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43 Cards in this Set
- Front
- Back
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What mechanism triggers vomiting?
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Afferent impulses to the vomiting center in the medulla
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What are the sensory centers that send impulses to the vomiting center?
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Chemoreceptor trigger zone (CTZ)
Cortical structures Visceral afferents Vestibular structures |
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Where is the CTZ located?
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Area Postrema in the medulla
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What are the receptor types that can lead to vomiting?
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Cholinergic
Histamine Dopamine Serotonin Opiate Substance P/Neurokinin 1 |
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What is the MOA of antiemetic agents?
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Block the receptors in the sensory centers
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What are the causes of complex nausea and vomiting?
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Noxious agents
Psychogenic events |
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What is the MOA of antihistamine/anticholinergic antiemetics?
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Antihistamine, anticholinergic effect on the vestibular apparatus
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What are the indications for antihistamine/anticholinergic antiemetics?
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Treatment of simple N/V
Adjunctive treatment in complex N/V Motion sickness |
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What are the drugs that are best for motion sickness?
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Scopolamine
Meclizine |
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What are the antihistamine antiemetics?
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Dimenhydrinate (Dramamine)
Diphenhydramine (Benadryl) Hydroxyzine (Vistaril) Meclizine (Antivert, Bonine) Scopolamine (Transderm-Scop) Trimethobenzamide (Tigan) |
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What is the MOA of phenothiazine antiemetics?
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Block dopamine receptors, especially in CTZ
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What are the indications for phenothiazine antiemetics?
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Treatment of simple N/V
Treatment & prevention of mildly emetogenic CINV Postop N/V |
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What are the adverse effects of phenothiazine antiemetics?
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Drowsiness
Extrapyramidal reactions Sedation Bone marrow suppression |
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What are the phenothiazine antiemetics?
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Promethazine (Phenergan)
Prochlorperazine (Compazine) |
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What are the adverse effects of antihistamine/anticholinergic antiemetics?
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Sedation
Dry Mouth Urinary retention |
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What is the MOA of butyrophenone antiemetics?
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Block dopamine receptors in the CTZ
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What is the use for butyrophenone antiemetics?
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Post-op N/V
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What are the adverse effects of butyrophenone antiemetics?
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Sedation
Dystonic reactions QT prolongation |
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Droperidol (Inapsine) is in what class of drugs?
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Butyrophenone antiemetics
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Metoclopramide (Reglan)
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Dopamine antagonist in CTZ and gut; cholinergic
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What are the physiologic effects of Metoclopramide (Reglan)?
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Increases LES
Aids gastric emptying Accelerates bowel transit |
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What are the uses for metoclopramide (Reglan)?
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Gastroparesis
Adjunctive for CINV |
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What are the side effects of metoclopramide (Reglan)?
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Extrapyramidal effects (higher doses)
Diarrhea Sedation |
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What is the MOA of serotonin antagonists?
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Block serotonin in the CTZ and GI tract
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What are the uses for serotonin antagonists?
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Prevention/treatment of CINV
PONV |
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What are the adverse effects of serotonin antagonists?
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Constipation
Drowsiness Headache |
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What are 4 examples of serotonin antagonists?
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Dolasetron (Anzemet)
Granisetron Ondansetron (Zofran) Palonosetron (Aloxi) |
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What is the brand name for the Granisetron patch?
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Sancuso
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What is the brand name for the PO/IV forms of Granisetron?
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Kytril
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What is the MOA of lorazepam (Ativan)?
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Affects cortical structures
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What is the use for dexamethasone (Decadron)?
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Adjunctive agent for prophylaxis of CINV
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What are the adverse effects of dexamethasone (Decadron)?
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Insomnia
Increased appetite Hyperglycemia Psychosis |
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What are the uses for lorazepam (Ativan)?
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Anticipatory CINV
Adjunct for mildly-emetogenic chemotherapy |
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What is the use for aprepitant (Emend)?
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Prevention of acute and delayed N/V with highly-emetogenic chemo
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What kind of drug is aprepitant (Emend)?
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Substance P/neurokinin 1 (NK1) receptor antagonist
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What are the adverse effects of aprepitant (Emend)?
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Fatigue
Diarrhea/constipation hiccups |
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What is the name for the IV form of aprepitant (Emend)?
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Fosaprepitant
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What type of drug is dronabinol (Marinol)?
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Cannabinoid
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What is the use for dronabinol (Marinol)?
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Treatment of delayed CINV refractory to other therapies
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What are the adverse effects of dronabinol (Marinol)?
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Mood change
Anxiety Euphoria Hallucinations |
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What drugs can be used as prophylaxis for mildly emetogenic chemo?
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Lorazepam +/- prochlorperazine +/- dexamethasone
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What drugs can be used as prophylaxis for moderately emetogenic chemo?
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Serotonin antagonist + dexamethasone
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What drugs can be used as prophylaxis for highly emetogenic chemo?
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Aprepitant + serotonin antagonist + dexamethasone
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