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32 Cards in this Set

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Name 5 neurotransmitters involved with nausea & vomiting
- M1 - D2 - H1 - 5HT-3 - NK1
What are physiologic causes of nausea & vomiting?
- constipation - gastric stasis/outlet obstruction - brain metasteses - increased intercranial pressure - bowel/intestinal obstruction - hepatomegaly - oral thrush - cough
What are some metabolic causes of nausea & vomiting?
- uremia - endocrine imbalance - electrolyte imbalance (hypercalcemia, hyponatremia)
What are some treatment-related causes of nausea & vomiting?
- chemotherapy - radiation therapy - opioid therapy (narcotics) - antibiotics (tetrocyclines, quinolones) - aspirin/NSAIDS - Carbamazepine - Steroids
Where is the Chemotrigger Zone?
underneath the 4th ventricle; in front of the cerebellum
What is the area postrema?
the area of the vomiting center where the majority of the neurotransmitters are located
Name different types of nausea & vomiting
- Post-op N/V - obstruction - chemotherapy - gastroenteritis/gastroperesis - pregnancy - vestibular neuritis (labyrinthitis) - unidentified origin
Name a muscarinic (M1) receptor antagonist used to treat nausea & vomiting
Scopolamine (aka transdermscop)
Name 4 antihistamines used to treat nausea & vomiting
- Diphenhydramine (Benadryl) - Dimenhydrate (Dramamine) - Meclizine (Antivert) - Promethazine (Phenergan)
Meclizine (Antivert) blocks which receptor?
Histamine 1 (H1)
Promethazine (Phenergan) blocks which receptors?
5HCT, muscarinic, and histamine receptors
What is a common side effect of anticholinergic agents?
sedation
Name the 3 classes of Dopamine receptor antagonists
1. Phenothiazines 2. Butyrophenone 3. Benzamides
What is the mechanism of action for Phenothiazines?
- antagonize D2 receptors in the postrema - also have M1 and H1 blocking effects
Give 2 examples of phenothiazines
1. Prochlorperazine (Compazine) 2. Chlorpromazine (Thorazine)
What are the different formulations of Compazine and Thorazine?
IV, IM, supp, PO
Which drug is used to treat hiccups?
thorazine
When is compazine given orally?
to treat anticipitory nausea & vomiting
What are some side effects of phenothiazines?
- dytonias (involuntary rigid muscle movements) - tardive dyskinesia (repetitive movements)
What is used to treat acute dystonias?
anticholinergic drugs (benadryl)
When are butyrophenones used?
- for nausea & vomiting of preanesthetic or post-op patients
Name 2 types of Butyophenones
- Droperidol (Inapsine) - Haloperidol (Haldol)
What is the half-life of Haloperidol (Haldol)?
18 hrs
Give an example of a Benzamide
Metoclopramide (Reglan)
What are some effects of Metoclopramine (Reglan)?
- at low doses, it is a central and peripheral D2 antagonist - at high doses, it is a 5-HT3 blocker - stimulates cholinergic receptors on gastrin smooth muscle (slows down gastric motility)
Give 4 examples of Serotonin antagonist
- Ondasteron (Zofran) - Granisetron (Kytril) - Dolasetron (Anzemet) - Palonosetron (Aloxi)
Which serotonin antagonist is used for chemo-induced nausea & vomiting?
Palonosetron (Aloxi)
Which drug is indicated to treat N/V in pregnant women?
Ondasteron (Zofran)
What is Arprepitant (Emend)?
- a new class of antiemetics - used to treat chemo-induced nausea & vomiting
Name 2 corticosteroids used for N/V
Dexamethasone (Decadron) Methylprednisilone (Medrol)
Give an example of a cannabinoid used to treat N/V
Marinol
What are some side effects of Cannabinoids?
- Xerostomia (dry mouth) - vertigo - hypotension