GI: N/V/D/C Flashcards
(91 cards)
1
Q
vomiting: receptor involvement (4)
A
dopamine
cholinergic
histamine
serotonin
2
Q
dopamine: vomiting
A
dopamine is found in GIT, the vomiting center of the brain, and the chemoreceptor trigger zone. lower medulla of brain.
3
Q
cholinergic: vomiting
A
vomiting center
visceral afferents
4
Q
histamine: vomiting
A
vomiting center
visceral afferents
5
Q
serotonin: vomiting
A
vomiting center
6
Q
assessing pt with vomiting
A
temporal relationship with meal or med? characteristics of vomit frequency past similar symptoms other symptoms lab values psych assessment
7
Q
1st line tx: nausea
A
serotonin antagonists
phenothiazines
benzamides
8
Q
2nd line tx: nauses
A
benzo corticosteroids antihistamines anticholinergics NK1 antagonists
9
Q
phenothiazines drug examples (2)
A
prochlorperazine
promethazine
10
Q
MoA phenothiazines
A
dopamine antagonist
11
Q
indications for phenothiazines
A
chemo induced nausea/vomiting
motion sickness
post op
12
Q
SEs phenothiazines
A
sedation dry mouth urinary retention blurred vision EPS
13
Q
routes of phenothiazines
A
PO
paraenteral
rectal
14
Q
benzamides: drug examples
A
metoclopramide
trimethobenzamide
15
Q
MoA benzamides
A
inhibits dopamine receptors in GIT/CTZ
16
Q
EPS may be seen in what drug groups?
A
phenothiazines
benzamides, less so
17
Q
SE benzamides
A
sedation
EPS
18
Q
serotonin antagonists drug suffix`
A
-setron
19
Q
serotonin antagonist MoA
A
inhibits serotonin receptors in the vomiting center
20
Q
uses of serotonin antagonists
A
severe chemo induced n/v
post op
21
Q
YEs of serotonin antagonists
A
headache, malaise, constipation, hypotension, EPS, anorexia
22
Q
issue with serotonin antagonists
A
QTc prolongation
watch electrolytes
23
Q
dose limit for ondansetron re: QTc prolongation
A
16g single dose max
24
Q
benzos: nausea
MoA
A
prevent limbic input from reaching the vomiting center
25
benzos: nausea
| indication
lorazepam
| anticipatory nausea
26
corticosteroids: nausea
dexamethasone for chemo induced n/v
27
Moa corticosteroids for nausea
unknown
28
antihistamines and anticholinergics for nausea
motion sickness
29
MoA of antihistamines/anticholinergics for nausea
inhibits cholinergic receptors which decrease stimulation of vomiting center
30
aprepitant (emend)
NK receptor antagonist
31
MoA aprepitant
quiets NK receptors found in GIT/CTZ are responsible for chemo induced N/V or post op
32
emend should be given with
corticosteroid
| serotonin antagonist
33
combination therapy for nausea
using first line with one or two second lines, all with different MOAs. may decrease side effects bc you arent maxing out any of them
34
chemo induced nausea/vomiting
| combo
ondansetron plus dexamethasone plus lorazepam
35
FYI for combination therapy for nausea
maintain hydration
36
mild N/V tx: (4)
benzos
antihistamines
anticholinergics
other remedies like coke syrup
37
moderate n/v tx: (4)
phenothiazines
dexamethasone
butyrophenones
benzamides
38
severe n/v tx:
metoclopramide
serotonin antagonists
aprepitant
combo regimens
39
diarrhea can be
acute
chronic
drug induced
40
acute diarrhea
lasts 72 hours after onset
41
chronic diarrhea
> 2 weeks
42
leading cause of diarrhea
viral gastroenteritis
43
if someone has chronic diarrhea, what is imprint to ask about
history of episodes
44
before treating diarrhea, consider
if it is wise to stop the diarrhea
45
non pharm diarrhea tx
stop solid foods for 24 h
avoid dairy
rehydrate
46
anti peristaltic agents for diarrhea:
loperamide
| diphenoxylate/atropine
47
antisecretory agents for diarrhea:
bismuth
| octreotide
48
adsorbent agents for diarrhea
polycarophil
kaolin pectin
attapulgite
49
MoA octreotide
blocks serotonin and other peptides, used in VIPomas
50
anti peristaltic agent MoA
slows GI motility
51
anti peristaltic agents should be used cautiously in
infectious diarrhea
52
fyi for anti peristaltics
may see some sedation
53
anti peristaltic agents in children
use cautiously
54
adsorbants MoA
adsorb water - absorbs water in the GI tract
55
issue with adsorbants like polycarbophil, attapulgite, kaopectate
may absorb other drugs
56
main use for bismuth
traveler's diarrhea
57
properties of bismuth subsalicylate
antisecretory
antimicrobial
adsorbant
58
bismuth subsalicylate toxicity
broken down into salicylate, watch if patient is on AC or excessive ASA.
59
treating acute diarrhea without fever or other symptoms
fluids and lytes
loperamide or diphenoxylate
diet restrictions
60
treating acute diarrhea with fever or other symptoms
check feces for WBC/RBC/O&P
61
after checking stool for WBC/RBC/O&P in the patient with diarrhea and fever, what do you do if symptoms are neg? pos?
neg: symptomatic therapy
pos: appropriate abx and symptomatic therapy
62
treating chronic diarrhea:
identify possible cause
| do appropriate diagnostics (cultures, sigmoidoscopy, biopsy)
63
if no diagnosis is made in chronic diarrhea...
rehydrate
loperamide
adjust diet
64
if diagnosis is made in chronic diarrhea:
treat cause
65
diarrhea is often
minor and self limiting
66
who do we worry about re: diarrhea?
children
AIDs patients
elderly
immusuppressed
67
goals of diarrhea tx:
prevent excessive water/lyte loss
relieve symptoms
treat curable causes and secondary disorders
68
when do you order a GI consult for the pt with diarrhea? (8)
```
children < 3
pregnant
frail/elderly
mod/severe volume depletion
chronic heart/renal/liver disease
AIDs
high fever
bloody/mucous stools
```
69
contipation "defined"
< 2 BMs a week
70
most common cause of constipation
low fiber and inactivity
71
non pharm mgmt of constipation
```
diet changes
inc fiber
correct underlying disease
increase fluids
exercise
```
72
pharmacologic mgmt of constipation
laxatives CAREFULLY
73
drugs for constipation 5
```
bulk forming laxatives
surfactants
saline agents
hyper osmotic agents
stimulants
```
74
bulk forming laxatives are preferred because
they are not systemically absorbed
75
DoA bulk forming laxative
1-3 days
76
MoA bulk forming
holds water into stool increasing bulk and then stimulating a BM
77
AE bulk forming lax
flatulence
78
bulk forming lax is not
for quick relief
79
surfactants DoA
1-3 days
80
MoA surfactant (colace)
facilitates mixture of fats and aqueous materials
81
surfactants should be used as a
preventative, eps in those who shouldn't be straining
82
saline laxatives should be used for
occasional constipation or bowel prep
83
use saline lax cautiously in
HTN
sodium restricted diets
renal disease
84
osmotic agents
lactulose
sorbitol
glycerin
polyethylene glycol
85
osmotic MoA
metabolizes solutes in GI tract, moving water osmotically and facilitating propulsion and evacuation.
86
stimulants: bisacodyl cause
colonic contractions and thus evacuation
87
why is bisacodyl enteric coated
so that it does not dissolve until it reaches the colon
88
bisacodyl is not for
everyday use
89
DoA stimulants for constipation
6-12 hrs
90
stimulant: senna
similar to bisacodyl but gentler. also promotes fluid accumulation in colon.
91
institue bowel regimens for those who take
opioids
| verapamil
