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95 Cards in this Set
- Front
- Back
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Emetic response direct acting stimuli
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anticipation or fear, upsetting sights, noxious odors or pain or signals from vestibular appartus from inner ear
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Emetic response in-direct acting stimuli
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activate the chemoreceptor trigger zone (CZT) - signals stomach or by direct action of compounds - drugs
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How does vomiting center work?
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signals the stomach diaphragm and abdominal musicles which expell gastric contents
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What receptors are involved in the emetic response?
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serotonin, glucocorticoids, substance P, neurokinin1, dopamine, acetylcholine, and histamine - antiemetics block one of these receptors
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Name Serotonin receptor antagonists
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Zofran (Ondansetron), Granisol (Granisetron), Anzemet (Dolasetron), Aloxi (Palonsetron)
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What are the best antiemetics for supressing n/V for cancer drugs?
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serotonin receptor antagonists
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Ondansetron (Zofran) increases effectiveness when administered with this other drug
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dexamethasone
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Route of Zofran
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oral or parenteral
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Which serotonin receptor antagonist has a great half-life and is effecitive against delayed emesis
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Palonsosetron (Aloxil)
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Which serotonin receptor antagonist can be given transdermal?
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Granisetron (GRanison, Kytril or Sancuso)
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Name the glucocorticoid antiemetic drugs
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methylprednisolone (Solu-Medrol) & dexamethosone (Decadron)
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How do glucocorticoid drugs work to supress nausea & are they approved for this?
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They suppress teh CINV and are not approved - mechanism unknown
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Name Substance P & Neurokinin1 antagonists
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Aprepitant (Emend) & Fosaprepitant
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What are serotonin antagonist used for?
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chemotherapy, radiation, post-op
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What are glucocorticoids used for?
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Chemotherapy
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What are substance P/neurokinin1 used for?
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chemotherapy
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What are dopamine antagonists used for?
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Chemotherapy, post-op , general
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What are cannabinoids used for?
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chemotherapy
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What are anticholinergics used for?
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motion sickness
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What are antihistamines used for?
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motion sickness
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Substance P/Neurokinin1 are prodrugs that undergo conversion in the body Tor R
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True - used for chermotherapy
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Name benzodiazepine
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Lorazepam (Ativan)
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What is action of Ativan?
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used in combination with other drugs to suppress the chemotherapy-induced nausea and vomiting (CINV) - sedates, suppresses anticipatory emesis, and production of amnesia
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Name the dompamine antatgonists?
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Phenothiazines (Thorazine, Trilafon, Compazine, Phenergan), Butyrophenones (Haldol, Inapsine) Others (Reglan, Motilium)
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How do phenothiazines surpress vomiting?
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block dopamine 2 receptors and suppress emesis -
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Side effects with phenothiazines?
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extra-pyamidal reactions, anticholinergic effects, hypotension, and sedation
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What is a dangerous side effect of inapsine and haldol (butyrophenones)?
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prolonged QT interval and fatal dysrhythmisa
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How to treat chemotherapy induced vomiting
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Give antiemetic prior to therapy - ususally need at least 2 from different classes and sometimes 3- they work better to prevent nausea than treat it
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Name motion sickness drugs
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scopolamine & antihistamines (Dramamine, Meclizine (antiver), cyclizine (marezine)
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How does scopalamine work?
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suppresses nerve traffic in the nerve pathway that connects the vestibular apparatus to inner ear
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Side effects of scopalamine
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dry mouth, blurred vision, drowsiness
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Routes of scopalamine
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oral subq, and transdermal
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How does antihistamine work?
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suppress H1 and muscarinic cholinergic receptors that connect inner ear to vomiting center
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What is best motion sickness drug?
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scopalamine
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What are side effects of antihistamine motion sickness drugs
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sedation mostly then dry mouht, blurred vision, urinary retention and constipation
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What are 2 types of anti-diarrheal drugs?
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nonspecific - provided symptomatic releif, but do not treat underlying cause & specific: treat underlying cases
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Nonspecifc antidiarrheal drugs?
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Opiods - decrease intestinal motility (lomotil and imodium most prescribed)
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Diphenoxylate (Lomotil) actions
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is not dissolved in water and has no CNS effects at regular dosage Schedule V drug
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Loperamide (Imodium)
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analog of merperidine - supresses fluid secretion in to the intestinal lumen.
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Management of infectious diahrrhea
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Do not use antibiotics unless clearly indicated except for salmonella, shigella, campylocacter, clostridium
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How to treat travelers diarhea?
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usually self limiting caused by E-coli and will resolve self - if severe given cipro
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Who gets irritable bowel syndrome?
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more women than men - 3 times higher in women, - leadign cause of missing work besides common cold
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What is IBS?
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cramping abdominal pain can ahve both diarrhea and constipation
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Define IBS by what symptoms
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presence of s/s for 12 wks w/ at least 2 of these symptoms: Pain relieved by defecation, Pain starts with constipation or diarrhea, pain starts wtih change in stool consistency
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What can trigger IBS?
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stress, depression, diet
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What 2 drugs are used for IBS?
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Nonspecific (antispasmodics, bulk-foming agents, antidiarrheals & tricyclic antidepressnts) and IBS specific (Alosetron, Lubiprostone & tegaserod)
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What studies have shown to be the best non-specific drug for IBS?
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Tricyclic antidepressants - not related to treating depression - maybe antibiotics or acid suppression
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Alosetron (Lotronex) IBS-D
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only used in women - only used in severe disease lasting over 6 months not responding to other therapy- less 5% qualify for this drug - refer out
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Lubiprostone (Amitiza) IBS-C
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Approved for women 18 yo and older - benifits are modest
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How is Inflammatory Bowel disease (IBD) caused?
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exaggearted immune response directed against normal bowel flora in genetically predisposed people
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Name 2 types of IBD
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Chron's disease & ulcerative colitis
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Name 5 types of drug therapy for IBD
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5-aminosalicylates(sulfasalazine), hydorcortisone, azathioprine, infliximab and antibtiotics
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When are 5-aminosalicylates prescribed for IBD?
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mild or moderated and to maintain remission after symptoms subsided
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How does sulfazalazine (5-aminosalicylates) work?
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same family as sulfa antibiotics - metabolized by intestinal bacteria and broken down to decrease inflammation
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Side effects with sulfazalzine?
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nausea, fever, rash adn arthralgia - hematologist disorders may also occur
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When are immunosuppresants used for IBD?
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long-term therapy for patients not responding to traditional therapy - can take 6 months to work
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Name an Immunomodulators
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Infliximab (Remicade),
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How does Remicade work?
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moderate or severe IBD - inactivated tumor necrosis factor to decreaes inflammatory response - must be taken IV
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What do prokinetic agents do?
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increase tone and motilityu of GI tract - treat GERD, and CINV and diabetic gastroparesis
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Name prokinetic agents.
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metoclopramide (reglan), cisapride (propulsid)
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How does reglan work?
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suppresses emesis and increases uper GI motility - not for long term use d/t irreversible tardive dyskinesia
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Waht is Palifermin (Kepivance) used for?
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decreasing oral mucositis - a side effect of chemo for patients with hematologic malignancies
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When are pancreative enzyme replacement indicated?
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without enzymes digestions can be compromised - in pacreatectomy, cystic fibrosis, pancreatitis and obstruction of pancreatice duct - help to digest fats, carbs and protiens
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Medication to dissolve gallstones
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surgery better - Chenodial - bile acid that reduces hepatic production of cholesterol - not used much - only in women taks up to 2 years.
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What do anorectoal prepartions do?
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decrease pain and swelling and lubricate
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8 questions to ask for GI drugs
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1) what pathology trying to alter 2) related drug classes and how categories different 3) Mechanism of action 4) distinguishing feacture sof drugs 5) How drug absorbed 6) How distributed 7) how get out of body 8) Safety
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Gastric acidity may lead to
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Gastritis 2) GERD 3) PUD
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What does H.pylori cause?
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duodenal ulcer & gastric ulcer
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Decreased spincter tone leads to
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GERD & worsened by nicotine and alcohol
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Aluminum salts as an antacid can cause constiptation - T or F
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True
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Calcium carbonate antacids (tums & rolaids) can cause diarrhea or constitapation T or F
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Trued
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What is side effect of magnesium salts antacid?
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diarrhea
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Watch for drug -drug interactions wtih Tagamet T or F
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true
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H2 antagonist end in
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-dine
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PPI (proton pump inhibitors) end in
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-prazole
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What drug should not be used when prescribing carafate?
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fluoroquinolones
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What is most common cause of diarrhea
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viral
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Underlying path of gastric motility - diarrhea
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virus, bacterial - salmonella, shigella, E.coli, Protozoal--giardia, chronic inflammation of IBS, UC and Crohns
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Underly path of gastric motility - constipation or obstruction
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related to other meds 2) lack of fiber of luids 3) structural abnormality
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Varying gastric motility - vasilating between diarrhea and constipation
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IBS
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Drugs to use wih diarrhea & IBS - stool thickeners
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Kaopectate & immodium AD
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Drugs to use wih diarrhea & IBS - Motility Agents
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Lomotil, Propulsid,
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Drugs to use wih diarrhea & IBS - Antisposmodics
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Zelnorm - 5HT receptor agonist
2) anticholinergices: Levsin/levbid (hyoscyamine) Bentyle, donnatol |
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What teaching shoudl be done with prescribign metamucil or psylium?
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take with full glass of water or juice to decrease chance of obstruction
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What is pharmokinetics of acid reducers?
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H2 antagonist - oral - work in 2 hours, metabolized in liver & excreted in kidneys. PPI - oral, liver through the P450 pathway, urine & feces. Antacids: oral urine excretion
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Pharmocokinetics of cytotec
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extensive first pass effect
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Pharmocokinetics of carafate
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minimal absorption, unchanged in feces
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Pharmocokinetics of reglan
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oral - metabolized in live, exrection in urine
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Safety of H2 Antogonist in elderly?
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watch these
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Side effect of cimetadien
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gynecomastia
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Reglan side effects
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extrapyramidal effects
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Should anti-emetics be used in children
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not routine use d/t sedation
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What is primary concern in GI system
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acidity and motitlity
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Watch for drug/drug interaciton dealing with what in teh stomach
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pH
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When is gastric motility alteration used with caution?
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infectioius disease
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