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Pharm Nausea Vomiting
KYCOM Block 15
66
Pharmacology
Graduate
04/05/2014

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Cards

Term
causes of nausea and vomiting in adults 10
Definition
metabolic
neuro
CV disorder
GI disorder
infection
pregnancy
operations
drugs
chemo
emotions
Term
causes of nausea and vomiting in kids 14
Definition
pyloric stenosis
duodenal ulcer
stress ulcer
adrenal insufficiency
septicemia
disease of pancreas, liver, biliary tree
GI obstruction
increased ICP
overfeeding
rapid feeding
inadequate burping
laying down too soon after feeding
Term
define nausea
Definition
immediate need to vomit, gastric stasis
Term
define retching
Definition
rhythmic action of respiratory muscles (abdominal, inercostal, diaphragmatic) against closed glottis
Term
define vomiting
Definition
forceful expulsion of gastric contentents caused by GI retroperistalsis, salivation, shivering, vasomotor changes
Term
afferent sensory nerves send receptors for nausea and vomiting to 3
Definition
chemoreceptor trigger zone (CTZ)
cerebral cortex
visceral afferents from pharynx and GI
Term
afferent signals are intergrated by vomiting center in medulla and efferent impulses go to 5
Definition
salivation center
respiratory center
pharyngeal, GI, abdominal muscles
Term
NT involved in vomiting center, CTZ, GI tract 4
Definition
ACH (M), histamine (H1), dopamine (D2), serotonin (5-HT3), opiate receptors
Term
categories of drugs that help with nausea and vomiting 5
Definition
5-HT3 antagonist
dopamine antagonist
antihistamine
anticholinergics
cannabis
Term
2 5-HT3 antagonists used in nausea and vomitin
Definition
odansetron
palonostron
Term
5 dopamine antagonist used in nausea and vomiting
Definition
chlori was a pro, a pro at doing meth, a pro chlori was, she drop it like it hot on the metro, chlori pride
chelrpromazine
promethazine
prochlorperazine
deoperidol
metoclopramide
Term
2 antihistamines used in nausea and vomiting and their administrations
Definition
meclizine (oral)
diphenhydramine (oral, IM, IV)
Term
1 anticholinergic used in nausea and vomiting
Definition
scopolamide
Term
cannabis aka
Definition
dronabinol
Term
odansetron: MOA
Definition
antagonist of central/peripheral 5-HT3 on vagal afferents, NTS, postremia
Term
what is the cause of post chemo nausea
Definition
serotonin released by enterochromaffin cells in SI in response to chemo may stimulate vagal afferents to vomiting reflex
Term
odansetron administration 4
Definition
tablets
oral
solutions
IV
Term
odansetron: use 4
Definition
most effective for chemo and upper abdominal irridation nausea
effective against hyperemesis of pregnacy
somewhat effective for post-op nausea
Term
how is palonostron different than odansetron
Definition
has t1/2 40h, longest of serotonins
Term
prochlorperazine, chlorpromazine, promethazine: MOA 3
Definition
D2 antagonist at CTZ
antihistamine
anticholinergic
Term
prochlorperazine, chlorpromazine, promethazine: use 2
Definition
most common general antinausea and antiemetic
NOT effective for nausea associated with chemo
Term
prochlorperazine, chlorpromazine, promethazine: SE
Definition
most common drug to cause drowsiness
Term
droperidol: MOA
Definition
D2 antagonist at CTZ
Term
droperidol: administration 2
Definition
IV, IM
Term
droperidol: use 2
Definition
surgical antiemetic
preop med when other tx not effective
Term
droperidol: SE 2
Definition
alters cardiac conduction
sedation
acute dystonia
Term
metoclopramide: MOA 5
Definition
stimulate ACh release from enteric neurons increasing GI motility and LES pressure (prokinetic)

Blocks D3 receptors at CTZ

supresses inhibitor interneurons by antagonizing 5-HT3 receptor

stimulates 5-HT4 receptor

agonist of D2 receptors that inhibit cholinergic neurons
Term
metoclopramide: administration 3
Definition
oral, IM, IV
Term
metoclopramide: use 4
Definition
adjunct to PPI and H2 blocker for GERD

gastroparesis (increases gastric emptying)

antinausea

antiemetic
Term
metoclopramide: SE
Definition
chronic use >12wk: tarditive dyskinesia

acute use: acute dystonia (reversible tarditive dyskinesia) or pseudoparkinsonism EPS symptoms
Term
MOA antihistamines for nausea and vomiting
Definition
H1 antagonist on vestibular afferents in brain stem
Term
use of antihistamines for nausea and vomiting
Definition
motion sickness
Term
MOA of scopolamide
Definition
anticholinergic
Term
scopolamide: administration 2
Definition
injectable bromide
transdermal patch
Term
scopolamide use
Definition
prevent and tx motion sickness
NO role in chemo nausea
Term
MOA dronabinol
Definition
stimulate CB1 cannaboid receptors on neurons in vomiting center
Term
use dronabinol 2
Definition
prophylactic for nausea in chrmo when other antiemetic uneffective

stimulate appetite in AIDS patients
Term
SE dronabinol 3
Definition
central sympathomimetic activity
tachycardia
high
Term
antiemetics used in pregnancy 3
Definition
antihistamines
odanzatron
promethazine considered
Term
antiemetic used in severe nausea in chemo 3
Definition
metoclopramide
odanzetron
cannibis
Term
antiemetic used in moderate emesis in chemo 3
Definition
prochlorperazine
odanzetron
dronabinol
Term
antinausea and antiemetic used in severe chemo
Definition
combinations of ones for mild and moderate symptoms
Term
cause of IBS
Definition
visceral hypersensitvity from alterations to neuroreceptor in afferent spinal neuron function

CNS odulation of afferent input in way that results in long term sensitization of pathways involved in visceral sensation

no structural or biochemical factors
Term
IBS associated diseases 5
Definition
depression
anxiety
chronic fatigue syndrome
functional dyspepsia
fibromyalgia
Term
symptoms of IBS 4
Definition
lower abdominal pain
constipation
diarrhea
bloating
Term
tx of constipation predominate IBS 2
Definition
dietary fiber
psyllium if unable to tolerate dietary fiber
Term
DC tx of constipation predominate IBS and why, MOA, dosing
Definition
tagsarod
heart attacks, severe diarrhea
12wk short term tx
5-HT4 agonist
Term
tx of diarrhea predominate IBS 3
Definition
psyllium
ipoeramide
avoid triggers
Term
triggers of diarrhea predominate IBS 7
Definition
caffiene
alcohol
sweeteners: sorbitol, fructose, mannitol
herbal medicines
tea (senna is laxative)
Term
tx of IBS with abdominal pain and bloating 2 and MOA
Definition
antispasmotics:
dicylomide
atropine-hyoscyamide-phenobarbitol-scopolamide: anticholinergic DOC for IBS effectiveness not proven
Term
adjnct tx for IBS 2, 2 effects
Definition
TCA, SSRI
help with analgesia with eating
relieve depression
Term
components of bile acids 3
Definition
cholic acid
chenodeoxycholic acid
deoxycholic acid
Term
functions of bile acids 4
Definition
induce flow of bile
feedback inhibition of cholesterol synthesis
eliminate cholesterol (promote excretion)
disperase and absorb lipids and fat soluble vitamins
Term
drug used for gallbadder
Definition
ursodeoxycholic acid
Term
ursodeoxycholic acid: MOA
Definition
cytoprotective on hepaticytes
functional gallbladder needed: modified by bile
degrades cholesterol monohydrate crystals in 40%
Term
ursodeoxycholic acid: use 2
Definition
cannot be used for bile acid therapy alone due to unfavorable surface area to size ratio

gall bladder dissolution

cholestatic liver disease
Term
define pancreatitis
Definition
loss of gland function (Exocrine and endocrine), inflammation, and pain
Term
function of pancreatic enzymes
Definition
protein and fat digestion
Term
how are pancreatic enzymes released
Definition
CCK releasing monitor peptide from duodenum triggers CCK then is degraded by trypsin

CCK stimulates release of pancreatic enzymes
Term
effects of chronic pancreatitis on physiology
Definition
trypsin insufficiency increases CCK and causes pain due to continous stimulation of enzymes and increased intraductal pressure

decreased digestive enzymes cases protein maldigestion and seatorrhea when >90% pancreas lost leading to malabsorption and diarrhea
Term
goals of tx of chronic pancreatitis 2
Definition
prevention of malabsorption
pain relief
Term
2 drugs used in chronic pancreatitis
Definition
lipase, protease
Term
lipase MOA
Definition
delivered to duodenum during 4h period with and after a meal
Term
use of lipase
Definition
decrease diarrhea and malabsorption due to pancreatitis
Term
protease MOA
Definition
delivered to duodenum and interrupts CCK mediated pain loop
Term
why would lipase and protease be coated or uncoated
Definition
coated: treat malabsorption
uncoated: treat malabsorption and pain
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