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Ondanestron (zofran) is which type of antiemetic medication?
Serotonin 5-HT3 receptor antagonist
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How can serotonin lead to vomiting?
- Serotonin binds receptor on vagus nerve and can send input to the vomiting center
- So antagonist of the serotonin receptor would block that
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Which anti emetic is indicated when there is acute infectious gastroenteritis?
Sertonoin 5HT receptor antagonist (Ondanestron)
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What are adverse effects of 5-HT antagonist (Ondanestron)?
- HA, dizziness, constipation
- Prolonged QT interval
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Which antiemetic can cause prolonged QT interval?
Serotonin 5HT3 receptor antagonist (Ondanestron)
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Dexamethasone is a _______ that is given with 5HT antagonists as antiemetic treatment
Corticosteroid
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what is the therapeutic use for corticosteroid?
Enhance efficacy of serotonin 5HT3 receptor antagonist
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What is aprepitant?
It is a neurokinin receptor antagonist (NK1). Taken orally only
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Where is the NK1 receptor located?
In the area postrema, that is why NK1 antagonist works to stop vomiting
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True/false: NK1 antagonists (aprepitant) are metabolized by CYP3A4
True
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What are adverse effects of NK1 antagonist (aprepitant)?
Fatigue, dizziness, diarrhea
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Why do NK1 antagonist (aprepitant) cause decreased INR in patients taking warfarin?
Because it induces CYP2C9, which is important in metabolizing warfarin
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True/false: Ondanestron delays emesis more than standard therapy
False; Aprepitant delays emesis more than standard therapy
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Agents of phenothiazines:
- Promethazine
- prochlorperazine
- Dopamine antagonist
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MOA of phenothiazine?
Dopamine (D2) receptor or muscarinic receptor antagonist
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Adverse effects of phenothiazine:
- Constipation
- Dry mouth (cuz muscarinic receptor blocker)
- Parkinsonism
- Blurred vision and sedation (sedation because of histamine blocker)
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Which drug is a contraindication if pt has CNS depression?
phenothiazine
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MOA of metoclopramide:
Central blockage of dopamine receptor in the brain, thereby increase ACh release and increase gastric emptying
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Patients with impaired gastric emptying (gastroparesis), should use _____
Metoclopramide
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Adverse effect of metoclopramide:
Restlessness, insomnia, anxiety
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MOA for scopolamine:
Antimuscarininc
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Patient recovering from anesthesia and surgery and use ____ to prevent N/v
Scopolamine
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Route of administration for scopolamine:
Oral, parental, transdermal patch
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Adverse effects of scopolamine?
Sedation and dry mouth (because it is a antimuscarinic drug)
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Which drug is contraindicated if pt has angle-closure glaucoma?
Scopolamine
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_____ is man made analog of THC
Dronabinol
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What is the MOA of cannabinoids when it comes to antiemetic effect?
We don’t know. Not understood
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Which antiemetic drug can stimulate appetite?
Dronabinol (cannabinoid)
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What are adverse effects of Dronabinol?
- Euphoria
- Dysphoria
- Sedation
- Hallucination
- Increased appetite
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Which drug is used to treat vomiting that is related to anxiety?
Benzodiazepines – Lorazepam, diazepam
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