PHM 424 – PUD, N/V/D, CONSTIPATION, IBS EXAM
What is the MOA of metoclopramide?
-blocks dopamine receptors (and serotonin receptors at high doses) in CTZ
-increases lower esophageal sphincter tone
-prokinetic
What are the major adverse effects of metoclopramide?
-extrapyramidal symptoms, headache, CNS depression, akathisia (motor restlessness)
-BBW: tardive dyskinesia
Metoclopramide
- Reglan
Rx only
PO, IV
nausea/vomiting
How is pyridoxine used for nausea/vomiting?
-vitamin B6
-treatment and prophylaxis of N/V in pregnancy
-available OTC as monotherapy or Rx as combination with doxylamine
How is ginger used for nausea/vomiting?
-prevention or treatment of simple nausea and vomiting, surgery, motion or pregnancy
related
-may cause heartburn, diarrhea, mouth irritation
-ginger ales typically too dilute to be therapeutic
What are the patient-related risk factors for PONV?
,-age <50
-female
-nonsmoker
-history of PONV or motion sickness
-hydration status
What are the anesthesia-related risk factors for PONV?
-use of general anesthesia
-use of volatile anesthetics
-NO
-use of opioids
What are the surgery-related risk factors for PONV?
-type of procedure (laparoscopic, gynecological, cholecystectomy)
-duration of surgery
How are risk factors for PONV ranked and how does treatment differ for these categories?
-low risk: 0-1 risk factors
-moderate risk: 2-3 risk factors (provide 2 meds for prophylaxis)
-high risk: >3 risk factors (provide 2 antiemetics from 2 different classes for prophylaxis)
What is the prophylaxis regimen for PONV with the best data?
- ondansetron plus dexamethason
What is the treatment given for PONV after prophylaxis?
-give medication from different class than prophylaxis
-if no prophylaxis given: low dose 5HT3 RA like ondansetron, dexamethasone IV, or
promethazine IV
How are corticosteroids used for nausea/vomiting"
-unknown MOA
, -dexamethasone is most common (PO or IV)
-used in PONV, NOT simple N/V
What are the recommendations for nausea/vomiting in pregnancy (NVP)?
-every patient should start a prenatal vitamin, may help if started 1 month before fertilization
-lifestyle changes: small, frequent meals high in protein, avoid trigger foods
-first line: ginger, P6 acupressure wristbands, switching from iron to folic acid supplements
-pyridoxine (+/- doxylamine) as first pharmacologic therapy
-if refractory, consider adding dimenhydrinate, diphenhydramine, prochlorperazine,
promethazine
-if N/V persists: IV hydration with thiamin (B1), consider enteral tube feedings, ondansetron,
promethazine, metoclopramide
-limited duration steroids (<10 weeks) as last resort
What is the MOA of doxylamine? What are the adverse effects?
-ethanolamine derivative that acts as a histamine 1 antagonist (first gen)
-given with pyridoxine for NVP
-AE: CNS depression, dizziness, urinary retention, anticholinergic SE's
What is PUD?
-large ulcers that extend deep into mucosa
-ulcer recurrence is common (may be H. pylori or NSAID induced)
What are the classifications of PUD?
-H. pylori positive
-NSAID induced
-stress-related mucosal damage (SRMD)
What are the characteristics of H. pylori induced PUD?
-chronic
-duodenal damage
What is the MOA of metoclopramide?
-blocks dopamine receptors (and serotonin receptors at high doses) in CTZ
-increases lower esophageal sphincter tone
-prokinetic
What are the major adverse effects of metoclopramide?
-extrapyramidal symptoms, headache, CNS depression, akathisia (motor restlessness)
-BBW: tardive dyskinesia
Metoclopramide
- Reglan
Rx only
PO, IV
nausea/vomiting
How is pyridoxine used for nausea/vomiting?
-vitamin B6
-treatment and prophylaxis of N/V in pregnancy
-available OTC as monotherapy or Rx as combination with doxylamine
How is ginger used for nausea/vomiting?
-prevention or treatment of simple nausea and vomiting, surgery, motion or pregnancy
related
-may cause heartburn, diarrhea, mouth irritation
-ginger ales typically too dilute to be therapeutic
What are the patient-related risk factors for PONV?
,-age <50
-female
-nonsmoker
-history of PONV or motion sickness
-hydration status
What are the anesthesia-related risk factors for PONV?
-use of general anesthesia
-use of volatile anesthetics
-NO
-use of opioids
What are the surgery-related risk factors for PONV?
-type of procedure (laparoscopic, gynecological, cholecystectomy)
-duration of surgery
How are risk factors for PONV ranked and how does treatment differ for these categories?
-low risk: 0-1 risk factors
-moderate risk: 2-3 risk factors (provide 2 meds for prophylaxis)
-high risk: >3 risk factors (provide 2 antiemetics from 2 different classes for prophylaxis)
What is the prophylaxis regimen for PONV with the best data?
- ondansetron plus dexamethason
What is the treatment given for PONV after prophylaxis?
-give medication from different class than prophylaxis
-if no prophylaxis given: low dose 5HT3 RA like ondansetron, dexamethasone IV, or
promethazine IV
How are corticosteroids used for nausea/vomiting"
-unknown MOA
, -dexamethasone is most common (PO or IV)
-used in PONV, NOT simple N/V
What are the recommendations for nausea/vomiting in pregnancy (NVP)?
-every patient should start a prenatal vitamin, may help if started 1 month before fertilization
-lifestyle changes: small, frequent meals high in protein, avoid trigger foods
-first line: ginger, P6 acupressure wristbands, switching from iron to folic acid supplements
-pyridoxine (+/- doxylamine) as first pharmacologic therapy
-if refractory, consider adding dimenhydrinate, diphenhydramine, prochlorperazine,
promethazine
-if N/V persists: IV hydration with thiamin (B1), consider enteral tube feedings, ondansetron,
promethazine, metoclopramide
-limited duration steroids (<10 weeks) as last resort
What is the MOA of doxylamine? What are the adverse effects?
-ethanolamine derivative that acts as a histamine 1 antagonist (first gen)
-given with pyridoxine for NVP
-AE: CNS depression, dizziness, urinary retention, anticholinergic SE's
What is PUD?
-large ulcers that extend deep into mucosa
-ulcer recurrence is common (may be H. pylori or NSAID induced)
What are the classifications of PUD?
-H. pylori positive
-NSAID induced
-stress-related mucosal damage (SRMD)
What are the characteristics of H. pylori induced PUD?
-chronic
-duodenal damage
