n/v, IBD Flashcards by Jenny P

Scopolamine (Transderm Scop®)

class

anticholinergic

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"Diphenhydramine(Benadryl®)
Meclizine (Bonine®)
Doxylamine (Unisom)
dimenhydrinate(Dramamine)"
class

anti-histamines (1st gen)

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class: Promethazine (Phenergan®), Prochlorperazine (Compazine®)

dopamine antagonists

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class: Metoclopramide (Reglan®)

dopamine antagonist

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Dronabinol (Marinol®) & Nabilone (Cesamet®)

class

cannabinoids

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“Lorazepam (Ativan®) & alprazolam (Xanax®)
usually IV for hosp pt”
class

Benzodiazepines

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class: "Ondansetron (Zofran®) – 4mg IV or PO Q8 hrs PRN n/v
Granisetron (Sancuso®) – IV, patch
Dolasetron (Anzemet®) - IV
Palonosetron (Aloxi®) – IV
Long t1/2 – 40 hours"

Serotonin Antagonists

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Aprepitant (Emend®), rolapitant (Varubi®)

class

Neurokinin-1 Receptor Antagonists

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Olanzapine (Zyprexa®)

class

Antipsychotic

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Sulfasalazine and Mesalamineare the main two, PO or rectal. OlsalazineandBalsalazine(alts very similar to mesalamine)
class

Aminosalicylate Derivatives (5-ASA)

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Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO

class

Immunomodulators and Immunosuppressants

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Cyclosporine(Gengraf)

class

Immunomodulators and Immunosuppressants

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name the anti-TNF alpha drugs

etanercept (Enbrel), infliximab (Remicade) IV only, adalimumab (Humira), certolizumab pegol (Cimzia) and golimumab (Simponi)

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SEs: Xerostomia, drowsiness, constipation, blurred vision, disorientation, dizziness

anticholinergics

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Pt counseling: \Wash hands after applying or taking off patch

Scopolamine (Transderm Scop®)

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how often to change patch for Scopolamine (Transderm Scop®)

every 3 days

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contraindication for meclizine

under 12 y/o

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contraindication for dramamine

under 2 y/o

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1st line for pregnancy related N/V

Doxylamine+pyridoxine(VitB6) brand name: Diclegis

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Pt counseling for antihistamines

Warn about ADDITIVE anticholinergic issues!

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are 2nd gen antihistamines effective for motion sickness?

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MOA: inhibition of central dopamine, muscarinic and H1 histamine receptors

Promethazine (Phenergan®), Prochlorperazine (Compazine®)

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contraindications for Promethazine (Phenergan®), Prochlorperazine (Compazine®)

“Both: AVOID in elderly.
Compazine: BBW: elderly for dementia-related psychosis! Has anticholinergic effects in addition to the Dopamine antagonism. AVOID in altered consciousness,in addition to other sedative/opioids as further sedation and respiratory decline can occur additively
Phenergan: avoid IV, IM due to tissue necrosis”

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AE: EPS symptoms (with chronic PO use), sedation, dizziness, headache, low blood pressure (orthostatic hypotension), and blurred vision, carry anticholinergic effect too!!
Extrapyramidal symptoms (EPS) = dystonia, tardive dyskinesia (irreversible)

Promethazine (Phenergan®), Prochlorperazine (Compazine®)

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Pt counseling for Promethazine (Phenergan®)

Following use of promethazine, hCG-based pregnancy tests may result in false-negatives or false-positives.

MOA: antipsychotic effects by centrally blocking postsynaptic dopamine receptors

Droperidol, | Haloperidol (Haldol®),"

indications for Droperidol, | Haloperidol (Haldol®),"

"n/v, Acute Psychosis, Tourette syndrome, agitation, behavioral disorders. Droperidol: post-op n/v"

what class of meds has EPS as an AE?

dopamine antagonists, antipsychotic

BBW for Droperidol, | Haloperidol (Haldol®)

BBW: QT prolongation leading to torsades de pointe and sudden cardiac death

which is tolerated better: Droperidol, | Haloperidol (Haldol®),"

droperidol

MOA: D2 receptor antagonist. Centrally (CNS) and peripherally (GI tract). Cholinergic activity: increases lower sphincter tone and promotes gastric motility

Metoclopramide (Reglan®)

Metoclopramide (Reglan®) indications

chemo and post-op n/v prevention. (if benefit outweighs the risk). Promote postpartum lactation. gastroparesis, GERD

how to reduce risk of EPS w/ Reglan

Concurrent diphenhydramine use

AEs: Drowsiness, fatigue, QTc prolongation. EPS. Hyperprolactinemia: amenorrhea, galactorrhea, gynecomastia

Reglan

AEs: Sodium & fluid retention, hypertension, edema, hyperglycemia. Hypokalemia, dyspepsia

Dexamethasone (Decadron®) & methylprednisolone (Solu-Medrol®)

med associated with oral clefts during first trimester

Methylprednisolone

indications for Dexamethasone (Decadron®) & methylprednisolone (Solu-Medrol®)

mod-severe chemo or radiation n/v

BBW for Reglan

tardive dyskinesia

indications: chemo n/v for those who fail to respond to conventional therapies. AIDS/chemo associated anorexia (stimulates appetite)

Dronabinol (Marinol®) & Nabilone (Cesamet®)

consideration w/ dosing cannabinoids

avoid abrupt stop w/ high dose to prevent withdrawal

MOA: selective 5HT3 receptor antagonist

``` "Ondansetron (Zofran®) – 4mg IV or PO Q8 hrs PRN n/v Granisetron (Sancuso®) – IV, patch Dolasetron (Anzemet®) - IV Palonosetron (Aloxi®) – IV Long t1/2 – 40 hours" ```

dosing for ondansetron

4mg IV or PO Q8 hrs PRN n/v

contraindications for Serotonin Antagonists

"Sig hyper/hypokalemia if high dose IV. Caution: prolong QT interval Consider underlying cardiac issues and other medications that have QT prolongation when used WITH zofran"

are Serotonin Antagonists ok for kids?

yes

risk of Zofran use in pregnancy

can be used for severe n/v in pregnancy but concern for risk of cleft palate (24% increase)

Pt counseling for Zofran

Take Zofran 20-30 min before pain killer

MOA: NK1 receptor antagonist. Can combine with 5HT3 antagonist & corticosteroid. Increased efficacy over 2 agents alone

Aprepitant (Emend®), rolapitant (Varubi®)

mod-severe chemo n/v (big guns) and prevention

Aprepitant (Emend®), rolapitant (Varubi®)

AEs: Fatigue, dizziness, hiccups, diarrhea / constipation. Transient elevations in hepatic transaminases (rare)

Aprepitant (Emend®), rolapitant (Varubi®)

med adjustments for Aprepitant (Emend®), rolapitant (Varubi®)

Moderate CYP3A4 inhibitor. Adjust chemotherapeutic agents  Vinblastine, Etoposide. Adjust warfarin

MOA: 5-HT2A Antagonist, Moderate D2 Block

Olanzapine (Zyprexa®)

last ditch for chronic n/v. Schizophrenia, Bipolar Disorder, Agitation, Depression (Adjunct)

Olanzapine (Zyprexa®)

AEs: Sedation, Weight Gain, Metabolic Syndrome. Low risk of EPS and Hyperprolactinemia

Olanzapine (Zyprexa®)

class: Sulfasalazine and Mesalamine are the main two, PO or rectal. Olsalazine and Balsalazine (alts very similar to mesalamine)

Aminosalicylate Derivatives (5-ASA)

MOA: Anti-inflammatory+immunosuppressant effects that act locally/topically in the GI tract

Sulfasalazine and Mesalamine are the main two, PO or rectal. Olsalazine and Balsalazine (alts very similar to mesalamine)

1st line for inducing remission in UC

Mesalamine PO or rectal

Mesalimine red flags

3% will worsen with F, diarrhea, abd pain, bleeding. Consider this an allergy and never use a 5-ASA again

AEs: HA, n, fever, rash. Rare: leukopenia, aplastic anemia, agranulocytosis, pancreatitis, hepatitis

suflasalazine

``` Aminosalicylate Derivatives (5-ASA) ok in pregnancy? ```

safe in pregnancy but need to take extra folic acid.

Mesalimine caution in pts w/ ____

renal dz

monitoring for Aminosalicylate Derivatives (5-ASA)

"mesa: BMP at 6 weeks, 6 months, then Q 12 months | sulfa: Monitor CBC and LFTs before starting therapy then routinely Q3 mo"

pt counseling for Sulfasalazine

men must stop 3 mo before trying to conceive

preferred in CD to “Induce remission”

budesonide

Used in active IBD to suppress inflammation rapidly (short term use).

prednisone, prednisolone, methylprednisolone, hydrocortisone, budesonide

contraindications for corticosteroids

use w/ caution in HF, HTN, post- acute MI, DM. caution in pts with GI dz (diverticulitis, fresh intestinal anastomoses, active or latent peptic ulcer, ulcerative colitis, abscess or other pyogenic infection) due to perforation risk

dosing consideration for corticosteroids

Always taper steroids gradually if used longer than ~3 weeks and at a high dose to prevent adrenal crisis

MOA: inhibit purine biosynthesis in lymphocytes and reduce IBD-associated GI inflammation. Slow onset of action (3-12 mo)

Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO

Top choice for maintaining remission in CD

Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO

AEs: nausea. Rare AE: pancreatitis, fever, rash hepatitis, and leukopenia, bone marrow suppression. Risk for non-melanoma skin cancer. VERY small increased risk of lymphoma

Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO

Azathioprine(Imuran) and 6-mercaptopurine(6-MP) PO drug interactions

SERIOUS drug interactions with allopurinol(Zyloprim) and febuxostat (Uloric) (both for gout)

pt education forAzathioprine(Imuran) and 6-mercaptopurine(6-MP)

use sun protection

monitoring for Azathioprine(Imuran) and 6-mercaptopurine(6-MP)

"IF leukopenia (WBC ≤4000) or thrombocytopenia (platelet count <150,000) dose should be reduced by 50 percent or the drug should be discontinued Labs every week X 4 wks, then periodically after (burden on pt)"

Methotrexate | MOA

folate antagonist

methotrexate indication

used primarily for maintaining remission of CD

methotrexate contraindication

pregnancy

AEs of methotrexate

Long-term use may result in serious adverse effects, including hepatotoxicity, pulmonary fibrosis, and bone marrow suppression

drug interactions for methotrexate

do NOT use w/ Bactrim

AEs: Significant toxicities: nephrotoxicity, risk of infection, seizures, hypertension, and liver function test abnormalities

Cyclosporine(Gengraf)

indications forCyclosporine(Gengraf)

used to prevent organ rejection in transplant pts; fluminant or refractory active IBD

indications: maintaining remission in CD, UC, RA, psoriasis and psoriatic arthritis, hidradenitis suppuritiva, juvenile RA, ankylosing spondylitis

anti-TNFalpha

are anti-TNF ok in pregnancy?

ok in pregnancy but think about disease state and goals

screening for anti-TNF prior to starting

Screen for TB, Hep B and C before starting

what to do if pt on anti-TNF develops sepsis or serious infx

stop meds

can a person on anti-TNF get vax'ed?

yes, but not live vaxes

AEs: Natalizumab(Tysabri) and vedolizumab (Entyvio)

Both are associated with risk of development of progressive multifocal leukoencephalopathy (PML) from reactivation of JCV, but natalizumab is more likely to cause

moderate to severe CD patients who failed immunomodulators or corticosteroids

Ustekinumab(Stelara):

Tofacitinib (Xeljanz): | contraindication

Hx of VTE/DVT/PE

Tofacitinib (Xeljanz) must get what vax first

increases risk of herpes zoster (so must get vax)

n/v, IBD Flashcards

(88 cards)