Notes in N/V/D

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Published	09/08/2024	Name the 6 neurotransmitters that are involved with n/v:SSHMOD•{{c1::Serotonin : 5-hydroxytriptamine  •Substance P: Neurokinin 1 (NK1)•Hista…
Published	09/08/2024	the vestibular system involves what two receptors?{{c1::H1 and M2 }}
Published	09/08/2024	what chemoreceptors are in the chemoreceptor trigger zone? 3{{c1::D2 and NK1 and 5-Ht3 }}
Published	09/08/2024	what receptors are in the vomiting center? 4{{c1::H1 and M1 and NK1 and 5-HT3 }}
Published	09/08/2024	what receptors are involved with the GI tract and heart via cranial nerve 9 or 10? {{c1::mechanoreceptors, chemoreceptors, 5-HT3}}
Published	09/08/2024	•{{c2::Serotonin}} : {{c1::5-hydroxytriptamine  (HT3)}}
Published	09/08/2024	•{{c2::Dopamine}}: {{c1::D2}}
Published	09/08/2024	•{{c3::Muscarinic}}: {{c1::M1}} – {{c2::Acetylcholine}}
Published	09/08/2024	•{{c2::Histamine}}: {{c1::H1}}
Published	09/08/2024	•{{c2::Substance P}}: {{c1::Neurokinin 1 (NK1)}}
Published	09/08/2024	•{{c2::Opioid}} {{c1::(Mu and Delta)}}
Published	09/08/2024	what kind of meds could be used for motion sickness?3{{c1::anticholinergics: scopolamine tansdermal patch, Hyoscymaine antihistamines: Diphenhydr…
Published	09/08/2024	What medication has the side effects of dry mouth, blurry vision, urinary retention, and constipation? {{c1::Anticholinergics}}
Published	09/08/2024	What receptor does anticholinergics affect the most? {{c1::Acetylcholine}}Which does it not affect? {{c1::Serotonin }}
Published	09/08/2024	What are precautions to consider for anticholinergics? 4: {{c1::Glaucoma, GU/GI obstruction, CV disease, and seizure disease }}
Published	09/08/2024	Name two anticholinergic medications: {{c1::scopolamine transdermal patch (transderm scop) and hyoscyamine }}
Published	09/08/2024	Anticholinergics are used for: 3 {{c1::motion sickness, pre/post op, and CINV }}
Published	09/08/2024	Scopolamine transdermal patch (transderm scop) should be applied {{c1::behind ear every 72 hours}}
Published	09/08/2024	Scopolamine is {{c1::expensive}} and can also cause {{c2::dizziness and tachycardia/arrhythmias}} along “cant see, cant pee, cant …
Published	09/08/2024	Name 3 antihistamines: {{c1::diphenydramine (Benadryl®) (PO, IV, IM)Dimenhydrinate(PO)Meclizine (PO)}}
Published	09/08/2024	Name the receptors that antihistamine targets from greatest to least effect: {{c1::histamine, acetylcholine, dopamine}}
Published	09/08/2024	What are the side effects of antihistamines? 2 {{c1::Sedation and anticholinergic effects }}
Published	09/08/2024	Name the precautions for antihistamines: 3 {{c1::glaucoma, GU/GI obstruction, CV disease }}
Published	09/08/2024	Phenothiazines are used for 4 {{c1:: motion sickness, migraine, post op, CINV}}
Published	09/08/2024	Phenothiazines affect {{c1::dopamine, acetylcholine, and histamines}} the same amount. The only one that affects serotonin is {{c2::pro…
Published	09/08/2024	Name 2 phenothiazines: {{c1::Prochlorperazine(PO, IV, IM, PR); Promethazine (Phenergan®) (PO, IV, IM, PR)}}
Published	09/08/2024	Name the 5 side effects of phenothiazines: {{c1::Sedation, extrapyramidal symptoms (shaking/tremors), orthostatic hypotension, photosensitivity a…
Published	09/08/2024	What are the precautions for prescribing phenothiazines: 5: {{c1::Parkinson’s Disease, seizure disorders, CV disease, Glaucoma, GU/GI obstruction…
Published	09/08/2024	5-HT3 receptor antagonists are used for {{c1::CINV, and post op}}
Published	09/08/2024	5-HT3 receptor antagonist only affect {{c1::serotonin}}
Published	09/08/2024	Name 3 5-HT3 receptor antagonist medications: {{c1::GraniseTRON (PO,IV, Patch) OndanseTRON (Zofran®) ( PO, IV, IM)PalonoseTRON (IV) }}
Published	09/08/2024	Which 5HT3 receptor antagonist medications are expensive? {{c1::GraniseTRON (PO,IV, Patch) $$ PalonoseTRON (IV) $$}}
Published	09/08/2024	Name the 4 side effects of 5-HT3 receptor antagonist: {{c1::headache, constipation, drowsiness, QTc prolongation}}
Published	09/08/2024	The precaution for prescribing 5HT3 receptor antagonist is {{c1::QTc prolongation}}
Published	09/08/2024	5-HT3 receptor antagonist is safer for patients with {{c1::seizure disorders}} but still use with caution
Published	09/08/2024	Neurokinin receptor antagonist are used for {{c1::CINV (MOSTLY), post op}}
Published	09/08/2024	Name 2 neurokinin receptor antagonist medications: {{c1::Aprepitant/Fosaprepitant  PO/IV and Fosnetupitant/Palonosetron PO/IV}}
Published	09/08/2024	Side Effects of Aprepitant/Fosaprepitant are: 5: {{c1::fatigue (minimal), hiccups, constipation (? There could other things causing this in this …
Published	09/08/2024	Aprepitant/Fosaprepitant (Emend ®) is more {{c1::expensive}} than other neurokinin receptor antagonists so should save for {{c1::severe}}&nb…
Published	09/08/2024	{{c3::Fosnetupitant/Palonosetron (PO/IV}} is a combination between {{c1::NK-1 and 5-HT3}}; use when you need {{c2::multiple agents}}&nb…
Published	09/08/2024	Benzamides are used for {{c1::refractory CINV and gastroparesis. }}
Published	09/08/2024	Benzamides affect {{c1::dopamine}} the most. It also affects {{c2::histamine and serotonin}} the same.
Published	09/08/2024	Name one benzamide medication: {{c1::Metoclopramide (Reglan®) (PO,IV,IM)}}
Published	09/08/2024	Metoclopramide (Reglan®) is used for {{c1::Antiemetic (refractory CINV) and prokinetic properties (gastroparesis)}}
Published	09/08/2024	Side Effects of {{c1::Metoclopramide (Reglan)}} are: 4 {{c2::sedation (knock pts out), extrapyramidal side effects, hallucinations (bc …
Published	09/08/2024	Precautions for prescribing Metoclopramide (Reglan®) are:  {{c1::Parkinson’s Disease , seizure disorders}}
Published	09/08/2024	Metoclopramide (Reglan) is safer for patients with {{c1::QTc prolongation}}
Published	09/08/2024	Which medication is used as adjunct treatment for CINV (refractory) and as an appetite stimulant that is derived from THC? {{c1::Dronabinol}}&nbs…
Published	09/08/2024	Which medication is used as adjunct treatment for CINV (acute and delayed!)? {{c1::Dexamethasone}} what are some side effects? {{c2::hy…
Published	09/08/2024	What N/V medication is good for those who induce their own nausea with anxiety? {{c1::Lorazepam (Ativan®)}} what could it also be used for?&…
Published	09/08/2024	{{c1::phenothiazines}} and {{c1::benzamides}}  should not be used for patients with parkinson's disease. this would include {{c1::PROchlorperaZIN…
Published	09/08/2024	{{c1::phenothiazines}} and {{c1::benzamides}} and {{c1::anticholinergics}} should be avoided for patients with seizure disorders. This includes {{c1::…
Published	09/08/2024	what medications could you NOT use for CINV?{{c1::antihistamines }}
Published	09/08/2024	what medications are NOT used for pre or post op N/V?{{c1::benzamidesdronabinoldexamethasonelorazepam}}
Published	09/08/2024	which is the only medication used for pre-op N/V? {{c1::anticholinergics}}
Published	09/08/2024	what medications are used for migraines for n/v? {{c1::anthistamines and phenothiazines}}
Published	09/08/2024	what medication is used for gastroparesis? {{c1::benzamides}}
Published	09/08/2024	which medications are used for ONLY CINV AND post op? {{c1::NK1 antagonists and 5HT3 antagonist }}
Published	09/08/2024	Important to recognize dronabinol as an adjunct to CINV especially in patients who have {{c1::refractory CINV}} and are also experiencing {{c1::weight…
Published	09/08/2024	Risk Factors for Chemotherapy   Induced Nausea/Vomiting (CINV): •Concomitant Medications – {{c1::opioids}} •{{c1::Female}} Gender •Age <…
Published	09/08/2024	•{{c1::Refractory}} Emetic Syndromes –Occurs when prophylaxis and rescue agents have failed
Published	09/08/2024	•{{c1::Breakthrough}} Emetic Syndromes –Occurs despite adequate prophylaxis and requires rescue agents
Published	09/08/2024	•{{c1::Acute}} Emetic Syndromes  Onset within 24 hours, peaks ~6 hours after onset
Published	09/08/2024	•{{c1::Delayed}} Emetic Syndromes  –Onset at 24 hours or later and peaks ~48-72 hours after onset
Published	09/08/2024	•{{c1::Anticipatory}} Emetic Syndromes  –Conditioned response to poor control of previous regimens –Prevent with appropriate antiemetic control
Published	09/08/2024	for {{c1::high}} risk emetic syndromes, olanzapine + 2-3 drugs is recommended
Published	09/08/2024	for {{c1::moderate}} risk emetic syndromes, DEXAMETHASONE + 1-2 drugs is recommended
Published	09/08/2024	for {{c1::low}} risk emetic syndromes, 1 drug such as dexamethasone, metaclopramide, or 5-HT3 is recommended
Published	09/08/2024	for {{c1::minimal}} emetic syndrome, as needed Rx only
Published	09/08/2024	{{c1::Olanzapine}} is an antipsychotic drug that is only used in highest risk of CINV
Published	09/08/2024	{{c1::1st}} trimester, pregnant women should use ginger, vitamin B6, and antihistamines for N/V
Published	09/08/2024	{{c1::2nd}} trimester, pregnant women should use promethazine (serontonin) for N/V
Published	09/08/2024	constipation is defined as <{{c1::3}} BM per week, hard stools, excessive straining, incomplete evacuation
Published	09/08/2024	Initial Management  of  constipation: Assess desired {{c1::onset of action}} (acute/intermittent vs chronic)• •{{c2::P…
Published	09/08/2024	{{c2::Psyllium, Methylcelluose, and Calcium Polycarbophil}} are {{c1::bulk forming laxatives }}
Published	09/08/2024	bulk forming laxatives are for patients with {{c1::chronic}} issues
Published	09/08/2024	bulk forming laxatives onset is {{c1::days }}
Published	09/08/2024	mechanism of action of {{c2::bulk forming laxatives}} is that it {{c1::absorbs}} water, bulks up the stool and increases {{c1::fecal mass}} to make it…
Published	09/08/2024	SE's of bulk forming laxatives is {{c1::bloating and flactualance }}
Published	09/08/2024	you want to take bulk forming laxatives with {{c1::food}} to avoid {{c1::obstruction}}
Published	09/08/2024	Docusate Sodium (Colace®)  is a {{c1::surfactants }} (med class)
Published	09/08/2024	mechanism of action of surfactants is that it decreases {{c1::surface tension}} which increase the {{c1::permeability}} of water into stool so it {{c1…
Published	09/08/2024	{{c1::surfactants}} must be used in combo with {{c2::stimulant}} laxatives
Published	09/08/2024	surfactants are used for {{c1::prevention}}
Published	09/08/2024	time of onset of {{c1::surfactants}} is 12-72 hrs
Published	09/08/2024	SEs of surfactants are {{c1::abd cramping}} which requires adequate fluid intake
Published	09/08/2024	{{c2::Polyethylene Glycol (Miralax®), Magnesium Salt, and Lactulose}} are {{c1::osmotic agents  }}
Published	09/08/2024	{{c4::Polyethylene Glycol (Miralax®)}} and {{c4::Magnesium Salt (PO) ( MOM®)}})MOA: increases {{c1::water absorption}} via {{c1::osmoti…
Published	09/08/2024	Sorbitol Lactulose (PO,PR) MOA: Increases {{c1::water absorption}} via {{c1::osmotic action}}/ stimulate {{c3::peristalsis}}
Published	09/08/2024	all osmotic agents are used for {{c1::acute/imtermittent issues}}
Published	09/08/2024	{{c1::magnesium salt}} and {{c2::polyethylene glycol}} are also used for bowel prep
Published	09/08/2024	{{c1::polyethylene glycol}} and {{c2::sorbitol}} are used for chronic issues
Published	09/08/2024	of the osmotic agents, polyethylene glycol ({{c1::high}} dose) and {{c1::magnesium salts}} have a time of onset of 30 min-3 hrs while polyethylene gly…
Published	09/08/2024	{{c1::magnesium salt (MOM)}} is considered a saline laxative
Published	09/08/2024	abdominal cramps, hypermagnesemia, dehydration, diarrhea are SEs of {{c1::magnesium salts }}
Published	09/08/2024	abdominal cramps, electrolyte disturbances, dehydration, diarrhea are SEs of {{c1::polyethylene glycol }}
Published	09/08/2024	bloating, flatulence, abdominal cramping, dehydration, diarrhea are SEs of {{c1::sorbitol, lactulose  }}
Published	09/08/2024	there is a precaution of {{c1::obstruction}} in osmotic agents
Published	09/08/2024	{{c1::Stimulants}} (med class) are used for Acute, intermittent, bowel preparation, opioid induced constipation
Published	09/08/2024	Bisacodyl (Dulcolax) and Senna are {{c1::stimulants}}
Published	09/08/2024	{{c1::Bisacodyl (Dulcolax)}} (stimulant)  is used for Acute/intermittent Bowel prep
Published	09/08/2024	{{c1::senna}} (stimulant) is used for Acute/intermittent Opioid inducted constipation
Published	09/08/2024	stimulants time of onset is {{c1::12 hrs }}
Published	09/08/2024	•MOA of stimulants: alteration of {{c1::electrolyte transport}} (manipulating chemistry in GI tract)  increasing {{c1::intraluminal fluid}},…
Published	09/08/2024	stimulants are {{c1::not ideal}} for daily use because they could lose their effect and should only be used {{c2::PRN }}
Published	09/08/2024	Incontinence and Abdominal cramping are SEs of {{c1::stimulants}}
Published	09/08/2024	stimulants have a precaution of {{c2::obstruction}}
Published	09/08/2024	Bisacodyl ( Dulcolax)  and glycerin are {{c1::suppositories  }}
Published	09/08/2024	the use of {{c1::glycerin }} (suppository)  is for acute/intermittent issues and it is preferred in young children
Published	09/08/2024	the use of (stimulant) {{c1::Bisacodyl ( Dulcolax)  }} is for Acute severe /refractory constipation
Published	09/08/2024	time of onset of suppositories is {{c1::15 min-1hr }} (quick)
Published	09/08/2024	MOA of suppositories is that they increase {{c1::fluid absorption}} via {{c2::direct osmotic action}} and {{c2::rectal}} sti…
Published	09/08/2024	SEs of suppositories is {{c1::rectal irritation }}
Published	09/08/2024	Lubiprostone is a  {{c1::Chloride Channel Activator }}
Published	09/08/2024	{{c2::Lubiprostone}} and {{c1::Linaclotide}}  are used for {{c3::Chronic Idiopathic Constipation or IBS-C}}
Published	09/08/2024	Lubiprostone MOA:  increase intestinal {{c1::fluid secretion}} and intestinal {{c1::motility}}
Published	09/08/2024	{{c2::Linaclotide}}  is a {{c1::Guanylate Cyclase-C  agonist}}
Published	09/08/2024	Linaclotide  MOA:  increase in {{c1::chloride}} and {{c1::bicarbonate}} into intestinal lumen leads to a decrease in {…
Published	09/08/2024	{{c1::Sodium phosphate, Warm tap water, Soapsuds enema, Mineral oil enema}} are all enemas
Published	09/08/2024	{{c1::enemas}} are used for Acute/intermittent, Bowel prep, and Disimpaction
Published	09/08/2024	enemas time of onset is {{c1::very quick (5-15 minutes)}}
Published	09/08/2024	enemas MOA: {{c1::mechanical}} lavage/irritation and stimulation of {{c2::peristalsis/osmotic}} effect
Published	09/08/2024	Mechanical trauma, Hyperphosphatemia (Fleet), Rectal irritation are SEs of {{c1::enemas}}
Published	09/08/2024	precautions of enemas are to monitor {{c1::electrolytes}} with phosphate enemas
Published	09/08/2024	opiod receptors in the GI tract slow narcotics down so pts who are using narcotics  require management with {{c1::stool softener}} and {{c1::stim…
Published	09/08/2024	Methylnaltrexone (Relistor®) is used for {{c1::Refractory opioid induced}} constipation
Published	09/08/2024	Methylnaltrexone (Relistor®) is a {{c1::peripheral opioid}} antagonist meaning that it focuses on the {{c2::gut}} and does not really affect {{c2…
Published	09/08/2024	Methylnaltrexone (Relistor®) should be saved for pts that are on {{c1::chronic opioid}} use
Published	09/08/2024	Methylnaltrexone (Relistor®) MOA:  blocks {{c1::opioid}} binding at {{c2::peripheral mu}} receptors
Published	09/08/2024	SEs of {{c2::Methylnaltrexone (Relistor®)}} are {{c1::abdominal pain, flatulence, nausea}}
Published	09/08/2024	potential indications for use of acute/evacuation for constipation: {{c1::Osmotic, Stimulants Suppositories, Enemas, +/- Surfactant}}
Published	09/08/2024	potential indications for use of maintenance/chronic for constipation: {{c1::Bulk-forming, Surfactants PEG, Lactulose/Sorbitol?, +/- Surfactant}}
Published	09/08/2024	•Acute Diarrhea: {{c1::≤ 14}} days
Published	09/08/2024	•Persistent Diarrhea:  {{c1::> 14}} days
Published	09/08/2024	•Chronic Diarrhea:  {{c1::> 30}} days
Published	09/08/2024	•Diarrhea often defined {{c1::≥ 3 loose}} stools/day
Published	09/08/2024	Treating Diarrhea  •Treat {{c1::underlying cause}}• •{{c2::Discontinue medication}}s that may cause diarrhea • •{{c3::Fluid…
Published	09/08/2024	Adsorbents are {{c1::Calcium Polycarbophil }}
Published	09/08/2024	adsorbents are used as {{c1::OTC}}
Published	09/08/2024	Adsorbents MOA: provides {{c1::bulk}} to the {{c2::intestinal tract }}
Published	09/08/2024	SEs of adsorbents is {{c1::bloating}}
Published	09/08/2024	Diphenoxylate/Atropine (Lomotil®) is a {{c1::CV}} controlled substance
Published	09/08/2024	Diphenoxylate/Atropine (Lomotil®) and Loperamide are {{c1::mu-receptor agonists}}
Published	09/08/2024	Loperamide is used {{c1::OTC}} and for {{c2::mild-moderate}} diarrhea
Published	09/08/2024	Diphenoxylate/Atropine (Lomotil®) is used for {{c1::Moderate – severe Refractory}} diarrhea
Published	09/08/2024	•drowsiness, confusion, respiratory depression, constipation, anticholinergic effects are SEs of {{c1::diphenocylate/atropine (lomotil) }}
Published	09/08/2024	the {{c2::atropine}} in Diphenoxylate/Atropine (Lomotil®) discourages {{c1::abuse }}
Published	09/08/2024	precaution of {{c1::infectious diarrhea}} with mu-receptor agonists
Published	09/08/2024	Diphenoxylate/Atropine (Lomotil®) MOA: inhibits excessive GI {{c1::motility}} and GI {{c1::peristalsis}}
Published	09/08/2024	•Loperamide (Imodium A-D®) MOA: Inhibit {{c1::peristalsis}} and prolong {{c1::transit time}}, reduces {{c1::fecal volume}}, increases {{c1::…
Published	09/08/2024	Constipation, abdominal discomfort (minimal) are SEs of {{c1::loperamide }}
Published	09/08/2024	precautions of Reye’s syndrome in children and drug interactions when using {{c1::Bismuth Subsalicylate (Pepto-Bismol®)}}
Published	09/08/2024	SEs of {{c1::Bismuth Subsalicylate (Pepto-Bismol®)}} are black stools, discoloration of tongue
Published	09/08/2024	Bismuth Subsalicylate (Pepto-Bismol®) MOA:  salicylate moiety provides {{c1::antisecretory}} effect, Bismuth provides {{c2::antimicrobial}}&…
Published	09/08/2024	Bismuth Subsalicylate (Pepto-Bismol®) is used {{c1::OTC and for mild-moderate diarrhea }}
Published	09/08/2024	Bismuth Subsalicylate (Pepto-Bismol®) is an {{c1::antisecretory}} medication
Published	09/08/2024	Traveler’s Diarrhea  can be due to enterotoxigenic E Coli. It is usually is a {{c1::self limiting}} disease of 3-5 days. Pts sho…
Published	09/08/2024	Antibiotics (treatment) are indicated in traveler's diarrhea only if: •Experiences more than {{c1::4 unformed}} stools in 24 hours •There is {{c1…
Published	09/08/2024	•Lactase, ( Lactaid®) is {{c1::OTC}} and used for {{c1::celiac}}, and {{c1::Lactose intolerance}}
Published	09/08/2024	lactase,MOA: Replaces {{c1::lactase}} required for {{c2::carbohydrate digestion}}
Published	09/08/2024	•{{c2::Lipase (Creon®, Zenpep®) }}is used for {{c1::pancreatic}} enzyme for patients with {{c1::pancreatic deficiency (Cystic Fibrosis)}}
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