antiemetics

major complications of nausea and emesis

• dehydration

• electrolyte imbalance

  • low potassium + metabolic alkalosis

• aspiration

which key NTs are located in the CTZ

• Dopamine

• 5-HT3 (seortonin)

which key NTs are located in the vestibular system

• H1 (histamine)

• M1 (muscarinic / ACh)

which NT is key in chemotherapy induced N/V?

a) dopamine

b) substance P

c) serotonin

d) histamine

c) serotonin

which NT is key in DELAYED chemotherapy induced N/V?

a) dopamine

b) substance P

c) serotonin

d) histamine

b) substance P

SATA: which of the following receptors are targeted for motion sickness

a) H1

b) D2

c) M1

d) 5-HT3

a) H1

c) M1

5-HT3 receptor antagonists

• block 5-HT3 receptors in GI tract + CTZ

ondansetron ADR

• can increase QT interval

DDI with 5-HT3 antagonists

• antiarrhythmics (ex. ondansetron)

• antidepressants (serotonin syndrome)

indication for Neurokinin 1 antagonists

• chemotherapy induced nausea/vomiting

• gastroparesis

T/F: Neurokinin 1 antagonists are used as monotherapy for chemotherapy-related emesis

• false

  • used with 5HT3 blocks for chemotherapy-related emesis

neurokinin 1 antagonists class ADR

• fatigue

• hiccups

• neutropenia

Aprepitant drug class

• Neurokinin 1 antagonist

Fosaprepitant drug class

• Neurokinin 1 antagonist

Tradipitant drug class

• Neurokinin 1 antagonist

Rolapitant drug class

• Neurokinin 1 antagonist

DA antagonist ADR

• EPS

• tardive dyskinesia (chronic use)

• hyperprolactinemia

T/F: corticosteroids are only used in combination as anti-emetics

• true

Cannabinoids MOA

• activate CB1 receptors CNS

Dronabinol drug class

• cannabinoid

Nabilone drug class

• cannabinoid

Cannabinoids indications

• refractory CINV

• appetite stimulation

Cannabinoid DDI

• CNS depressants (additive alcohol)

• CYP3A4 inhibitors/inducers

• high PPB

what drugs should be avoided with dronabinol oral solution

• disulfiram + metronidazole

  • causes disulfiram reactions w/ alcohol in oral solution

Palonosetron indication

• delayed CINV

Netupitant + Palonosetron

• NK1 + 5-HT3 combination

  • simplified regimen

which antihistamine is used for pregnancy N/V?

a) dimenhydrinate

b) meclizine

c) diphenhydramine

d) doxylamine + pyridoxine

d) doxylamine + pyridoxine

olanzapine MOA + indication

• off-label for N/V (CINV)

  • D2 + 5HT2 blockade

which drug classes can be used for motion sickness

• antihistamines

• anticholinergics