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Pharm Dedo Exam3 > Nausea & Vomiting > Flashcards

Nausea & Vomiting Flashcards

(61 cards)

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1
Q

Nausea…

A

Unpleasant sensation of being about to vomit, which may occur alone or with vomiting

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2
Q

Vomiting…

A

forceful expulsion of gastric contents

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3
Q

Retching (aka dry heaves)…

A

differs from vomiting bc NO expulsion of gastric contents

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4
Q

GI motor function is controlled at 3 levels:

A

1 symp & parasymp NS
2 enteric neurons
3 smooth m cells

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5
Q

physiologic pathways involved with vomiting in the medulla…

A

1 vestibular fiber stimulation
2 afferent visceral fiber stimulation
3 Chemoreceptor trigger zone input (base of 4th ventricle)

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6
Q

5 main neurotransmitter receptor sites related to vomiting reflex:

A 
M1 (muscarinic)
H1 (histaminic)
D2 (dopamine)
5-HT3 (seratonin) 
NK1 (substance P)
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7
Q

Which receptor sites are most important from an inner ear perspective?

A

M1 & H1

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8
Q

Which receptor sites are most important in the GI tract?

A

D2 & 5HT3

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9
Q

consequences and complications of N/V:

A

fluid depletion, hypokalemia, metabolic alkalosis

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10
Q

Anticholinergic Agents work on what receptor type?

A

M1

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11
Q

M1 receptor antagonists

A

Scopolamine

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12
Q

route of scopolamine

A

transdermal patch (place on mastoid process)

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13
Q

MOA of M1 antagonists

A

block ACh at parasymp sites in smooth muscle, secretory glands, and CNS

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14
Q

indications for scopolomine

A

motion sickness prophylaxis

off label= dry OP secretions –> minimize aspirations post stroke

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15
Q

duration of action of scopolomine

A

starts 6-8hrs post application of patch

can last up to 72 hrs

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16
Q

Why do we prefer M1 blockers over H1 blockers for prevention of motion sickness?

A

they do not make pts sleepy (better if pt wants to be awake during travel)

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17
Q

ADRs of scopolamine

A

xerostomia, sedation, urinary retention, blurred vision (pupil dilation)

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18
Q

Antihistamines work on what receptors?

A

H1 receptor antagonists

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19
Q

H1 blocker drugs

A

Dimenhydrinate, Meclizine

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20
Q

MOA of H1 blockers

A

central anticholinergic action (blocks CTZ) and decreases excitability of middle ear labyrinth & blocks conduction of middle ear-cerebellar pathways

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21
Q

clinical indications for H1 blockers

A

motion sickness (quick onset and doesnt last very long)

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22
Q

Which H1 blocker is best for treating vertigo?

A

meclizine

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23
Q

Phenothiazine derivatives work on which receptors?

A

H1 and D2 antagonists

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24
Q

Example of phenothiazine derivatives:

A

promethazine

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25
MOA of promethazine?
D2 blocker in CTZ (decreases emetic input to medullary vomiting center) & a adrenergic blocker (decreases release of hypothalamic/hypophyseal hormones) & competes with histamine for H1 receptor
26
Clinical indications of promethazine
- motion sickness - antiemetic - adjunctive for pain management (and migraines) - tx allergic conditions
27
why do you not give promethazine to kids <2yrs?
potentially fatal respiratory depression
28
Drug interactions of promethazine:
- CYP2D6 substrate - anticholinergics & CNS depressants - Levodopa - QTc prolongation
29
ADRs of promethazine
similar to typical antipsychotics: - EPS - may alter cardiac conduction --> dysrhythmias - NMS - Amenorrhea/gynecomastia - Antihistaminic/cholinergic ADRs (like scopolamine)
30
Dopamine Antagonists 3 classes:
- Phenothiazines - Butyrophenones - Benzamides
31
Phenothiazine drug
prochlorperazine
32
MOA of prochlorperazine
blocks D1 & D2 receptors in the brain (including CTZ) | has a strong a adrenergic blocking effect
33
clinical indications for prochlorperazine
antiemetic (used mostly by anesthesia and chemotherapy) | *only moderately effective
34
contraindications of prochlorperazine
- do not use in kids <2yrs (resp depression) | - do not use in pregnant women
35
drug interactions and ADRs of prochlorperazine?
same as promethazine
36
Butyrophenone drug
droperidol
37
droperidol MOA
blocks central D1 & D2 receptors in brain (including CTZ)
38
clinical uses of droperidol
preanesthetic agent for PONV
39
droperidol BBW:
QTc prolongation
40
Benzamide drugs
- metoclopramide | - trimethobenzamide
41
metoclopramide MOA
centeral & peripheral D2 blocking, blocks serotonin receptors in CTZ at high doses *enhanced motility in UGI tissues
42
metoclopramide indications
DM gastroparesis!! | use for PONV if pt unresponsive to other tx
43
ADRs of metoclpramide
drowsiness | EPS (especially acute dystonia)
44
What is metoclpramide's BBW for?
acute dystonia
45
Serotonin antagonists 1st generation
- ondansetron - granisetron - dolasetron
46
Serotonin antagonists 2nd generation
palonosetron
47
serotonin antagonists MOA
block 5HT3 receptors in small bowel, Vagus N, and CTZ These are the 1* tx for variety of causes of nausea
48
setotonin antagonist clinical indications:
- prevent CIE --> ALWAYS SCHEDULE THEM - nausea from irradiation - prevention & tx of PONV
49
Ondansetron unlabeled use
peds with gastric enteritis in ED
50
Ondansetron CYP interactions
3A4 substrate
51
serotonin blockers class ARDs
HA = m/c | all have issues w QTc prolongation
52
do these agents (aka serotonin antagonists) "chase down nausea" very well?
NAH BRAH!! | always start preemptively or right at the start of nausea for best results
53
what weird method for treating nausea is "on the horizon"??
inhaled isopropyl alcohol
54
N/V management in pregnancy:
``` 1 lifestyle changes 2 pyridoxine (Vit B6) 3 add H1 blocker to B6 --Doxylamine* --Dimenhydrinate --Diphenhydramine 4 low dose ondansetron 5 phenothiazine --promethazine --metoclopromide ```
55
why do we not like to use ondansetron in 1st trimester?
linked to a slight increased risk of CHD & cleft palate (also prolongs QTc interval)
56
Other measures to help with nausea in pregnancy?
GINGER
57
Management of Gastroparesis:
``` 1 dietary management 2 optimize DM tx 3 avoid meds that can delay gastric emptying 4 use metoclopramide 5 try erythromycin 6 use doperidone or cisapride ```
58
common causes of gastroparesis
DM, abd surgery, and drugs that decrease GI motility
59
meds that can delay gastric emptying:
- opioids - antichoilinergics - DM meds - lubiprostone
60
domperidone & cosapride ADRs
QTc prolongation | *use only in refractory or severe gastroparesis!
61
agent to try and use for refractory abd pain & nausea:
TCAs

Pharm Dedo Exam3 (3 decks)

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