Flashcards in Vertigo Tx Deck (18):
1
Irreversibly vestibulotoxic drugs are?
- Aminoglycosides
- Cisplatin
- Ototoxicity caused by loop diuretcs may be reversible
2
Amonoglycosides enter into outer hair cells and result in cell death via ......
Caspase dependent or Caspase independent mechanisms
3
The steps involved in aminoglycoside ototoxicity
- AG enters via mechanoelectrical transducer channels
- Formation of an AG- iron complex
- AG- Iron interacts with electrical donors to form ROS.
- ROS then activate JNK which can translocate to the nucleus and activate teh cell death pathway
- genes from cell death pathway go to mitochondria which causes the release of cyt c. which can trigger apoptosis via caspases
4
Cisplatin results in what type of cell deathw
caspase dependent
Steps basically the same except that once CP enters through the mechano-transducer channels and it can form a monohydrate complex
5
Short term tx of vertigo is accomplished by drugs which act primarily where?
H1 and M1 (Histamine and Muscarinic) receptors on the cerebellum
6
WHich vertigo drugs act via H1 and M1 blockade
- Diphenhydramine
- Meclizine
- Promethazine
7
OF the three H1 and M1 blcokers, which are CYP2D6 inhibitors
Diphenhydramine and Promethazine
Di and Pro
8
All H1 and M1 blockers undergo what type of metabolism
hepatic
9
H1 and M1 blockers cause side-effects that are serious enough to prevent use in
old ppl
10
What are the serotonin antagonists used for?
Anti-emesis. They block serotonin in the stomach and small intestine.
- Called "setrons"
11
Where do the serotonin antagonists work?
In the CTZ (chemotherapeutic Trigger zone- monitors blood and CSF for toxic substances) and the STN (solitary tract nucleus).
12
AE of setrons
Hepatic metabolism (Ondansetron needs a dose adjustment)
All have ppotential for CV issues by action on cardiac cycle
13
What are the two anti-dopaminergics that we need to know?
Chlorpromazine
Prochlorperazine
- These also have a problem with the cardiac cycles
- Risk of QT prolongation and torsades de pointes
14
Aprepitant/ fosaprepitant
Substance P and NK1 antagonists. Used for adjunct chemo, crosses BBB so it acts centrally
- CYP3A4
15
KNOW that corticosteroids like dexamethasone and methyl prednisilone can increase the anti-emetic effect of other drugs and lower the adverse effects. May also have their own anti-emetic effect by lowering prostaglandins
ok
16
Benzodiazepines (Diazepem) and vomitting?
They are used in anticipatory vomitting (prior to chemo) because tehy cause somnolence and amnesia lasting for hours.
17
Dronabino
stimulates cannabinoid receptors. Used in chemo pts when all other possibilities fail
18