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TBL Flashcards

1
Q

Complications of N/V

A 
Dehydration
Electrolyte disturbances
Malnutrition
Aspiration Pneumonia
Esophageal Tears
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2
Q

Causes of N/V

A

CNS (migraine, vestibular dysfx)
GI (viral gastroenteritis)
Radiation induced (RINV)
Post-op (PONV)

Medications:
Chemo-induced (CINV)
Can be acute (hrs) or delayed (onset w/in days)

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3
Q

Receptors that promote N/V

A 
5-HT3
D2
Neurokinin (NK1)
M1
H1
Opioid
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4
Q

Receptors that inhibit NV

A 
Cannabinoid (CB1)
Glucocorticoid receptor (GR)
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5
Q

5-HT3 Antag

A

Ondansetron

Blocks 5HT3 receptor
Enhanced effects when combo w corticosteroids &/or NK1 antag

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6
Q

5-HT3 Antag Indications

A

Acute CINV
RINV
PONV
Acute gastroenteritis

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7
Q

5-HT3 Antag AE

A

HA
GI (constip/diar)
Elevated LFTs
Inc QTc interval (from Kr channel block) –> Inc risk for TdP

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8
Q

D2 Antag examples

A

Prochlorperazine

Metoclopramide

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9
Q

Prochelorperazine MOA & Indic

A

Blocks D2 receptors
Also blocks M, H1, alpha 1, Kr channels

General purpose

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10
Q

Prochlorperazine AE

A 
Blocking D2:
Movement disorder:
resting tremor
slow movements
rigidity
involuntary movements of eyes, mouth, head, arms (tardive dyskinesia)

Hyperprolactinemia:
reproductive dysfx
galactorrhea

Antimuscarinic (blocking M)

Sedation (blocking H1)

Orthostatic HOTN (blocking alpha 1)

Inc QTc inverval (from Kr channel block) –> Inc risk for TdP

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11
Q

Metoclopramide MOA & Indic

A

MOA: blocks D2 receptors; also blocks 5-HT3 and stimulates 5-HT4

Indications: PONV
migraine NV
GI motility related NV (gastroparesis)

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12
Q

Metoclopramide AE

A 
Movement disorder from blocking D2:
resting tremor
slow movements
rigidity
involuntary movements of eyes, mouth, head, arms (tardive dyskinesia)

Black Box warning for Tardive dyskinesia (Don’t use for >3 months)

Hyperprolactinemia (from blocking D2):
reproductive dysfx, galactorrhea

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13
Q

M antag

A

Scopolamine

Blocks M receptors

Motion sickness, vertigo

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14
Q

M antag AE

A

antimuscarinic

sedation

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15
Q

H1 antag

A

Meclizine, Dimenhydrinate

Block H1 & M receptors

Motion sickness, vertigo

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16
Q

H1 antag AE

A

antimuscarinic

sedation

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17
Q

NK1 antag

A

Aprepitant

Blocks NK1 receptors

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18
Q

NK1 antag Indic

A

CINV (in combo w setron & corticosteroids)

PONV

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19
Q

NK1 antag AE

A 
elevated LFTs
HA
dizziness
fatigue
hiccups
constip
20
Q

Corticosteroid

A

Dexamethasone

Stimulates GRs

21
Q

Corticosteroid Indic

A

CINV (in combo w/ setron and NK1 antag)

PONV

22
Q

Corticosteroid AE

A

Insomnia
Inc plasma glucose

Other corticosteroid AE not normally seen bc usually acute admin

23
Q

Cannabinoids

A

Dronabinol

Stim CB1 receptors

CINV (refractory to other tx)

24
Q

Cannabinoids AE

A

CNS
INc laughing, emotional changes, hallucinations
Inc HR

25
Drug Induced NV
``` Opiods Inc D2 activity SSRIs Chemotherapeutic agents Inc ACh activity in brain ```
26
Spironolactone MOA
blocks mineralocorticoid receptor (receptor for aldosterone) --> dec renal sodium retention Also blocks the androgen receptor (AR)
27
Spironolactone AE
Hyperkalemia | Gynecomastia, sexual dysfx (from blocking AR)
28
Propranolol MOA
Nonselective beta blocker | Blocks B2 --> dec splanchnic vasodil --> dec portal pressure --> dec risk of variceal bleeding
29
Propranolol Clin Use
Primary & secondary prophylaxis against variceal bleeding
30
Spironolactone Clin Use
Treats ascites
31
Propranolol AE
Beta blocker AE
32
Octreotide MOA
SST-R (Gi coupled) agonist | Stim of SST-R --> dec release of vasodil --> dec splanchnic vasodil --> dec portal pressure
33
Octreotide Clin Use
Tx acute esophageal varciceal bleeding *Also tx a variety of hormone secreting tumor syndromes
34
Octreotide AE
Abd pain diarrhea NV gallstones
35
Vasopressin MOA
Activates V1-R (Gq-coupled) --> splanchnic vasoconst. --> dec portal pressure
36
Vasopressin Clin Use
Acute esophageal varciceal bleeding
37
Vasopressin AE
HTN Hyponatremia (Stim V2 in kidney --> water retention)
38
Lactulose MOA
Metabolized by colonic bacteria to formic and acetic acid --> acidifies lumen --> protonates NH3 to NH4+ --> traps in lumen
39
Lactulose Clin Use
Tx hepatic encephalopathy, constipation
40
Lactulose AE
Abd pain flatulence diarrhea
41
Rifaximin MOA
Nonabsorbable antibiotic that kills GI bacteria that metabolize urea to NH3
42
Rifaximin Clin Use
Tx hepatic encephalopathy
43
Rifaximin AE
GI (abd pain, nausea)
44
Miscellaneous H2-R antag AE
HA Diarrhea Dizziness Drowsiness Hypergastrinemia after prolonged use
45
Notable PPI risks/AE
Inc risk of CKD and acute KDz Hypergastrinemia (worse than H2-R antag) Can cause hyperplasia of gastric cells
46
Hyoscyamine MOA, Use
Block M3 on GI smooth muscle --> dec contractions Tx spasms
47
Hyoscyamine AE
Antimuscarinic

GI (3 decks)

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