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12 Cards in this Set
- Front
- Back
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1. List the three systems/brain areas that can activate the vomiting center.
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a. Vestibular system (ears – tells you motion) – There are Histamine and muscarinic receptors on them. If you activate these receptors you get more signaling and more vomiting.
i. Give antihistamines and anticholinergices b. GI tract: If it thinks something is wrong and you’ve been poisoned it is going to make you throw up. Goes up through the Vagus nerve. If you activate 5HT3 receptors or neurokinin, it activates the vomiting center. But if you activate cannabinoid receptors, you decrease vomiting. i. Use 5HT3 antagonists (all –tron drugs), NK1 antagonists or cannabinoids c. Chemoreceptor trigger zone. Have dopamine (D2), 5HT3 receptors, and NK1 receptors. If someone is taking an opioids, we give them dopamine antagonists. |
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2. Know which receptors are involved in each of these pathways. For example, there are three receptor types involved in the GI tract activation of the vomiting center, be able to list all three.
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a. Vestibular system:
i. H1 and M1 receptors b. GI Tract: i. 5HT3, NK1 receptors c. Chemoreceptor trigger zone: i. DA (D2), 5HT3, NK1 |
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3. Be able to describe in a short answer or fill in the blank which of these three systems/areas and receptors are involved in each of the following types of nausea: opioid-induced, chemotherapy-induced, post-operative, motion-sickness.
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a. Opiod-induced:
i. Chemoreceptor trigger zone (DA) b. Chemotherapy-induced: i. Chemoreceptor trigger zone ii. GI tract (5HT in stomach) c. Post-operative: i. Chemoreceptor trigger zone (5HT3, NK1) d. Motion-sickness i. Activation of the vestibular system (H1 and M1) |
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4. For each drug (DRUG CHART), know the molecular MOA (this includes all receptors it acts at- for promethazine there are 3).
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a. Scopolamine:
i. M1 cholinergic antagonist ii. Motion sickness b. Meclizine (Antivert), Diphenhydramine (Benadryl Dramamine) i. M1 cholinergic antagonist & H1 antagonist ii. Motion sickness, migraine c. Promethazine (Phenergan) i. M1 cholinergic antagonist & H1 antagonist & D2 antagonist ii. Motion sickness, migraine, chemotherapy, opioid induced nausea d. Prochlorperazine (Compazine) i. H1 antagonist & D2 antagonist ii. Motion sickness, migraine, chemotherapy, opioid induced nausea e. Droperidol (Inapsine) i. D2 antagonist & alpha 1 adrenergic ii. Chemotherapy, opioid induced nausea f. Metoclopride (raglan) i. D2 antaonist & 5HT3 antagonist ii. Chemotherapy, opioid induced nausea, postop g. Ondansetron (Zofran), Granisetron (Kytril), Tropisetron (Navoban) i. 5HT3 antagonist ii. Chemotherapy, postop h. Aprepitant (Emend) i. SP/NK1 antagonist ii. Chemotherapy, postop i. Dronabinol, Nabilone i. CB agonist ii. Chemotherapy |
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5. For each type of receptor acted upon, know what side effects will be likely. For example, what are the side effects caused by D2 antagonism?
M1 H1 D2 5HT3 SP/NK1 CB |
a. M1 cholinergic antagonist
i. Sedating, anticholinergic b. H1 antaonist i. Sedating c. D2 antaonist i. Can cause EPS/ akathesia (jittery) d. 5HT3 antaonist i. Headache e. SP/NK1 antagonist i. Weakness, hiccups f. CB agonist i. Sedating |
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6. Be able to use this knowledge gained in #5 to learn the side effect profile of each drug in your drug list, but also be able to predict side-effects of new drugs. For example: what would the side-effect profile be of a new antiemetic that is a D2 antagonist/NK1 antagonist?
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a. D2 = EPS; NK1 = weakness, hiccups
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7. For each drug know what the common use is. For example: promethazine is used for opioid induced nausea, motion sickness, and migraine. But also be able to predict common-use of new drugs. For example: what would the likely use be of a new antiemetic that is a D2 antagonist/NK1 antagonist?
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figure this out from chart memorization
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8. Identify the anti-emetic agent with the black-box warning about QT prolongation. Recognize that patients given this agent should be monitored by ECG.
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a. Droperidol (Inapsine)
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9. Salad bar: would haloperidol work as an anti-emetic?
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a. Yes, because it acts on dopaminergic cells.
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10. Salad bar: know which would be bad for a Parkinson’s patient: prochlorperazine or odansetron? Explain why?
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a. Prochlorperazine would be bad because it acts as a D2 antagonist and would increase parkinsonian symptoms as it would further reduce dopamine in the body. Odansetron would be fine because it works on serotonin receptors.
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11. Salad bar: know which would be bad for an Alzheimer’s patient: scopolamine or metoclopride? Explain why?
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a. Scopolamine would be bad for alzheimers patients because it is an M1 cholinergic antagonist which would further decrease Ach in the body, increasing the affects of alzheimers. Metoclopride would be ok because it acts on D2 and 5HT3 receptors, which are not effected by alzheimers.
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Drug list
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Scopolamine
Meclizine (Antivert) Diphenhydramine (Benadryl, Dramamine) Promethazine (Phenergan) Prochlorperazine (Compazine) Droperidol (Inapsine) Metoclopride (Reglan) Odansetron (Zofran) Granisetron (Kytril) Tropisetron (Navoban) Aprepitant (Emend) Dronabinol Nabilone |
