PHARM GI Classes and Drugs
1. Chlorpromazine: Phenothiazines Block DA,
histamine, muscarinic N/V
BBW: increased death in dementia + psychosis
2. Prochlorperazine: Phenothiazines Block DA,
histamine, muscarinic
N/V
3. Promethazine: Phenthiazines Block DA,
histamine, muscarinic N/V
BBW: resp depression in pediatrics BBW: severe tissue
injury parenterally
4. Droperidol: Butyrophenonones Block DA
stim of CTZ
PONV
BBW: arrhythmia, QT prolongation
5. Haloperidol: Butyrophenones Block DA
stim of CTZ
N/V
BBW: inc death in dementia + psychosis CI: parkinson,
coma, Lewy bodies
6. Metoclopramide: Prokinetic
Block DA in CTZ (+5-HT), inc response to ACh in UGI, inc LES tone CIN/V, gastroparesis
BBW: tardive dyskinesia
CI: obstruction, perf, hemorrhage, seizures, dystonia/EPS
AE: drowsy, dystonia, NMS, EPS, inc prolactin, QT prolongation, HF (if renal impair- ment)
7. Dimenhydrinate
Diphenhydramine
Hydroxyzine
Meclizine: Antihistamine/Anticholinergic interupt visceral pathways
from H1 & muscarinic Motion sickness
CI: neonates, breast-feeding, asthma, CVD, glaucoma, prostatic hyperplasia, GI/GU obstruction
AE: anticholinergics, drowsiness
8. Scopolamine: Antihistamine/Anticholinergic (patch) interupt visceral
pathways from H1 & muscarinic
, PHARM GI Classes and Drugs
Motion sickness
CI: narrow-angle glaucoma AE: drowsy,
dizzy, xerostomia
9. Lorazepam: Benzodiazepine
Inhibit vomiting center, anxiolysis, amnesia, inc inhibitory effect of GABA and neuron permeability to Cl-
N/V
BBW: use w/ opioids, addiction, withdrawal
CI: acute narrow-angle glaucoma, resp depression
10.Alprazolam: Benzodiazepine
Inhibit vomiting center, anxiolysis, amnesia, inc inhibitory effect of GABA and neuron permeability to Cl-
N/V
BBW: use w/ opioids, addiction, withdrawal
CI: use w/ cyp3A4 inhibitor, acute narrow angle glaucoma
11.Ondansetron
Granisetron Dolasetron
Palonosetron: Serotonin (5-HT3) Antagonist Block receptor on vagal
n. and CTZ
CINV, PONV, Radiation N/V
CI: QT prolongation, arrhythmia, heart dz, electrolyte abnormalities AE: constipation, fatigue,
serotonin syndrome
12.Aprepitant
Fosaprepitant
Rolapitant: Substance P/NK-1 Antagonist
Prevent emesis, augment 5-HT antagonist and steroids CINV
CI: use w/ pimozide, use w/ narrow therapeutic index drugs AE: fatigue, neutropenia,
hiccups, abd pain, weak
13.Netupitant/Fosnetupitant + Palonosetron: Substance P/NK-1 Antagonist plus 5-HT3 Antagonist
Prevent emesis, augment 5-HT antagonist and steroids, inhibit crosstalk b/w 5-HT & NK-1
CI: severe hepatic impairment
AE: serotonin syndrome, fatigue, neutropenia, hiccup, abd pain, weakness DDI: substrates of CYP3A4, dec
INR 7-10 days after dose
14.Trimethobenzamine: Benzamide inhibit CTZ by
blocking impulses to VC
, PHARM GI Classes and Drugs
CI: IM in children
AE: sedation, dizzy, drowsy, EPS, HA, diarrhea, skin, seizure, hepatotoxicity Renal dose adjust, avoid in
hepatic impairment, supply shortage
15.Dexamethasone Methylprednisolone:
Corticosteroids
release 5-HT, dec permeability of BBB, dec inflammation PONV, CINV, RINV
CI: systemic fungal infxn, GI dz, diabetes, CVD, renal/hepatic impairment AE: GI upset, anxiety, insomnia,
hyperglycemia
16.Dronabinol: Cannabinoid C-III activate
CB1 & CB2
CINV
CI: sesame oil allergy, etoh, disulfiram, seizures, substance abuse AE: euphoria, dizzy, paranoia,
drowsy, N/V, abd pain
17.Nabilone: Cannabinoid C-II Activate
CB1
AE: ataxia, sleep, xerostomia, visual disturbance, vertigo, depression
18.Fructose, Dextrose, Phosphoric Acid: q 15 mins <5 doses for adults CI: diabetics, fructose
intolerance, >1 hr use
19.Doxylamine + Pyridozine (Diclegis): Antihistamine + B6 NV pregnancy
20.Calcium: Antacid
Neutralize
AE: constipation, hypophosphatemia, hypercalcemia, rebound hyperacidity
21.Magnesium Carbonate: Antacid Neutralize
AE: diarrhea, hypermagnesemia CI: renal
dysfunction
22.Aluminum: Antacid
Neutralize
AE: diarrhea, hyperaluminemia CI: renal
dysfunction
23.Simethicone: Anti-gas can be combined with alum/mag
24.Sodium bicarb: Antacid Neutralize
AE: belching, flatulence, inc urinary Na+, altered systemic pH SHORT TERM ONLY
25.Cimetidine: H2R Antagonists
inhibit H2 receptors on gastric parietal cells, dec HCl
1. Chlorpromazine: Phenothiazines Block DA,
histamine, muscarinic N/V
BBW: increased death in dementia + psychosis
2. Prochlorperazine: Phenothiazines Block DA,
histamine, muscarinic
N/V
3. Promethazine: Phenthiazines Block DA,
histamine, muscarinic N/V
BBW: resp depression in pediatrics BBW: severe tissue
injury parenterally
4. Droperidol: Butyrophenonones Block DA
stim of CTZ
PONV
BBW: arrhythmia, QT prolongation
5. Haloperidol: Butyrophenones Block DA
stim of CTZ
N/V
BBW: inc death in dementia + psychosis CI: parkinson,
coma, Lewy bodies
6. Metoclopramide: Prokinetic
Block DA in CTZ (+5-HT), inc response to ACh in UGI, inc LES tone CIN/V, gastroparesis
BBW: tardive dyskinesia
CI: obstruction, perf, hemorrhage, seizures, dystonia/EPS
AE: drowsy, dystonia, NMS, EPS, inc prolactin, QT prolongation, HF (if renal impair- ment)
7. Dimenhydrinate
Diphenhydramine
Hydroxyzine
Meclizine: Antihistamine/Anticholinergic interupt visceral pathways
from H1 & muscarinic Motion sickness
CI: neonates, breast-feeding, asthma, CVD, glaucoma, prostatic hyperplasia, GI/GU obstruction
AE: anticholinergics, drowsiness
8. Scopolamine: Antihistamine/Anticholinergic (patch) interupt visceral
pathways from H1 & muscarinic
, PHARM GI Classes and Drugs
Motion sickness
CI: narrow-angle glaucoma AE: drowsy,
dizzy, xerostomia
9. Lorazepam: Benzodiazepine
Inhibit vomiting center, anxiolysis, amnesia, inc inhibitory effect of GABA and neuron permeability to Cl-
N/V
BBW: use w/ opioids, addiction, withdrawal
CI: acute narrow-angle glaucoma, resp depression
10.Alprazolam: Benzodiazepine
Inhibit vomiting center, anxiolysis, amnesia, inc inhibitory effect of GABA and neuron permeability to Cl-
N/V
BBW: use w/ opioids, addiction, withdrawal
CI: use w/ cyp3A4 inhibitor, acute narrow angle glaucoma
11.Ondansetron
Granisetron Dolasetron
Palonosetron: Serotonin (5-HT3) Antagonist Block receptor on vagal
n. and CTZ
CINV, PONV, Radiation N/V
CI: QT prolongation, arrhythmia, heart dz, electrolyte abnormalities AE: constipation, fatigue,
serotonin syndrome
12.Aprepitant
Fosaprepitant
Rolapitant: Substance P/NK-1 Antagonist
Prevent emesis, augment 5-HT antagonist and steroids CINV
CI: use w/ pimozide, use w/ narrow therapeutic index drugs AE: fatigue, neutropenia,
hiccups, abd pain, weak
13.Netupitant/Fosnetupitant + Palonosetron: Substance P/NK-1 Antagonist plus 5-HT3 Antagonist
Prevent emesis, augment 5-HT antagonist and steroids, inhibit crosstalk b/w 5-HT & NK-1
CI: severe hepatic impairment
AE: serotonin syndrome, fatigue, neutropenia, hiccup, abd pain, weakness DDI: substrates of CYP3A4, dec
INR 7-10 days after dose
14.Trimethobenzamine: Benzamide inhibit CTZ by
blocking impulses to VC
, PHARM GI Classes and Drugs
CI: IM in children
AE: sedation, dizzy, drowsy, EPS, HA, diarrhea, skin, seizure, hepatotoxicity Renal dose adjust, avoid in
hepatic impairment, supply shortage
15.Dexamethasone Methylprednisolone:
Corticosteroids
release 5-HT, dec permeability of BBB, dec inflammation PONV, CINV, RINV
CI: systemic fungal infxn, GI dz, diabetes, CVD, renal/hepatic impairment AE: GI upset, anxiety, insomnia,
hyperglycemia
16.Dronabinol: Cannabinoid C-III activate
CB1 & CB2
CINV
CI: sesame oil allergy, etoh, disulfiram, seizures, substance abuse AE: euphoria, dizzy, paranoia,
drowsy, N/V, abd pain
17.Nabilone: Cannabinoid C-II Activate
CB1
AE: ataxia, sleep, xerostomia, visual disturbance, vertigo, depression
18.Fructose, Dextrose, Phosphoric Acid: q 15 mins <5 doses for adults CI: diabetics, fructose
intolerance, >1 hr use
19.Doxylamine + Pyridozine (Diclegis): Antihistamine + B6 NV pregnancy
20.Calcium: Antacid
Neutralize
AE: constipation, hypophosphatemia, hypercalcemia, rebound hyperacidity
21.Magnesium Carbonate: Antacid Neutralize
AE: diarrhea, hypermagnesemia CI: renal
dysfunction
22.Aluminum: Antacid
Neutralize
AE: diarrhea, hyperaluminemia CI: renal
dysfunction
23.Simethicone: Anti-gas can be combined with alum/mag
24.Sodium bicarb: Antacid Neutralize
AE: belching, flatulence, inc urinary Na+, altered systemic pH SHORT TERM ONLY
25.Cimetidine: H2R Antagonists
inhibit H2 receptors on gastric parietal cells, dec HCl
