clopidogrel to active metabolite (pantoprazole better w/ clopidogrel)

Inhibits other meds needing acidic environment: Iron, Itraconazole, Atazanavir)

151
Q

Pathophysiology of N/V?

A

Vomit center in CNS receives signal from other areas of brain/GI tract by chemoreceptor trigger zone (CTZ) –> stimulates vomit center by NT

152
Q

NT that trigger CTZ in chemo-induced N/V?

A

Serotonin- 5HT3, Substance P Neurokinin NK1, Dopamine D2

153
Q

NT that trigger CTZ in vertigo, motion sickness N/V?

A

Acetylcholine, Histamine H1

154
Q

Med that helps w/ anxiety of chemo-induced N/V?

A

Benzodiazepines

155
Q

Target NT antagonists for Chemo-induced N/V?

A

5-HT3 antagonists, NK-1 antagonists, Dopamine antagonists

156
Q

Aids in target NT antagonists for Chemo-induced N/V?

A

Corticosteroids (Dexamethasone), Olanzapine

157
Q

RF for chemo-induced N/V?

A

Specific chemo agents, young>older, women>men, hx of motion sickness/morning sickness

158
Q

Phases of chemo-induced N/V?

A

-Acute: 0-24 hrs post therapy
-Delayed (late): >24hrs
-Anticipatory: before new cycle in response to conditional stimuli (starts after 3-4 cycles)
-Breakthrough: w/in 5 days of prophylactic antiemetic use, requires rescue

159
Q

Chemo emetic high risk (>90% chance w/ Cisplastin Cyclophosphamide) category recommended therapy?

A

3 or 4 drug combo: NK1 antagonist + 5-HT3 antagonist + corticosteroid +/- olanzapine

160
Q

Chemo emetic moderate risk (30-90%) category recommended therapy?

A

2 or 3 drug combo: 5-HT3 antagonist + corticosteroid +/- olanzapine

161
Q

Chemo emetic low risk (10-30%) category recommended therapy?

A

Monotherapy: 5-HT3 antagonist or Dopamine antagonist or Dexamethasone

162
Q

Chemo emetic minimal risk (<10%) category recommended therapy?

A

No prophylaxis

163
Q

Serotonin (5-HT3) antagonists for chemo-related N/V?

A

Ondansetron, Alosetron, Granisetron, Dolasetron, Palonosteron

164
Q

MOA of Serotonin (5-HT3) antagonists for chemo-related N/V?

A

Blocks 5-HT3 R’s

165
Q

ROA of Serotonin (5-HT3) antagonists for chemo-related N/V?

A

All available PO or IV

166
Q

Use of Serotonin (5-HT3) antagonists for chemo-related N/V?

A

Acute>delayed (most effective in first 24hrs)

167
Q

Side effects of Serotonin (5-HT3) antagonists for chemo-related N/V?

A

Constipation, mild headache

168
Q

Precautions of Serotonin (5-HT3) antagonists for chemo-related N/V?

A

QT prolongation, serotonin syndrome

169
Q

Drug interactions w/ Serotonin (5-HT3) antagonists for chemo-related N/V?

A

Substrate of CYP3A4 (major)

170
Q

Special populations considerations with Serotonin (5-HT3) antagonists for chemo-related N/V?

A

Caution w/ risk of arrhythmia

171
Q

Substance P/Neurokinin R (NK-1) Antagonists for chemo-induced N/V?

A

Aprepitant (PO), Fosaprepitant (IV), Rolapitant (PO)

172
Q

MOA of Substance P/Neurokinin R (NK-1) Antagonists for chemo-induced N/V?

A

Antagonizes Substance P/Neurokinin (NK-1) R’s

173
Q

Use of Substance P/Neurokinin R (NK-1) Antagonists for chemo-induced N/V?

A

Prevention of acute & delayed N/V
-3 day regimen in combo for highly-emetic chemo (not very effective alone)

174
Q

Side effects of Substance P/Neurokinin R (NK-1) Antagonists for chemo-induced N/V?

A

Fatigue, dizzy, diarrhea

175
Q

Precautions w/ Substance P/Neurokinin R (NK-1) Antagonists for chemo-induced N/V?

A

Hypersensitivity rxn during IV infusion

176
Q

Drug interactions of Substance P/Neurokinin R (NK-1) Antagonists for chemo-induced N/V?

A

Many (CYP3A4 substrate), induces CYP2C9 (warfarin)

177
Q

Corticosteroids for chemo-induced N/V?

A

Dexamethasone, Methylprednisolone

178
Q

MOA of Corticosteroids for chemo-induced N/V?

A

Not fully determined as antiemetic, anti-inflammatory

179
Q

ROA of Corticosteroids for chemo-induced N/V?

A

PO and IV

180
Q

Use of Corticosteroids for chemo-induced N/V?

A

Effective for both acute & delayed
*improves antiemetic activity of 5HT3 antagonists and Substance P/NK-1 antagonists

181
Q

Side effects of Corticosteroids for chemo-induced N/V?

A

insomnia, jitters (only using short term for few days), fluid retention, blood glucose levels in DM

182
Q

Special populations use of Corticosteroids for chemo-induced N/V?

A

Caution in elderly (lowest dose/shortest duration possible)

183
Q

MOA of Olanzapine (Zyprexa) for chemo-induced N/V?

A

Second-gen antipsychotic w/ moderate antagonism of 5HT3, dopemine, histamine

184
Q

Use of Olanzapine (Zyprexa) for chemo-induced N/V?

A

Off label for acute & delayed along w other agents (dexa, serotonin antagonsists) for mod-high emetogenic agents

185
Q

ROA of Olanzapine (Zyprexa) for chemo-induced N/V?

A

PO (dissintegrating tab: ODT)

186
Q

Side effects of Olanzapine (Zyprexa) for chemo-induced N/V?

A

Sedation, hyperglycemia, dizzy, wt gain

187
Q

Dopamine antagonsists for chemo-induced N/V?

A

Prochlorperazine, Promethazine

188
Q

MOA of Dopamine antagonsists for chemo-induced N/V?

A

Mostly dopamine antagonsim, phenothiazine class of meds

189
Q

Use of Dopamine antagonsists for chemo-induced N/V?

A

w/ others or monotherapy w/ low emetogenic chemo (effective to stop vomiting once begun-breakthrough)

190
Q

Side effects of Dopamine antagonsists for chemo-induced N/V?

A

Sedation, extrapyramidal effects, constipation, dry mouth

191
Q

Benzodiazepines for chemo-induced N/V?

A

Lorazepam, Alprazolam

192
Q

MOA of Benzodiazepines for chemo-induced N/V?

A

Anxiolytic activity

193
Q

ROA of Benzodiazepines for chemo-induced N/V?

A

PO and IV

194
Q

Uses for Benzodiazepines for chemo-induced N/V?

A

Prevent anticipatory CINV
*no antiemetic properties
*good if wanting to sleep through N/V

195
Q

Precautions w/ Benzodiazepines for chemo-induced N/V?

A

Fall risk, additive risk w/ other sedatives

196
Q

Special population use for Benzodiazepines for chemo-induced N/V?

A

Monitor doses in older adults (Beers)

197
Q

MOA of Scopolamine patch for motion sickness?

A

Blocks Ach at smooth muscle, secretory glands and CNS

198
Q

Onset of Scopolamine patch for motion sickness?

A

6-8 hrs

199
Q

Uses of Scopolamine patch for motion sickness?

A

Behind ear at least 4 hrs before, change every 3 days (can be used for CINV)

200
Q

Side effects of Scopolamine patch for motion sickness?

A

Anticholinergic effects: dry mouth, sedation, constipation, urinary retention, blurred vision

201
Q

Special populations use of Scopolamine patch for motion sickness?

A

AVOID IN PREGNANCY and older adults (Beers)

202
Q

Antihistamines for motion sickness?

A

Dimenhydrinate, Meclizine

203
Q

MOA of antihistamines for motion sickness?

A

Block H1 R’s, crosses BBB

204
Q

Uses of antihistamines for motion sickness?

A

Prevention/tx of motion sickness, N/V, vertigo (short trips)

205
Q

Onset of antihistamines for motion sickness?

A

15-30 min

206
Q

Duration of Dimenhydrinate for motion sickness?

A

4-6 hrs

207
Q

Duration of Meclizine for motion sickness?

A

24 hrs

208
Q

Side effects of antihistamines for motion sickness?

A

Weak anticholinergic activity: dry mouth, sedation, constipation, urinary retention, blurred vision

209
Q

Special population use w/ antihistamines for motion sickness?

A

Caution in older adults (Beers), Kids okay for use

Pharm II Exam 4 (3 decks)

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