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GIT pharm > Nausea & vomiting > Flashcards

Nausea & vomiting Flashcards

1
Q

What are the 7 groups of antiemetic drugs?

A
  1. Serotonin 5-HT3 antagonists
  2. Corticosteroids
  3. Neurokinin receptor antagonists
  4. Dopamine receptor antagonists
  5. Muscarinic receptor antagonists
  6. H1 histamine receptor antihistamines
  7. Benzodiazepines
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2
Q

What are the 4 sites that an trigger the vomiting reflex?

A
  1. Chemoreceptor trigger zone in the brain
  2. GIT
  3. Vestibular system
  4. Higher centres in the CNS
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3
Q

What is the treatment for chemotherapy regiment with LOW emetogenic risk?

A

Serotinin 5-HT3 receptor antagonist (first-line) OR
Dexamethasone OR
Dopamine D2 receptor antagonist

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4
Q

Name 2 examples of serotonin 5-HT3 antagonists

A

Ondansetron
Granisetron

Granisetron longer half-life; better for cancer patients

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5
Q

MOA of ondansetron?

A

Act at 5-HT3 receptors primarily in the GIT

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6
Q

Which antiemetics increase risk of cardiac arrhythmias?

A

Serotonin 5-HT3 antagonists & droperidol

May prolong QT interval

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7
Q

What group of patients is ondansetron contraindicated in?

A

Cardiac abnormalities
Early pregnancy
Patients on drugs that prolong QT interval

Ondansetron increases risk of orofacial malformations in early pregnancy

Fluoroquinolones, macrolides, azoles, antidepressants, anti-arrhythmia medications

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8
Q

What can 5-HT3 antagonists be combined with to increase antiemetic effect?

A

5HT3 antagonist + corticosteroid (dexamethasone) + NK1-receptor antagonist

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9
Q

When is ondansetron given to prevent N&V in patients undergoing chemo?

A

30min before chemo; IV

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10
Q

Name an example of a D2 receptor antagonist

A

Meteoclopramide

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11
Q

MOA of metoclopramide?

A

Blocks dopamine D2-receptors in the CTZ

Chemoreceptor trigger zone

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12
Q

What are the side-effects of long-term metoclopramide use?

A

Irreversible tardive dyskinesia

Wrong movements like twitching of the face

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13
Q

Which antiemetic causes Parkinsonian symptoms?

A

Metoclopramide

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14
Q

Adverse effects of metoclopromide?

A

Parkinsonian symptoms
Irreversible tardive dyskinesia
Elevated prolactin

Elevated prolactin causes manboobs, impotence, galactorrhea

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15
Q

What is the treatment for chemotherapy regiment with HIGH emetogenic risk?

A

5-HT3 receptor antagonist + corticosteroid (dexamethasone) + neurokinin 1-receptor antagonist

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16
Q

Name 2 examples of NK1-receptor antagonists

A

Aprepitant (PO)
Fosaprepitant (IV)

17
Q

MOA of NK1-receptor antagonists?

A

Blocks neurokinin 1 receptors at the CTZ

Chemoreceptor triggerzone

18
Q

Severe adverse effects of NK1-receptor antagonists?

A

Peripheral neuropathy
Blood dyscrasias

19
Q

What is the treatment for delayed N&V?

A

Combinations of:
- Dexamethasone
- Metoclopromide
- Aprepitant
- Olanzapine (can be considered)

20
Q

Name 3 antipsychotics

A

Prochlorperazine
Promethazine
Olanzapine
Droperidol

21
Q

MOA of antipsychotics?

A

Dopamine (CTZ) + muscarinic + histamine antagonism (vestibular system + vomiting centre)

22
Q

What antiemetic should be given for anticipatory N&V?

N&V due to anxiety

A

Benzodiazepines (Lorazepam, diazepam)

23
Q

Name 2 examples of benzodiazepines

A

Lorazepam
Diazepam

24
Q

MOA of benzodiazepines?

A

Binds to allosteric site on GABA receptors increasing chloride conductance; anxiolytic

25
Q

What group of patients should avoid taking benzodiazepines?

A

Pregnant women

Risk of cleft palate

26
Q

What antiemetics should be taken for motion sickness?

A
  • Hyoscine; mACh-receptor antagonist
  • Cinnarizine; H1 antihistamine & mACh-receptor antagonist

Both act on vestibular system + vomiting centre

27
Q

What is the prodrug formulation of aprepitant?

A

Fosaprepitant

28
Q

Where are the 5-HT3 receptors found?

A

CTZ
Visceral afferents (in GIT)

29
Q

Where are the H1 histamine & mACh receptors found?

A

Vestibular nuclei
Vomiting centre

GIT pharm (4 decks)

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