Shared Flashcard Set

Details

N/V
TDX
40
Pharmacology
Professional
11/20/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
Chlorpromazine (Thorazine)
Definition
10-25mg every 4-6hr
25-50mg every 4-6h
Tab, liquid
IM/IV
Term
Prochlorperazine (Compazine)
Definition
5-10mg every 3-4h
5-10mg every 3-4h
2.5-10mg every 3-4h
25mg twice daily
Tab, liquid
IM
IV
Supp
Term
Promethazine (Phenergan)
Definition
12.5-25mg every 4-6h
Tab, liquid, IM, IV, supp
Term
Cyclizine (Marezine, Cyclovert, Bonine for kids)
Definition
50mg 30min before travel, then 50mg every 4-6h (max 200mg)
25mg every 6-8h (max 75mg)
Not recommended
Term
Dimenhydrinate (Dramamine, Travel-EZE)
Definition
50-100mg every 4-6h (max 400mg)
25-50mg every 6-8h (max 150mg)
12.5-25mg every 6-
Term
Diphenhydramine (Benadryl, and many others)
Definition
25-50mg every 4h (max 300mg)
12.5-25mg every 4h (max 150mg)
6.25mg every 4h (max 37.5mg)
Term
Meclizine (Antivert)
Definition
25-50mg 1h before travel (max 50mg)
Not recommended
Not recommended
Term
Hydroxyzine (Vistaril, Atarax)
Definition
25-100mg every 4-6h
Pill, capsule, liquid, suspension
Term
Meclizine (Antivert)
Definition
25-50mg 1hr before travel
tab
Term
Scopolamine (Transderm Scop)
Definition
1.5mg every 72h
Transdermal patch
Term
Trimethobenzamide (Tigan)
Definition
300mg 3-4 times daily
200mg 3-4 times daily
Cap
IM/supp
Term
Diphenhydramine (Benadryl)
Definition
25-50mg every 4-6h
10-50mg every 2-4h
Cap, tab, liquid
Term
Phenothiazines
Definition
MOA: thought to block dopamine receptors at the CTZ
Most useful for long term use in simple N/V
Side effects:
Extrapyramidal reactions
Excessive sedation
Hypotension
Possible liver dysfunction
Anticholinergic side effects
Drug interactions: other sedating medications, alcohol
Warnings: use caution in older adults with dementia, Parkinson's disease
Contraindications: Pregnant women in the last trimester
Term
Phenothiazines
Definition
MOA: thought to block dopamine receptors at the CTZ
Most useful for long term use in simple N/V
Side effects:
Extrapyramidal reactions
Excessive sedation
Hypotension
Possible liver dysfunction
Anticholinergic side effects
Drug interactions: other sedating medications, alcohol
Warnings: use caution in older adults with dementia, Parkinson's disease
Contraindications: Pregnant women in the last trimester
Term
Ondansetron (Zofran, Zofran ODT)
Definition
Dose in adults post-op for prevention of N/V (PONV)
Dose for adult prophylaxis of chemotherapy induced N/V (CINV)

4mg IV at the end of surgery
8-12mg IV or 16-24mg orally
Term
Dolasetron (Anzemet)
Definition
Dose in adults post-op for prevention of N/V (PONV)
Dose for adult prophylaxis of chemotherapy induced N/V (CINV)
12.5mg IV at the end of surgery
100mg IV or orally or 1.8mg/kg IV
Term
Granisetron (Granisol, Sancuso)
Definition
Dose in adults post-op for prevention of N/V (PONV)
Dose for adult prophylaxis of chemotherapy induced N/V (CINV)
0.35-1.5mg IV at the end of surgery
1mg IV or 0.01mg/kg IV or 2mg orally or 34.3mg transdermal patch
Term
Palonosetron (Aloxi)
Definition
Dose in adults post-op for prevention of N/V (PONV)
Dose for adult prophylaxis of chemotherapy induced N/V (CINV)
0.075mg IV at induction of surgery
0.25mg IV
Term
5HT3 – receptor antagonists
Definition
MOA: Block serotonin receptors in the gut wall
Use: most useful in treating the acute phase of chemotherapy induced N/V (CINV), post-operative N/V (PONV), and radiation induced N/V (RINV)
Side effects: constipation, headache, weakness
Drug interactions: Apomorphine, other medications that prolong QT interval
Warnings: Use caution in patients with prolonged QT
Term
Droperidol (Inapsine
Definition
2.5mg; additional 1.25mg may be given
IM, IV
Term
Haloperidol (Haldol)
Definition
1-5mg every 12h PRN
Tab, liquid, IM, IV
Term
Butyrophenones
Definition
MOA: Block dopaminergic stimulation at the CTZ
Use: Neither is first-line treatment, Haldol is sometimes used in palliative care situations, Droperidol is not used clinically much due to QT prolongation events
Side effects: QT prolongation, drowsiness/sedation, Extrapyramidal reactions, Tardive dyskinesia
Drug interactions: Other medications that can prolong the QT, CNS depressants, anticholinergic medications, alcohol
Warnings: Older patients with dementia, Parkinson’s disease
Term
Cannabinoids
Definition
MOA: Complex effects on the CNS and neural tissue receptors (cannabinoid receptors)
Use: Not first line - Refractory CINV
Side effects: tachycardia, euphoria, dizziness, somnolence, confusion, abdominal pain, weakness
Drug interactions: other medications with CNS affects, alcohol
Warnings: Cautious use in the elderly and patients with history of drug abuse
Term
Dronabinol (Marinol)
Definition
5-15mg/m2
Every 2-4h PRN
Cap (C-III)
Term
Nabilone (Cesamet)
Definition
1-2mg twice daily
Cap (C-II)
Term
Metoclopramide (Reglan) for delayed CINV
Definition
20-40mg 3-4 times daily
tab
Term
Olanzapine (Zyprexa) for breakthrough N/V following prophylaxis
Definition
2.5 – 5mg twice daily
tab
Term
Miscellaneous
Definition
MOA: Both block dopamine at the CTZ Use: Neither are first-line options, generally used to treat breakthrough N/V along with other agents Side effects: drowsiness, dizziness, EPS, anticholinergic side effects (Olanzapine) Drug Interactions: Other CNS active drugs, other antipsychotics, anti-Parkinson’s medications Warnings: Use caution in the elderly and those with Parkinson’s disease
Term
Aprepitant (Emend)
Definition
125mg orally
80mg days 2 and 3 after chemotherapy
40mg orally within 3h of induction
Term
Fosaprepitant (Emend injection)
Definition
115mg IV
Not FDA approved
N/A
Term
Substance P/NK1 receptor antagonists
Definition
MOA: Substance P (a neurotransmitter) is thought to mediate the acute phase of CINV along with serotonin. It is thought to be the primary mediator of the delayed phase. Aprepitant blocks the actions of Substance P by antagonizing it’s receptor NK1.
Use: First line for prophylaxis of CINV (acute and delayed) when using mod-highly emetic chemotherapy regimens
Side effects: fatigue, weakness, constipation, hiccups
Drug interactions: MANY – induces CYP3A4 and CYP2C9 – remember oral contraceptives and warfarin
Warnings: Not approved for use in children, use with caution in hepatic impairment, not recommended during lactation, not studied for use in existing N/V (chronic use)
Term
Chemotherapy induced N/V
Definition
5 categories: Acute, delayed, anticipatory, breakthrough, and refractory
Prophylaxis for acute and delayed N/V is based on the emetic risk potential of the chemotherapy regimen
High risk: 5HT3RA + dexamethasone+aprepitant
Moderate risk: 5HT3RA + dexamethasone (consider aprepitant if certain chemotherapy agents are used)
Low risk: Dexamethasone, prochlorperazine, metoclopramide, diphenhydramine, and/or lorazepam
Term
Prophylaxis of Delayed CINV
Definition
Use of acute phase prophylaxis and appropriate prophylaxis for the delayed N/V
Aprepitant, dexamethasone, and metaclopramide have been shown to be effective
5HT3RA’s are not consistant – the only one with evidence is palonosetron
Prophylaxis should always be given with highly emetic chemotherapy regimens: aprepitant + dexamethasone on days 2, 3 and dexamethasone on day 4
Moderately emetic regimens consider based on the medication used: dexamethasone, 5HT3RA, lorazepam, H2 blocker, or PPI days 2-3.
Term
Anticipatory N/V
Definition
Usually only occurs if the patient received chemotherapy before without adequate prophylaxis
Difficult to manage
Behavioral therapy may work
Benzodiazepines like lorazepam and alprazolam may lessen anxiety and the N/V
Term
Breakthrough CINV
Definition
Occurs in 10-40% of patients despite adequate prophylaxis
All patients should be prescribed rescue medication for breakthrough N/V regardless of emetic potential
Consider prochlorperazine, promethazine, lorazepam, metoclopramide, haloperidol, 5HT3RA, dexamethasone, dronabinol, or olanzapine for adults.
Chlorpromazine, lorazepam, and dexamethasone recommended in pediatrics
Term
Treatment of Refractory N/V
Definition
Upgrade to the next level of prophylaxis
Add another agent from a different class
Consider a non-oral route of administration
Corticosteroids, haloperidol, olanzapine, and nabilone on alternating schedules/routes are recommended
Term
Post-operative N/V (PONV)
Definition
Occurs in about ¼ of all adults undergoing surgical procedures requiring anesthesia
Occurs from 2-24h post-operatively
Most patients do not require prophylaxis
Use prophylactic anti-emetics in those patients with high risk
Other options include regional instead of systemic anesthesia, and avoiding nitrous oxide and other volatile anesthetics
Term
Treatment of PONV
Definition
For patients who received prophylaxis:
Use an anti-emetic from a different drug class
Repeating the agent used for prophylaxis within 6h of surgery is not effective
After 6h treatment can include repeat of prophylactic medication except dexamethasone and scopolomine
For patients who did not receive prophylaxis:
5HT3RA at a low dose
Dexamethasone IV
Droperidol or promethazine IV
Term
Risks for PONV
Definition
The most important predictors are Hx of PONV or motion sickness, female gender, non-smoking, and use of post-op opiods
0-1 risk factor = low risk
2 risk factors = moderate risk
3-4 risk factors = high risk
Patients at moderate risk should receive prophylaxis with 1-2 antiemetics
High risk patients should receive two antiemetics as prophylaxis.
Term
Prophylaxis of PONV
Definition
Aprepitant 40mg within 3h of induction of anesthesia
Dexamethasone 4-5mg IV at induction of anesthesia
5HT3RA IV doses at the end of surgery
Others: haloperidol IM or IV, Prochlorperazine IM/IV at end of surgery, Promethazine IV at induction, Scopolamine patch the evening before surgery
Droperidol is very effective but use is limited by concerns regarding torsades de pointes
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