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Flashcards in Tx of N/V Deck (37)
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1

N/V receptors include

serotonin 5-HT (setron)
Neurokinin (pitant)
Histamine H1
Dopamine D2
Muscarinic M1 (scopalamine)
cannabinoid receptors (dronabinol nabilone)

2

in addition to antagonists/agonists to a bunch of receptors, what agents are used in the tx of N/V

glucocorticoids such as dexamethasone
benzodiazepines such a alprazolam/lorazepam

3

serotonin receptor antagonsists

setron
dolasetron
granisetron
ondansetron
palonosetron

4

IV only 5-ht antagonist

palonosetron (all others have PO/IV)

5

unique 5-ht antagonist in its indicaiton

alosetron is only indicated for IBS-D

6

5-ht receptor antagonists are indicated for

CINV
RINV
PONV
NVP
STRONG antiemetic agents
block 5-HT receptors at CTZ from intestinal enterochromaffin cells

7

AE of 5-ht antagonists

CNS -HA
GI - constipation/diarrhea (Serotonin syndrome)
WORST POSSIBLE AE
Dose-dependent QT prolongation and Torsade's
use extreme caution when using with other QT prolonging agents

8

longest lasting 5-HT antagonists

palonosetron and sutstained SQ granisetron
effective for delayed CINV as a single dose

9

drug interactinos for 5-HT receptor antagonsits

QT prolonging agents
Antiarrhythmics

10

NK1 receptor antagonists include

aprepitant (and fosaprepitant)
netupitant (and fosnetupitant)
rolapitant

11

MoA of NK 1 receptor antagonists

block substance p (neurokinin 1) receptors in CTZ/VC
peripheral blockade of NK1 receptors located on vagal terminals in gut maybe too
moderate antiemetic agents

12

unique indication of aprepitant

PONV
given up the 3 hours prior to anesthesia

13

-pitants are most effective when given with

a glucocorticosteroid and 5-ht3 antagonist

14

AE of NK1 antagonsits

gi - dyspepsia/constipation/diarrhea
cns - dizziness/fatigue/somnolence

15

H1 receptor antagonists

diphenhydramine
dimenhydrinate
hydroxyzine
promethazine
meclizine
cyclizine

16

unique indication for doxylamine (h1 receptor antagonist)

prepared with b6 (pyridoxine)
INITIAL THERAPY FOR NVP

17

PO only h1 receptor antagonists

meclizine
cyclizine
dramamine (dimenhydrinate, generic is IV/IM as well)

18

indications for H1 receptor antagonists as it relates to N/V

PONV
block histamine type 1 receptors in VC and vestibular system

19

huge consideration for h1 blockers

exhibit anticholinergic effects
drowsiness
dry mouth
constipation
urinary retention
blurred vision
decreased BP

20

therapeutic uses of h1 receptor antagonsits

idiopathic/mild n/v
PONV
NVP
motion sickness/vertigo (meclizine and cyclizine)
CINV/RINV add on therapy

21

unique indication for meclizine and cyclizine

motion sickness/vertigo

22

D2 receptor antagonists

phenothiazines (chlorpromazine, perphenazine, prochlorperazine)
other (metoclopramide, haloperidol, olanzapine, trimethobenzamide)

23

D2 receptor antagonist MoA

weak-moderate antiemtic agents
block dopamine 2 recpetors in CTZ

24

unique MoA of metoclopramide

stimulates Ach actions in GI, enhancing GI motility and increasing LES tone
no impact on GI secretion

25

gastroparesis/dysmotility indicates

metoclopramide

26

AE of d2 receptor antagonists

anticholinergic effects
drowsiness
dry mouth
constipation
urinary retention
blurred vision
hypotension

27

m3 receptor antagonist name and use

scopalamine
used for motion sickness
SIGNIFICANT ANTICHOLINERGIC PROPERTIES AVOID USE WITH OTHER ANTICHOLINERGICS

28

cannabinoid receptor AGONISTS

dronabinol
nabilone

29

indicatinos for cannabinoids

TREATMENT RESISTANT CINV
reserved for the big bad cases d/t scheduling

30

MoA of cannibinoid agoinsts

sitmulate CB1 and CB2 receptors in VC/CTZ
results in decreased excitability of neurons and reducing serotonin release from vagal afferents