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23 Cards in this Set
- Front
- Back
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What are the mechanisms of nausea?
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1. Stimulation of stretch R or chemosensitive afferent vagal (stomach/upperGI) in hypomotility synd.
2. Direct stimul. of area postrema (chemotrigger zone): rich in Musc, Nico, Opiate and Dopamingergic R-->nucleus of solitary tract 3. Stim. vestibular afferents 4. higher cortical centers (conditioned responses) |
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What are the general rules of anti-emetics?
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1. Drugs for motion sickness not work for drug-induced nausea x promethazine (phenergan)
2. Agent good at motion sickness (anticholinergics) also work for vertigo. |
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What are the agents for motion sickeness?
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1. Pure Muscarinic Antag= Scopolamine
2. Mix H1/muscarinic Antag= dimenhydrinate (dramamine); hydroxyzine; promethazine; meclizine; diphenhydramine |
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What are the SE of motion sicknes drugs?
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sedation and some anticholinergic i.e. dry mouth
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What is the selective 5-HT3 antag drug?
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Ondansetron
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What is Ondansetron used for?
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1st line tx of post-op nausea induced by opiates and cancerchemotherapeutic agents.
***Not work for motion or GI stasis |
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How is Ondansetron used?
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1. Alone
2. Combo: dexamethasone, lorazepam |
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What is metoclopramide?
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(reglan) pro-kinetic
**Site of action: area postrema and NTS +vagal afferents |
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What are the extrapyramidal symptoms of Metoclopramide?
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High doses: akathisia and dystonic reactions
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What is metoclopramide used for?
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1. Gastric stasis disorders
2. antiemetic to tx nausea from mildly emetic drugs |
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What is Chlorpromazine and prochlorperazine?
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Neuroleptic phenothizine=
DA receptor antagonist act at Area Postrema |
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What are Chlorpromazine and prochlorperazine used for?
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1.relief of post-op nausea,
2. vomiting from radiation, drugs with low emetogenic activity (opiates/cytotoxic agents) 3. 3rd line agent from cancer tx--"rescue therapy" ***low dose compared to tx of psychosis |
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What is dexamethasone and what is it used for?
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Glucocorticoid--many uses; but enhances effectiveness of other antiemetics in CA pts.
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What is lorazepam used for with anti-emetics?
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Adjunct for cancer chemotherapy. Pretx with BDZ reduces stress and anticipatory emesis
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What drugs would you use for GI irritation?
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Promethazine
Ondansetron Metoclopramide Phenothizine |
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What drugs do you use for Motion Sickness?
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Scopolamine (pure anti-musc)
or anti h1/anti musc (multi) |
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What do you use for severe pain induced nausea?
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opiates--careful can cause nausea
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What do you use for nausea caused by cardiac glycoside?
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reduce dose of med
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What do you use for nausea caused by SSRIs?
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adjust does, give ondasetron
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What for CA chemo nausea?
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Ondansetron + dexamethasone
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What give for post-op nausea?
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Ondansetron
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What do you give for nausea caused by migraine?
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metoclopromide
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What do you give for nausea in pregnancy?
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avoid drugs b/c of teratogenic effect
*think may give phenergan? |
