Term
| where is the emetic center, CTZ, and area postrema? |
|
Definition
| floor of the 4th ventricle in the caudal medulla |
|
|
Term
| the emetic center is accessed by what? |
|
Definition
|
|
Term
| emetic center receives inputs from? |
|
Definition
|
|
Term
| the area postrema is outside of what? |
|
Definition
|
|
Term
| area postrema controls what? |
|
Definition
vomiting
inputs from a variety of places |
|
|
Term
| 4 inputs to the area postrema? |
|
Definition
1. blood-borne stimulants
2. solitary taste inputs
3. vestibular inputs
4. vagal afferents |
|
|
Term
| what is responsible for the coordination of the physiological response of vomiting? |
|
Definition
|
|
Term
| what is the role of DMX in vomiting? |
|
Definition
| responsible for the physiological response of vomiting |
|
|
Term
|
Definition
1. apomorphine
2. vestibulation
3. ipecac
4. chemo
5. radiation |
|
|
Term
| 5 receptor types on the CTZ? |
|
Definition
1. opioid
2. D2
3. H1
4. muscarinic
5. 5HT3 |
|
|
Term
| what receptors on the CTZ are for vestibular inputs? |
|
Definition
|
|
Term
| what receptor on the CTZ is for vagal afferent input? |
|
Definition
|
|
Term
| what is the NT between the CTZ and emetic center? |
|
Definition
|
|
Term
| 3 inputs directly to the emetic center? |
|
Definition
1. higher centers for vision, taste, thought, etc
2. vagal input
3. gut distention |
|
|
Term
| 3 categories of anti-emetics? |
|
Definition
1. 5HT3 antagonists
2. H1/muscarinic blockers
3. neurokinin receptor blockers |
|
|
Term
| which type of anti-emetic is best for chemo induced vomiting? |
|
Definition
|
|
Term
| what is a 5HT3 antagonist used as an anti-emetic during chemo? |
|
Definition
|
|
Term
| what type of anti-emetic inhibits vestibular input? |
|
Definition
|
|
Term
| 3 H1/muscarinic blockers used as anti-emetics? |
|
Definition
1. dimenhydrinate
2. promethazine
3. scopolamine |
|
|
Term
| what type of anti-emetic is aprepitant? |
|
Definition
| neurokinin receptor blocker - inhibits substance P |
|
|
Term
substance P blockers is useful in blocking emesis from what inputs?
what inputs would they NOT be useful in blocking? |
|
Definition
useful in blocking emesis from activation of opioid, dopamine, serotonin, and muscarinic receptors
not useful for emesis induced by inputs of sensation from higher centers (vision, taste, though), vagal input, or gut distention |
|
|
Term
| 2 drugs that induce emesis? |
|
Definition
1. syrup of ipecac
2. apomorphine |
|
|
Term
| admin of syrup of ipecac? |
|
Definition
|
|
Term
| mechanism of syrup of ipecac? |
|
Definition
local irritant in the intestine
also has direct effect on CTZ |
|
|
Term
| onset of emesis with syrup of ipecac? |
|
Definition
|
|
Term
| syrup of ipecac should only be given to what types of patients? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| mechanism of apomorphine? |
|
Definition
|
|
Term
| why are syrup of ipecac and apomorphine not administered routinely in the management of poisoned patients? |
|
Definition
| they may counteract the efficacy of other, more effective treatments such as activated charcoal, oral antidotes, and whole-bowel irrigation |
|
|
Term
| 3 more effective treatments than emetic drugs in the management of poisoned patients? |
|
Definition
1. activated charcoal
2. oral antidotes
3. whole-bowel irrigation |
|
|
Term
| 3 5HT3 receptor antagonists? |
|
Definition
1. ondansetron
2. granisetron
3. palonosetron |
|
|
Term
| use of 5HT3 receptor antagonists? |
|
Definition
| alone or in combination for chemo-induced nausea and hyperemesis of pregnancy |
|
|
Term
| adverse effects of 5HT3 receptor antagonists? |
|
Definition
1. well tolerated
2. constipation
3. headache |
|
|
Term
| 2 dopamine D2 receptor antagonists? |
|
Definition
1. promethazine
2. metoclopramide |
|
|
Term
| promethazine also blocks what receptors (besides D2)? |
|
Definition
1. cholinergic
2. histaminergic |
|
|
Term
| therapeutic use of dopamine D2 receptor antagonists? |
|
Definition
1. gastroenteritis
2. drug induced nausea
3. motion sickness |
|
|
Term
| adverse effects of dopamine D2 receptor antagonist? |
|
Definition
1. drowsiness
2. diarrhea
3. extra-pyramidal effects |
|
|
Term
| anti-histamines used as anti-emetics are antagonists at which receptor? |
|
Definition
|
|
Term
what other activity do anti-histamines have (besides H1)?
why are they important? |
|
Definition
1. anti-muscarinic
2. anti-cholinergic
leads to side effects |
|
|
Term
|
Definition
1. dimenhydrinate
2. dipehnhydramine
3. meclizine |
|
|
Term
| therapeutic uses of anti-histamines? |
|
Definition
|
|
Term
| adverse effects of anti-histamines? |
|
Definition
|
|
Term
| how does scopolamine work? |
|
Definition
| its a muscarinic receptor antagonist |
|
|
Term
| what is the drug of choice anti-cholinergic used as an anti-emetic? |
|
Definition
|
|
Term
| how is scopolamine administered? |
|
Definition
|
|
Term
| therapeutic use of scopolamine? |
|
Definition
| motion sickness - used prior to motion |
|
|
Term
| adverse effects of scopolamine? |
|
Definition
1. drowsiness
2. dry mouth
b/c of muscarinic blocking effects |
|
|
Term
| dronabinol is what type of drug? |
|
Definition
|
|
Term
| how is dronabinol administered? |
|
Definition
|
|
Term
| therapeutic use of dronabinol? |
|
Definition
1. prophylactic agent in cancer chemo
2. appetite stimulant in patients with AIDS or anorexia |
|
|
Term
| adverse effects of dronabinol? |
|
Definition
| central sympathetic stimulation leading to tachycardia |
|
|
Term
| what happens upon withdrawal of dronabinol? |
|
Definition
| irritability and insomnia |
|
|
Term
| what glucocorticoid is used as an anti-emetic? |
|
Definition
|
|
Term
| therapeutic use of dexamethasone? |
|
Definition
| anti-nausea drug in patients with widespread cancer |
|
|
Term
| how does dexamethasone work as an anti-nausea drug? |
|
Definition
| through its anti-inflammatory activity and decreased PGE secretion |
|
|
Term
| adverse effects of dexamethasone? |
|
Definition
| typical effects of parenteral corticosteroids --> hypoglycemia and mood changes |
|
|
Term
| what is a substance P/NK1 receptor antagonist used as an anti-emetic? |
|
Definition
|
|
Term
| what type of drug is aprepitant? |
|
Definition
| substance P/NK1 receptor antagonist |
|
|
Term
| therapeutic use of aprepitant? |
|
Definition
used in combo with dexamethasone and a 5HT3 receptor antagonist for acute and delayed emesis a/w cancer chemo
pre-treatment for chemo --> effective regardless of type of chemo they are undergoing |
|
|
Term
| adverse effects of aprepitant? |
|
Definition
|
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