Gi_Test 2: Maloney_Antiemetics And Ibs

Front 1

What type of drugs will be effective
in preventing motion sickness?

Back 1

Muscarinic Blockers

H1 Blockers

Front 2

What type of drugs will be effective
in preventing PONV?

Back 2

Muscarinic antagonists

H1 antagonists


D2 antagonists

5-HT3 antagonists

NK1 antagonists

Front 3

Drugs that block Vestibular Apparatus?

(Motion Sickness)

Back 3

M blockers

H1 Blockers

Front 4

Drugs That block CTZ, NTS and Gut caused nausea and vomiting?

Back 4

D1 antagonists

5-HT3 antagonists

NK1 antagonists

Front 5

What type of drugs will be effective in
preventing chemotherapy-induced
nausea and vomiting?

Back 5

D2 antagonists

5-HT3 antagonists

NK1 antagonists

Cannabinoids

Corticosteroids

Front 6

**Summary**

What receptors would you want to block for:

-Motion Sickness

-CINV

-PONV

Back 6

Front 7

Which muscarinic blocker is used for motion sickness?

Back 7

Scopalomine

Front 8

Name the Histamine H1 receptor blockers (2)

Back 8

Dimenhydrinate

Promethazine

Front 9

Are 2nd generation antihistamines antiemetic?

Back 9

Second generation antihistamines do not cross the BBB.

Therefore they are not sedating, and are not antiemetic.

Front 10

What drug could you use to block both H1 and M receptors when treating motion sickness or PONV?

Back 10

Dimenhydrinate

**Blocks H1 and M receptors**

(Note: Scopalomine only blocks M receptors)

Front 11

Prochlorperazine blocks what receptor?

Back 11

Dopamine (D2) receptor

Front 12

MOA:

- Block dopamine receptors (D2) in the CTZ and NTS to prevent nausea and vomiting

- Block D2 receptors in the GI tract to prevent the inhibition of intestinal motility associated with NV

Back 12

Prochlorperazine and Doperidol

(Antipsychotics)

Front 13

Emetogenic potential of antineoplastic agents:

Cisplatin

Back 13

High Emetogenic Potential

Front 14

Emetogenic potential of antineoplastic agents:

Methotrexate

Back 14

Low Emetogenic Potential

Front 15

Will prochlorperazine be useful in preventing motion sickness?

Back 15

No

Doesn't hit H1 and M receptors

Front 16

MOA:

- Blocks D2 receptors in the CTZ and NTS

- HIGH DOSES also block 5-HT3 receptors in the CTZ, NTS and the GI tract

- Enhances gastric emptying, which is believed to minimize stasis that precedes vomiting


****

Back 16

Metoclopramide

Front 17

Clinical Use:
- Chemotherapy-induced nausea and vomiting – High dose

- Radiation-induced nausea and vomiting –High dose

Post operative nausea and vomiting – Low dose-->Doesn’t work

Back 17

Metoclopramide

Front 18

Would metoclopramide be
useful for motion sickness?

Back 18

No

Doesn't effect M or H1 receptors

Front 19

Adverse Effects:

**CNS effects**

**Extrapyramidal reactions**
- Blocks D2 receptors in the CNS
- Especially with high doses
- TARDIVE DYSKINESIA


******

Back 19

Metoclopramide

Front 20

A patient on high dose Metoclopramide for N/V is complaining of clumsiness and tripping. What's going on?

***

Back 20

**Extrapyramidal reactions**
- Blocks D2 receptors in the CNS
- Especially with high doses
- TARDIVE DYSKINESIA

Front 21

"-setron"

Back 21

5-HT3 Blockers

**Block Serotonin Receptors**

Front 22

Class of Drugs?:

Ondansetron
Granisetron
Dolasetron
Palonosetron

Back 22

5-HT3 Blockers

(block serotonin receptors)

Front 23

Where are 5-HT3 receptors located?

Back 23

NTS, CTZ and Gut

Front 24

Clinical Use:

- Chemotherapy-induced nausea and vomiting

- Prevents acute NV (within 24 h)

- Little effect on delayed NV (1-5 days) when used as monotherapy

Back 24

5-HT3 Blockers

Front 25

Treats Acute NV associated with chemotherapy

Back 25

5-HT3 Blockers

Front 26

Treats delayed NV associated with chemotherapy

Back 26

Aprepitant

**Substance P**

Front 27

Adverse Effect:

- Prolongs QT Interval

Back 27

5-HT3 Blockers

Front 28

What is the advantage of using
ondansetron vs. metoclopramide in a patient with Chemotherapy NV?

Back 28

Unlike metoclopramide, ondansetron doesn't block D2 (dopamine) receptors.

LESS CNS SIDE EFFECTS!!

Front 29

Substance P/neurokinin 1(NK1)
receptor antagonists used for acute and delayed NV associated with Chemotherapy

Also used for PONV

Back 29

Aprepitant

Front 30

Corticosteroid to treat CINV and PONV

Back 30

Dexamethasone

Front 31

This drug:

- Combined with other agents (e.g. 5-HT3 antagonist or high dose metoclopramide) to improve efficacy in preventing chemotherapy-induced nausea and
vomiting

- Monotherapy or combination therapy for delayed chemotherapy-induced nausea and vomiting

- Post operative nausea and vomiting

Back 31

Dexamethasone

Front 32

What class of drug is Dronabinol?

Back 32

Cannabinoids

Front 33

Clinical Use:

- Chemotherapy-induced nausea and vomiting

**Not adequately controlled by other drugs**

Back 33

Dronabinol

(Cannabinoids)

Front 34

Adverse Effects:

Dysphoria
Hallucinations
Sedation
Vertigo
Dry mouth
Disorientation

Back 34

Dronabinol

(Cannabinoids)

Front 35

Another Summary!!

Yaaayy!

Back 35

Front 36

A 47-year-old male is being treated with methotrexate for cancer. What would be the best preventative therapy for his nausea and vomiting?

A. D2 antagonist (eg prochlorperazine)
B. 5HT3 antagonist (eg palonosetron)
C. M blocker (eg scopolamine)
D. NK1 antagonist (eg aprepitant)
E. Metoclopramide
F. Dexamethasone

Back 36

Front 37

A 47-year-old male is being treated with methotrexate for cancer. What would be the best preventative therapy for his nausea and vomiting?

Answer: Dexamethasone

What if this drug was contraindicated for some reason. What would you use?

A. D2 antagonist (eg prochlorperazine)
B. M blocker (eg scopolamine)
C. NK1 antagonist (eg aprepitant)
D. Metoclopramide
E. H1 blocker (eg dimenhydrinate)

Back 37

Front 38

A 47-year-old male is being treated with cyclophosphamide for cancer. What would be the best preventative combination therapy for his nausea and vomiting?
(select all that apply)

A. D2 antagonist (eg prochlorperazine)
B. Palonosetron (5HT3 antagonist)
C. M blocker (eg scopolamine)
D. NK1 antagonist (eg aprepitant)
E. Metoclopramide
F. Dexamethasone

Back 38

Front 39

A 47-year-old male is being treated with cisplatin for cancer. What would be the best preventative combination therapy for his nausea and vomiting?
(select all that apply)

A. D2 antagonist (prochlorperazine)
B. 5HT3 antagonist (ondansetron)
C. M blocker (eg scopolamine)
D. NK1 antagonist (eg aprepitant)
E. Metoclopramide
F. Dexamethasone

Back 39

B. 5HT3 antagonist (ondansetron)

D. NK1 antagonist (eg aprepitant)

F. Dexamethasone

(Remember, Cisplatin has a HIGH emetogenic potential)

Front 40

You are using the following drug combo to treat NV in a Chemo patient on cisplatin:

5HT3 antagonist, NK1 antagonist, Dexamethasone

The drug combo is not working well enough.
What can you do to help control his nausea and vomiting?
(select all that apply)

A. Add D2 antagonist (eg prochlorperazine)
B. Add M blocker (eg scopolamine)
C. Add H1 blocker (eg dimenhydrinate)
D. Add cannabinoid (eg dronabinol)
E. Switch from ondansetron to high
dose metoclopramide

Back 40

Add D2 antagonist

Add cannabinoid

Switch from ondansetron to high dose metoclopramide

Front 41

What is Gastroparesis?

Back 41

Gastric emptying is delayed in the
absence of mechanical obstruction

Front 42

What effect does serotonin have on gut motility? What about dopamine?

Back 42

Serotonin (binds 5-HT4) enhances the release of ACh by neurons which stimulates gut motility

Dopamine inhibits ACh release and thus decreases gut motility

Front 43

How will metoclopramide
affect gut motility?

Back 43

It blocks Dopamine receptors which keeps them from inhibiting gut motility

It also enhances activated 5-HT4 receptors which enhance gut motility by allowing more ACh release from neurons

(High Dose metoclopramide can INHIBIT 5-HT3 receptors!!)

Front 44

Gastroparesis is a complication of_____

Back 44

Diabetes