Gi Agents- N/v

Front 1

Drugs to treat and prevent N/V

Back 1

1. Histamine antagonists
2. Phenothiazines and butyrophenones
3. Metoclopramide- post-op and chemo N/V
4. Corticosteroids
5. Selective serotonin antagonists

Front 2

Antihistamine and anticholinergic agents

Back 2

-MOA: interrupt afferent pathways that trigger vomiting
-used for simple N/V, motion sickness, vertigo
1. promethazine (phenergan)- IM, supp, po
2. Timethobenzamide
3. Meclizine (antivert)
4. Dimenhydrinate (dramamine)
5. Scopolamine (transderm scop)-patch best for prevention of motion sickness

Front 3

Antihistamine and anticholinergic agents cont

Back 3

-take prior to motion to prevent motion sickness
-may be used in combo with other agents
-AE:

Front 4

Phenothiazines

Back 4

-most widely used antiemetics
-MOA: dopamine receptor blocker
-commonly used: Prochlorperazine (compazine), Chlorpromazine (thorazine)
-AE: extrapyramidal effects (stiffness, rigidity, restlessness, dystonic rxns), hypersensitivity,excessive sedation, anticholinergic effects, bone marrow suppression,skin rxns

Front 5

Metoclopramide (Reglan)

Back 5

MOA: dopamine receptor blocker
-po, IV
-peripheral effects on lower esophageal sphincter, gastric emptying and intestine transit time
-used in combo for complex N/V and for gastroparesis assoc with diabetec autonomic neuropahty
-AE: extrapyramidal effects, drowsiness, diarrhea

Front 6

Corticosteroids

Back 6

-used for complex causes of N/V (chemo, post-op)
-increases appetite and feeling of well-being
-Dexamethasone (IV)
-Methylprednisolone (IV)
-used for a few days
-AE: mood changes, HA, metallic taste, hyperglycemia and itchy throat

Front 7

Selective serotonin antagonists

Back 7

-useful for CINV (chemo indiced N/V) and POIV (post op)
-Ondasetron-shortest acting
-Granisetron
-Dolasetron
-Palonsetron- longest acting
-MOA: block 5HT receptor
-adults and kids; admin before and after chemo
-AE: HA, diarrhea, dizziness, constipation

Front 8

Emend (aprepitant)

Back 8

-po/IV
-a substance P/neurokinin 1 receptor antagonists prevents sub P from binding and causing its affect on the vomiting center
-indicated for prevention of acute and delayed N/V assoc with initial and repeat courses of highly emetogenic chemo
-CYP450 inhibitor --> DI

Front 9

Cannabionoids

Back 9

-ONLY FOR CINV
-MOA: not well known
-AE: anxiety, time distortion, hallucinations, hunger, dry mouth, sedation, paranois
-Dronabinol (Marinol)- schedule III
-Nabilone (Cesamet)-sch II -->less euphoria

Front 10

CI-NV

Back 10

-combo of 2 or more agents
-combine Metoclopramide, diphenhydamine and dexamethasone
-use a selective serotonin antagonist with dexamethasone for delayed effects
-Benzodiazepines such as lorazepam are useful for anticipatory N/V

Front 11

PONV

Back 11

-common esp with women, inc age and obesity
-selective serotonin antagonists
-Dexamethasone
-antihistmines

Front 12

Pregnancy related N/V

Back 12

-antihistamines such as dimenhydrinate, meclizine and promethazine* are effective and safe
-Vit B 6, Ginger, small freq high CHO meals, Bendectin