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What are the four sources of N/V?
- GI tract
- Vestibular system
- Chemoreceptor Trigger Zone
- Higher areas of the CNS
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What is special about the chemoreceptor trigger zone?
It lacks the blood brain barrier
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What are the two main receptors involved in nausea?
- Histamine 1 receptors
- Acetylcholine muscarinic type 1 receptors
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What are the receptors that mediate N/V?
- Dopamine
- Enkephalin
- Histamine (H1)
- Muscarinic cholinergic (M1)
- Neurokinin
- Opioid
- Serotonin
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______ is a prodrug to ondansetron, and should, therefore, be used prophylactically.
Dolasetron
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5-HT3 antagonists (dolasetron, granisetron, ondansetron) are not effective in what type of N/V?
Motion sickness
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What are the 3 primary indications for 5-HT3 antagonists (dolasetron, granisetron, ondansetron)?
- Chemotherapy
- PONV
- Radiation therapy
-
What is the single primary use for D2 antagonists?
PONV
-
What are the 3 D2 antagonists?
- Droperidol
- Prochlorperazine
- Metoclopramide
-
What is the black box warning for droperidol?
- Psychiatric symptoms (feelings of being trapped inside your body)
- Also a problem with prolonged QT syndrome
-
What is the black box warning for metoclopramide?
Extrapyramidal side effects
-
What can you do to combat extrapyramidal side effects?
Treat with diphenhydramine
-
What are the 4 H1/ACh antagonists?
- Promethazine
- Dimenhydronate
- Diphenhydramine
- Hydroxyzine
-
What are the 3 indications for H1/ACh antagonists?
- Motion sickness
- Vertigo
- PONV
-
What is the primary indication for the ACh antagonist scopolamine?
Motion sickness
-
What is the indication for the NK1/SP antagonist Aprepitant?
Chemotherapy
-
Aprepitant is metabolized by CYP 3A4 and could pose a harmful interaction with what?
Warfarin (can decrease INR)
-
What is the 1 mentioned benzodiazepine that is primarily used for anticipatory N/V?
- Midazolam
- (Can also use diazepam)
-
What are the 3 phases of emesis?
- Preejection
- Ejection
- Postejection
-
Dexamethasone has an unknown MOA for relief of N/V. What indications is it useful for?
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