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Flashcards in TBL Deck (47):
1

Complications of N/V

Dehydration
Electrolyte disturbances
Malnutrition
Aspiration Pneumonia
Esophageal Tears

2

Causes of N/V

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)

3

Receptors that promote N/V

5-HT3
D2
Neurokinin (NK1)
M1
H1
Opioid

4

Receptors that inhibit NV

Cannabinoid (CB1)
Glucocorticoid receptor (GR)

5

5-HT3 Antag

Ondansetron

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

6

5-HT3 Antag Indications

Acute CINV
RINV
PONV
Acute gastroenteritis

7

5-HT3 Antag AE

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

8

D2 Antag examples

Prochlorperazine

Metoclopramide

9

Prochelorperazine MOA & Indic

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

General purpose

10

Prochlorperazine AE

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

11

Metoclopramide MOA & Indic

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

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

12

Metoclopramide AE

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

13

M antag

Scopolamine

Blocks M receptors

Motion sickness, vertigo

14

M antag AE

antimuscarinic
sedation

15

H1 antag

Meclizine, Dimenhydrinate

Block H1 & M receptors

Motion sickness, vertigo

16

H1 antag AE

antimuscarinic
sedation

17

NK1 antag

Aprepitant

Blocks NK1 receptors

18

NK1 antag Indic

CINV (in combo w setron & corticosteroids)
PONV

19

NK1 antag AE

elevated LFTs
HA
dizziness
fatigue
hiccups
constip

20

Corticosteroid

Dexamethasone

Stimulates GRs

21

Corticosteroid Indic

CINV (in combo w/ setron and NK1 antag)
PONV

22

Corticosteroid AE

Insomnia
Inc plasma glucose

Other corticosteroid AE not normally seen bc usually acute admin

23

Cannabinoids

Dronabinol

Stim CB1 receptors

CINV (refractory to other tx)

24

Cannabinoids AE

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