GI motility drugs Flashcards
(89 cards)
1
Q
Location of emesis center
A
Medulla
2
Q
Afferents of the emesis center
A
CTZ in area postrema
Vestibular apparatus
Vagal afferents via solitary tract nucleus
3
Q
Activating receptors on the CTZ
A
Serotonin
5-HT3
Dopamine D2
Muscarinic M1
4
Q
Substances released by vestibular apparatus to activate vomiting center
A
Ach
Histamine
5
Q
Drug class of Hyoscine
A
Anticholinergic antiemetic
6
Q
Drug class of scopolamine
A
Anticholinergic antiemetic
7
Q
Drug class of dicyclomine
A
Anticholinergic antiemetic
8
Q
Most effective drug for motion sickness
A
Hyoscine
9
Q
Side effects of anticholinergic antiemetics
A
Sedation and dry mouth
10
Q
Use of anticholinergic antiemetics
A
Motion sickness
11
Q
H1 antihistamine with significant antimuscarinic acitivity
A
Promethazine
12
Q
Drug class of promethazine
A
H1 antihistamine and D2 blocker
13
Q
Drug class of Doxylamine
A
H1 antihistamine
14
Q
Drug class of meclizine
A
H1 antihistamine
15
Q
H1 antihistamine that is less sedative and has a longer duration of action
A
Meclizine
16
Q
Duration of action of meclizine
A
24 hrs
17
Q
Antiemetic available in a slow-release patch that lasts 72 hrs
A
Scopolamine
18
Q
Drug class of cinnarizine
A
H1 antihistamine
19
Q
Use of meclizine
A
Sea sickness
20
Q
Uses of cinnarizine
A
Vertigo
Motion sickness
21
Q
General uses of H1 antihistamine antiemetics
A
Motion sickness
22
Q
General side effects of H1 antihistamine antiemetics
A
Sedation and dry mouth –> anticholinergic action
23
Q
Drug class of chlorpromazine
A
D2 blocker (neuroleptic) antiemetic
24
Q
Drug class of domperidone
A
D2 blocker (neuroleptic) antiemetic
25
Mechanism of D2 blocker antiemetics
D2 receptor antagonist that primarily acts on CTZ, as it does not cross the BBB
26
Drug class of ondansetron
First generation 5-HT3 antagonist
27
Drug class of Granisetron
First generation of 5-HT3 antagonist
28
Drug class of dolasetron
First generation 5-HT3 antagonist
29
Use and administration of first generation 5-HT3 antagonists
Given 3-5 days after chemotherapy for N/V
Also used for postoperative nausea
30
Drug class of palonosetron
Second generation 5-HT3 antagonist
31
5-HT3 antagonist with a longer duration of action
Palonosetron
32
Antiemetic that may prevent N/V for up to 7 days after chemotherapy, approved for treating both acute and delayed N/V
Palonosetron
33
Antiemetic drug class that prevents both peripheral and central stimulation of the vomiting center
5-HT3 antagonists
34
Drug class of aprepitant
NK1 receptor antagonist
35
Drug that blocks the emetic action of substance P at NK1 receptor
Aprepitant
36
Drug used for delayed phase vomiting (days 2-5) from cisplatin and for pts undergoing multiple chemotherapy cycles
Aprepitant
37
Adjuvant antiemetics
Dexamethasone
Cannabinoids
38
Drug class that is an agonist of CB1 receptor
Cannabinoids
39
Types of cannabinoids
Dronabinol
Nabilone
40
Drug class of metoclopramide
Prokinetic
41
Drug used for gastroparesis or postop emptying delay that speeds up gastric emptying by enhancing coordinated propulsive motility
Metoclopramide
42
Actions of metoclopramide
D2 antagonism
5-HT3 antagonism
5-HT4 agonism
43
Drug that increases the release of Ach from cholinergic motor neurons in the enteric nervous system
Metoclopramide
44
Main side effects of metoclopramide
Sedation
Dizziness
Loose stools
Muscle dystonias (children)
45
Possible effects of long-term use of metoclopramide
Parkinsonism
Galactorrhea
Gynecomastia
46
Macrolides used to promote gastric motility by stimulating motilin receptors
Erythromycin
47
Anticancer drugs with high emetogenic potential
Cisplatin
Cyclophosphamide
Dacarbazine
48
High emetic risk CINV acute phase treatment regimen
Combination of:
NK1 receptor antagonist
5-HT3 receptor antagonist
Dexamethasone
49
Moderate and high emetic risk CINV delayed phase treatment
NK1 receptor antagonist
Dexamethasone
50
Low and moderate emetic risk CINV acute phase treatment regimen
Combination of:
5-HT3 receptor antagonist
Dexamethasone
51
NT that plays a vital role in promoting GI motility
Serotonin
52
First line treatment for constipation
Diet and lifestyle modifications:
-Increased fiber intake
-Adequate fluid intake
-Regular exercise
53
Examples of bulk-forming laxatives
Psyllium
Methylcellulose
Polycarbophil
54
Preferred drug class for the management of chronic constipation because they can be used for a long time without noticeable side effects
Bulk-forming laxatives
55
Examples of stool-softening laxatives
Docusate
Glycerin
Mineral oil
56
Examples of osmotic laxatives
Magnesium oxide
Sorbitol
Lactulose
Magnesium citrate
Sodium phosphate
Polyethylene glycol
57
Laxative used in hepatic encephalopathy associated with elevated blood ammonia levels
Lactulose
58
Risk of excessive use of osmotic laxatives
Significant electrolyte and fluid loss
59
Examples of stimulant/secretory laxatives
Aloe
Senna
Cascara
Castor oil
Bisacodyl
60
Agent used for evacuating the bowel before surgery or examination that is available as a suppository
Bisacodyl
61
Adverse effects of stimulant/secretory laxatives
Abdominal cramping
Significant electrolyte and fluid loss (long-term use)
62
Examples of chloride channel activator laxatives
Lubiprostone
Linaclotide
63
Example of opioid receptor antagonists used as laxatives
Methylnaltrexone
Alvimopan
64
Examples of colloidal bulk forming substances used for diarrhea
Psyllium hydrophilic mucilloid
Calcium polycarbophil
Methyl cellulose
65
Do colloidal bulk forming substances reduce water and electrolyte loss?
No
66
Uses of colloidal bulk forming substances
Constipation and diarrhea phases of IBS
67
Drug class of diphenoxylate and its brand name
Antimotility drug
Lomotil
68
Drug class of loperamide and its brand name
Antimotility drug
Imodium
69
Synthetic opioid that is chemically related to pethidine and mu opiate receptor agonist. Used exclusively as a constipating agent.
Diphenoxylate
70
Adjuvant to diphenoxylate to discourage abuse by taking several tablets
Atropine
71
Rare side effects of diphenoxylate
Respiratory depression
Paralytic ileus
Toxic megacolon (children)
72
Mu opiate receptor agonist with poor water solubility limiting its intestinal absorption.
Loperamide
73
Most effective antimotility drug for diarrhea that is available OTC.
Loperamide
74
Adverse effects of loperamide
Paralytic ileus
Toxic megacolon (children <4 yo)
75
Drug class contraindicated for use in acute infective diarrheas because they delay the clearance of pathogens from intestine
Antimotility drugs
76
Drug class of racecadotril
Antisecretory antidiarrheal
77
Enkephalinase inhibitor that prevents degradation of ENKs, which act as agonists on mu opioid receptors
Racecadotril
78
Use of racecodotril
Acute secretory diarrheas
Can be used in children
79
Disease characterized by progressive degeneration of ganglion cells in the myenteric plexus of the esophageal wall causing failure of LES relaxation and loss of peristalsis in distal esophagus
Achalasia
80
Drugs used for treatment of achalasia
Nitrates
Nifedipine --> Ca channel blocker
Botox into LES
81
A rare, acquired, premalignant disorder of the stomach characterized by large gastric folds due to overgrowth of mucous cells
Menetrier's disease
82
Symptoms of Menetrier's disease
Epigastric pain
Hypoalbuminemia
83
Possible associations of Menetrier's disease
CMV
H pylori infection
84
Monoclonal antibody used to treat Menetrier's disease that blocks EGFR
Cetuximab
85
Treatment options for Menetrier's disease
PPI or H2 blocker
Albumin transfusion
Cetuximab
Treatment of underlying disease if present
Octreotide
86
Somatostatin analogue that reduces EGFR signaling, used to treat Menetrier's disease
Octreotide
87
Antivirals used for treatment of CMV related Menetrier's disease
Ganciclovir
Foscarnet
88
Mechanism of Ganciclovir
Nucleoside analogue that inhibits DNA synthesis via chain termination
89
