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74 Cards in this Set
- Front
- Back
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What is nausea?
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the inclination to vomit or a feelin in the throat of epigastric region alerting an individual that vomiting is imminent
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What is vomiting?
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the ejection or expulsion of gastric contents through the mouth (often forceful, using accessory muscles/diaphragm)
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What is DINV?
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drug-induced nausea/vomiting
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What is CINV?
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chemotherapy induced n/v
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What are possible etiologies of N/V?
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gastrointestinal, cardiovascula, neurologic, metabolic, operative procedures, infectious, psych, drug-induce, drug with drawl, pregnancy
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What are the phases of N/V?
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nausea (imminent need to vomit), retching (labored movement of abdominal and thoracic muscles before vomiting), vomiting (forceful expulsion of gastric contents caused by GI retroperistalsis
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What body parts provide a coordinated work to achieve vomiting?
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pylorus, salivation center, respiratory center, and the pharyngeal, GI, and abdominal muscles
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What is regurgitation?
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The elevation of gastric contents to the pharynx due to pressure difference in the system, possibly loss of lower esophageal sphincter (LES) pressure
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What in the body triggers vomiting?
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afferent impulses to the vomiting center in the medulla
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Where are impulses for vomiting received from?
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Chemoreceptor trigger zone (CTZ), cerebral cortex, visceral senesors in the pharynx and GI tract
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Where is the CTZ?
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located in the area postrema of the fourth ventricle of the brain
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What is a benefit of the location of the CTZ?
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gives this area easy access to the blood-brain barrier (defense against potential toxins to the brain)
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What receptors are located in the CTZ?
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cholinergic, histaminic, dopaminergic, opiate, serotonergic, neurokinin, benzodiazepine
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What neuroreceptors are thought to be principal factors in the development of N/V (especially CINV)?
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5-HT3 and dopamine receptors
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What are the goals of treatment of N/V?
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Prevent or eliminate N/V, prevent and/or treat with the most appropriate agent while minimizing adverse effects, treat the complications associated with n/v, provide the most effective agent with regard to cost
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What are the three categories of non-pharmacological tx for NV?
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dietary, physical, and psychological
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What are the dietary tx for NV?
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clear liquid diet, low fat/fiber diet, small meals
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What are the physical tx for NV?
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assume a stable position (for motion-related sickness or vertigo)
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What are the psychological tx for NV?
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relaxation, self hypnosis, cognitive distraction, guided imagery, systemic desensitization
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What is the basis for tx and antiemetic selection?
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suspect etiology; freq, duration, and severity of symptoms; ability to toleratate oral, rectal, injectable and/or transdermal dosage forms, success of previous antiemetic therapy
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What are the possible pharmacologic tx options for NV?
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antacids, H2 receptor antagonists, PPIs, antihistamine/anticholinergic agents, phenothiazines, butyrophenones, corticosteroids, substituted benzamides, cannabinoids, neurokinin (NK) receptor anatagonists, serotonin (5-HT3) receptor antagonist, benzodiazepines (BZDs)
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What is the generic for tums?
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calcium carbonate
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What is the purpose of antacids in NV?
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acts as a buffer to neutralize gastric acid to treat simple NV
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What is the moa of PPIs?
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Bind to the H-K-ATPase in gastric parietal cells, blocking the final step in the secretion of HCL
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What is the role of H2 receptor antagonists or PPIs in NV?
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treat simple NV
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What is the generic for antivert?
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meclizine
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What is the generic for transderm-scop?
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scopolamine
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What is the moa of antihistamine-anticholinergic drugs in the prevention of NV?
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interrupt visceral afferent pathways and vestibular stimulation; only used to treat simple NV or NV assoc with motion sickness; usual anticholinergic side effects
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What is the generic and type of drug for Thorazine?
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chlorpromazine, phenothiazines
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What is the generic and type of drug for Compazine?
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Prochlorperazine, phenothiazines
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What is the generic and type of drug for Phenergan?
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Promethazine, phenothiazines
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What is the moa of phenothiazines?
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antagonize dopamine (D2) receptors
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What are the side effects of phenothiazines?
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sedation, hypotension, akathesia (Restless leg syndrome is a disorder in which there is an urge or need to move the legs to stop unpleasant sensations), dystonia (movement disorder which causes involuntary contractions of your muscles)`
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What are the NV indications for phenothiazines?
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widely accepted agents for a variety of NV
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What is the generic and drug type for Haldol?
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haloperidol/butyrophenones
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What is the generic and drug type for Inapsine?
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droperidol/butyrophenones
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What is the NV indications for butyrophenones?
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not first line; alternative therapy to phenothiazines when a D2 antagonist is indicated
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What are the side effects of butyrophenones?
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sedation, anticholinergic effects, hypotension, akathesia, dystonia, QTc prolongation/Torsades de Pointes
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What is the generic and drug type for Decadron?
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dexamethasone/corticosteroid
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What is the moa of corticosteroids in NV?
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unknown
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What indications are corticosteroids used for in NV?
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most commonly CINV and PONV(post operative nausea and vomiting) (not indicated for simple NV)
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What are the side effects of corticosteroids?
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euphoria, anxiety, insomnia, increased appetite, hyperglycemia, mild fluid retention
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What is the generic and drug type for Reglan?
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metoclopramide/substituted benzamide
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What is the MOA of substituted benzamides?
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block D2 receptors
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What are the side effects of substituted benzamides?
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sedation, diarrhea, edema, hypertension (due to NA retention) reversible impotence, akathesia, dystonia
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What is the generic and drug type of Marinol?
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dronabinol/cannainoids
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What is the generic name and drug type of Cesamet?
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nabilone/cannabinoids
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What is the indication for cannabinoids in NV?
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CINV pts who have failed to respond adequately to conventional antiemetic therapy
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What is the moa of cannabinoids in NV?
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uknown; thought to be due to the interaction with the cannabinoid receptor (CB1) in the central and peripheral nervous system
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What are the side effects of cannabinoids?
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drowsiness, dizziness, euphoria, dysphoria, mood changes, orthostatic hypotension, ataxia, hallucinations, time disorientation, increased appetite
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What is the drug type and generic name for Emend?
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neurokinin receptor antagonist / aprepitant
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What are the indications in NV for neurokinin receptor antagonists?
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approved for use in combination with other antiemetics to prevent CINV
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What is the moa of aprepitant?
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blocks the action of substance P at the NK1 receptor
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What are the side effects of aprepitant?
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fatigue, dizziness, hiccups, gastritis, diarrhea, LFT elevations
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What drugs are usually used in combination with aprepitant?
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corticosteroid and 5-HT3 antagonist
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What is the generic name and drug type of Zofran?
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ondansetron/5ht3 receptor antagonist
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What is the generic name and drug type of Anzemet?
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dolasetron/5ht3 receptor antagonist
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What is the generic name and drug type of Kytril?
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granisetron/5ht3 receptor antagonist
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What is the generic name and drug type of Aloxi?
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palonosetron/5ht3 receptor antagonist
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What is the indication in NV for 5ht3 receptor antagonists?
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for a wide variety of NV, first used in CINV
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What is the MOA of 5HT3 receptor antagonists?
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blocks the effects of serotonin at the 5HT3 receptor
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What are the side effects of 5ht3 receptor antagonists?
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HA, ECG interval abnormalities, somnolence, constipation, diarrhea, elevated LFT, dizziness, and transient blurred vision
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Which 5ht3 is available for IM injection?
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zofran
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What is the generic name and drug type for Xanax?
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alprazolam/benzodiazepines
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What is the generic name and drug type for Ativan?
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lorazepam/benzodiazepines
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What is the MOA of benzodiazepines in NV?
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no antiemetic MOA; primarily used to prevent anticipatory CINV (produces antegrade amnesia and sedation)
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What are the side effects of benzodiazepines?
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sedation, hypotension, hallucinations, urinary incontinence, disinhibition, motor incoordiation
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Where are the guidelines for CINV?
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National Comprehensive Cancer Network
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What are the 5 categories of NV in CINV?
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Acute-onset, delayed-onset, anticipatory, breakthrough, refractory
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In NV in CINV, describe acute onset NV
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Occurs within a few min to h after administration and usually resolves within 24h
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In NV in CINV, describe delayed onset NV
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develops more than 24h after chemo
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In NV in CINV, describe anticipatory NV
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conditioned response that develops before the pt receive their next chemo (nausea>vomiting)
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In NV in CINV, describe breakthough NV
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occurs despite prophylatic treatment
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In NV in CINV, describe refractory NV
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recurring emesis during subsequent tx cycles when prophylaxis and rescue tx have failed
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