TBL QuestionsThe pathophysiology of motion sickness is due to activation of ____________.

The pathophysiology of motion sickness is due to activation of ____________.

vestibular nuclei → conflicting signals from the vestibular system and visual input

The neurotransmitter associated with motion sickness is _______________.

Acetylcholine

The mechanism of action of scopolamine is _______________.

Antagonist on M receptor

The target of Donepezil is a(n) _______________.

enzyme → acetylcholinesterase; increase levels of ACh

Which is NOT an adverse effect of scopolamine?

• Salivation

• Urinary retention

• Confusion

• Blurred vision

Salivation → side effects of scopolamine are anti-SLUD

What is a likely effect of adding Scopolamine to her cognitive impairment symptoms?

Becomes more severe → anticholinergics can affect cognition and memory

What would be an appropriate alternative for Scopolamine for motion sickness?

Meclizine → crosses BBB; 2nd gen antihistamines don't work

The mechanism of action of meclizine is ________________.

H1 receptor inverse agonist → stabilizes inactive conformation of receptor

The advantage of a transdermal patch compared to oral dosing is ___________.

More consistent pharmacokinetics

Which drug is linked to esophageal inflammation?

1. Alendronate → oral bisphosphonate, brand name Fosamax

   1. other drugs in this class: ibandronate (Boniva), risedronate (Actonel) 

   2. must be renally adjusted

   3. < 30 is RI and < 35 is AZ

Which drug should be taken on an empty stomach with 6-8oz of water after which the patient should not lie down for at least 30 minutes?

1. Alendronate → due to esophageal inflammation

   1. highly acidic and can lead to mucosal lining damage

   2. bisphosphonate moa → inhibit osteoclast action, preventing bone resporption

Which drug is not recommended if patient had CrCl <35mL/min?

Alendronate → AZ is < 35 and RI is < 30

Which is the correct brand name for meclizine?

Bonine® → or antivert

Scopolamine patch should be replaced every

72 hours → 3 days

If scopolamine patch falls off, the patch should be ______________.

Replaced with a new patch

Release of serotonin in the _________ contributes to chemotherapy-induced N&V.

1. intestinal mucosa →small intestine (enterochromaffin cells)

   1. EC secrete histamine in stomach, serotonin in small intestine

Which of the following mechanisms of actions confer antiemetic effect?

5-HT3 receptor antagonist

Which drug is indicated for delayed N&V? (select all that apply)

• Ondansetron

• Aprepitant

• Dexamethasone

• Dolasetron

• Aprepitant

• Dexamethasone → long t1/2 and indicated for CINV

Which medication is MOST likely to cause hiccups?

Aprepitant

Dexamethasone is classified a(n) on the glucocorticoid receptor.

1. agonist → ligand of glucocorticoid receptor is cortisol

   1. dexamethasone does not target MR at all

   2. cortisol targets both GR and MR

Efficacy__________________ when dexamethasone is added to 5-HT3 therapy.

Increases

Which receptor is an ion channel?

• 5-HT3

• NK1

• Glucocorticoid

• CB1

5-HT3 → allows influx of Na and Ca upon 5HT binding; depolarization

Which receptor is a transcriptional factor?

Glucocorticoid

CR comes back 3 weeks later for his second round of chemotherapy. While waiting in the infusion center, he starts to experience N&V. This type of N&V is called ________.

anticipatory → this is in the cerebral cortex

Which drug is most effectuve for treating anticipatory NV?

Lorazepam → benzodiazepine are the only agents indicated for anticipatory N/V

The mechanism of action of lorazepam is _________________.

1. allosteric modulator → on GABA receptor

   1. changes GABA receptor to allow channel to stay open longer for more hyperpolarization

Which 5-HT3 receptor antagonist comes in ODT formulation?

Ondansetron

Pyridoxine is vitamin _____________________.

B6, water soluble vitamin → fat soluble is ADEK

Doxylamine is a(n) __________________ medication.

antihistamine → Unisom

Patient has compromised G.I. blood flow, how would this influence your decision when treating stress ulcers?

Start famotidine IV 20mg q12

What is the MOA for famotidine?

Blocks H2 receptors

Based on SCCM and ASHP guidelines, which is a major risk factor for stress-related UGIB in critically ill adults? (select all that apply)

• Coagulopathy

• Enteral nutrition

• Chronic liver disease

• Mechanical ventilation

• Coagulopathy

• Chronic liver disease

Would a patient’s age be a risk foactor for an upper GI bleed if they are 36?

No, greater than 65 is a risk factor

The goal of therapy when treating GI bleed is?

1. inhibit pepsin activation → pepsin needs acidic environment to be activated, so increase pH

   1. allow stomach to heal

It was determined that LA’s Rockall score is 4. This indicates _______. (select all that apply)

• Low risk for re-bleeding

• Low mortality risk

• High risk for re-bleeding

• High mortality risk

• Low mortality risk

• High risk for re-bleeding

What does dehydration do the albumin levels?

Increases them

As a result of PPI use during hospitalization, LA may be at risk for developing

Pneumonia → nosocomial pneumonia is common; C. diff too

When is the best time to take omeprazole?

30-60 minutes before breakfast

Which enzyme is responsible for H. pylori’s ability to colonize the mucosa?

Urease

The most important and clinically significant drug-drug interaction with clarithromycin is?

1. simvastatin → due to CYP3A4 inhibition and simvastatin levels will increase

   1. should hold simvastatin during treatment (14 days)

   2. increase muscle pain

What is the mechanism of action and target organ of simvastatin?

Enzyme inhibitor, liver → HMG-CoA reductase inhibitor

Due to stress induced GI bleeding ulcer which is considered an ulcer complication this patient has a __________________ CV risk and __________________ GI risk. Should he require NSAIDs in the future, the best NSAID for him would be ________________.

Low; high; celecoxib