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65 Cards in this Set
- Front
- Back
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Mechanisms of Nausea and Vomiting
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- Vomiting center in the Medulla, gets into from stomach (stretch signal)
- CTZ located in the 4th ventricle, area postrema - Input from vestibular apparatus |
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Receptors between medulla and vestibular apparatus?
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M1 and H1
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Receptors in solitary tract?
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5HT, D2, M1 and H1
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Receptors in CTZ
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5HT, D2, M1
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Receptors in Stomach?
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5HT3
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Types of antiemetic drugs?
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- Anti-muscarinic
- Antihistamine - Anti-serotinergic - Anti-dopaminergic - Cannabinoids - Substance P antagonists |
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Antimuscarinic drugs? for? S/E?
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Scopolamine for motion sickness
S/E: dry mouth, blurred vision, urinary retention |
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Antihistamine drugs? S/E?
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Dimenhydrinate
Promethazine S/E: Sedation, antimuscarinic |
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Antiserotinergic drugs? MOA?
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Ondansetron
Dolasetron 5HT3 receptor antagonist in both CNS and periphery |
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Antiserotinergic effective in? S/E?
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Chemotherapy nausea
S/E: Headache, diarrhea, constipation |
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Antidopaminergic drugs? MOA?
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Prochlorperazine
Chlorpromazine Fluphenazine Haloperidol MOA: D2 receptor antagonists in CTZ |
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Antidopaminergic S/E?
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Dizziness
Fatigue Sedation Seizures |
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Antidopaminergic increases what? causiong?
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Increase in prolactin to cause neuroleptic malignant syndrome
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Antidopaminergic used in?
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Nausea in flu
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Cannabinoids drugs? MOA?
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Dronabinol
MOA: Delta9-THC, central action on comiting center (exact MOA unknown) |
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Cannabinoids used in?
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Chemo when other agents have failed
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Cannabinoids S/E?
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confusion
euphoria dizziness hallucinations mood change orthostatic hypotension increase in appetite |
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Substance P antagonists? MOA?
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Aprepitant
Antagonist at NK1 substance P receptor |
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Substance P antagonists useful in?
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Vomiting to cisplatin in the delayed phase
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Substance P interactions?
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CYP3A4 interactions
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Prokinetic drugs?
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Metoclopramide
Cisapride Erythromycin |
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Metoclopramide MOA?
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D2 antaonist, will increase ACh release
Prokinetic action on GI tract, increase gastric emptying, increase GI motility, increase esophageal sphincter tone |
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Metoclopramide does what to CTZ?
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decrease CTZ sensitivity
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Metoclopramide used for?
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Gastroparesis
GERD |
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Metoclopramide S/E?
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dizziness
fatigue seizures sedation increase in prolactin to cause neuroleptic malignant syndrome |
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Cisapride MOA?
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5HT4 AGONIST
5HT3 ANTAgonist |
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Cisapride used for?
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GERD
Gastroparesis not controlled by other tx |
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Cisaprise major S/E?
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cardiac arrhythmias, prolonged QT interval due to 3A4 interaction
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Erythromycin MOA?
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motilin type actions in upper GI tract and LES
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Erythromycin used in?
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Diabetic gastroparesis
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Erythromycin S/E?
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Cramps
impaired motility |
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Tegaserod MOA?
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5HT4 partial agonist
stimulates motility and accelerates transit |
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Tegaserod used in?
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Constipation predominant IBS
Gastroparesis |
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Tegaserod S/E
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Diarrhea
Headache |
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Tegaserod withdrawn for?
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CV side effects
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Lubiprostone MOA?
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PGE1 analog that activated Cl channels to increase fluid into GI
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Lubiprostone used for
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constipation IBS
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Alosetron MOA?
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5HT3 antagonist decreases gastric motility
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Alosetron used in?
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Diarrhea prominant IBS
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BBW on Alosetron?
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Acute ischemic colitis
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Laxatives MOA?
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Increase motility
Increase water content in stool Decrease colonic water and NaCl absorption |
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Laxatives used for?
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Prepare bowel for surgery
Hasten excretion of toxins Post-op stimuation Minimize straining in pts Relief of temporary constipation |
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Laxatives CI in?
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underlying bowel disease
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Laxatives S/E?
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Nausea
Cramps Diarrhea Cathartic colon syndrome |
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Cathartic colon syndrome
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Mucosal inflammation
atrophy of muscles damage to nerves malabsorption dehydration protein loss |
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Types of Laxatives
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Stimulants/Irritants
Bulk forming Stool softeners Osmotic agents |
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Stimulants/Irritants?
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Castor oil
Senna Bisacodyl Phenothalin |
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Stimulants S/E?
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cramps
diarrhea muscle weakness |
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Bulk forming laxatives
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Psyllium
Methycellulose |
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Bulk forming laxatives MOA?
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increased bulk and water content and increased volume
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Stool softeners?
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Mineral oil
Glycerin Docusate sodium |
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Osmotic agents?
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Magnesium sulfate
Magnesuum hydroxide Lactulose Mannitol |
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Antidiarrheals:
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Diphenoxylate
Difenoxin Loperamide Kaolin pectin Bismuth Subsalicylate |
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Opioids moa?
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Enhance water absorption, decrease GI motility locally
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Opioids S/E?
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constipation, megacolon
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Kaolin-pectin MOA?
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absorb water and toxins
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Bismuth subsalicylate MOA? effective in?
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inhibits intestinal secretions
effective in infectious diarrhea |
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Two types of IBD?
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Ulcerative colitis
Crohn's disease |
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Ulcerative colitis?
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Cofluent inflammation of mucosal later of colon
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Crohn's disease?
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Transmural nonconfluent inflammation of submucosal layer leading to strictures and fistulas
Noncontinuous inflammation |
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Mesalamine MOA?
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metabolized to 5-ASA in colon to inhibits TNF, IL-2, NF-kB
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Mesalamine tox?
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Headache
Dyspepsia |
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Prodrugs for 5-ASA
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Sulfasalazine
Olsalazine Balsalazie |
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Prodrugs for 5-ASA vary in?
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Where the 5-ASA is released
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Other treatments for Crohn's disease?
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Glucocorticoids
Azathioprine 6-Mercaptopurine (severe) Methotrexate Cyclosporine Infliximab ATBs |
