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Questions and Answers
Which of the following is a common side effect associated with Dronabinol?
Which of the following is a common side effect associated with Dronabinol?
What is the primary mechanism of action of Dronabinol at the receptor level?
What is the primary mechanism of action of Dronabinol at the receptor level?
Which of the following best describes the classification of an Anthracycline and cyclophosphamide (AC) regimen in terms of emetogenicity?
Which of the following best describes the classification of an Anthracycline and cyclophosphamide (AC) regimen in terms of emetogenicity?
What is a paradoxical and rare condition associated with long-term and daily cannabis use, characterized by severe vomiting?
What is a paradoxical and rare condition associated with long-term and daily cannabis use, characterized by severe vomiting?
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Besides its action at the CB1R and CB2R receptors, what is another proposed mechanism of action of dronabinol in the context of nausea and vomiting?
Besides its action at the CB1R and CB2R receptors, what is another proposed mechanism of action of dronabinol in the context of nausea and vomiting?
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Which of the following best describes the mechanism of action of ondansetron in the treatment of nausea and vomiting?
Which of the following best describes the mechanism of action of ondansetron in the treatment of nausea and vomiting?
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A patient experiencing nausea and vomiting also presents with extrapyramidal symptoms. Which antiemetic drug class is most likely the cause of these symptoms?
A patient experiencing nausea and vomiting also presents with extrapyramidal symptoms. Which antiemetic drug class is most likely the cause of these symptoms?
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A patient with persistent nausea and vomiting due to gastroparesis would most likely benefit from which medication?
A patient with persistent nausea and vomiting due to gastroparesis would most likely benefit from which medication?
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Which of the following is a common side effect associated with the use of scopolamine?
Which of the following is a common side effect associated with the use of scopolamine?
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A patient is vomiting due to activation of which receptors in the vomiting center?
A patient is vomiting due to activation of which receptors in the vomiting center?
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Which of the following medications is most likely to be prescribed for a patient experiencing nausea and vomiting secondary to chemotherapy?
Which of the following medications is most likely to be prescribed for a patient experiencing nausea and vomiting secondary to chemotherapy?
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A patient who has overdosed on an antihistamine presents with delirium, hallucinations, and agitation. What is the most appropriate interpretation?
A patient who has overdosed on an antihistamine presents with delirium, hallucinations, and agitation. What is the most appropriate interpretation?
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Which of the following best describes the role of enterochromaffin cells in the nausea and vomiting response?
Which of the following best describes the role of enterochromaffin cells in the nausea and vomiting response?
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A patient with motion sickness is looking for a medication to help alleviate symptoms. Which of the following would be the most appropriate choice?
A patient with motion sickness is looking for a medication to help alleviate symptoms. Which of the following would be the most appropriate choice?
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What occurs during the ‘retch’ phase of the vomiting process?
What occurs during the ‘retch’ phase of the vomiting process?
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A patient has severe vomiting and develops metabolic alkalosis. How did the vomiting likely cause this?
A patient has severe vomiting and develops metabolic alkalosis. How did the vomiting likely cause this?
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Which of the following antiemetic agents is associated with a risk of QT interval prolongation?
Which of the following antiemetic agents is associated with a risk of QT interval prolongation?
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A patient is taking ondansetron and is experiencing severe constipation. What could be a possible reason for this?
A patient is taking ondansetron and is experiencing severe constipation. What could be a possible reason for this?
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Which of the following is a major target for Scopolamine?
Which of the following is a major target for Scopolamine?
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What is the primary mechanism of action of aprepitant in preventing nausea and vomiting?
What is the primary mechanism of action of aprepitant in preventing nausea and vomiting?
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Which factor is most associated with an increased risk of postoperative nausea and vomiting (PONV), according to the information provided?
Which factor is most associated with an increased risk of postoperative nausea and vomiting (PONV), according to the information provided?
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In the context of nausea and vomiting, which of the following is considered a common cause arising from the intraperitoneal region?
In the context of nausea and vomiting, which of the following is considered a common cause arising from the intraperitoneal region?
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According to the table, which of the following would be classified as an extra-peritoneal cause of nausea and vomiting?
According to the table, which of the following would be classified as an extra-peritoneal cause of nausea and vomiting?
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Besides cancer treatment, what other cause of nausea and vomiting is explicitly listed as a metabolic disorder in the provided content?
Besides cancer treatment, what other cause of nausea and vomiting is explicitly listed as a metabolic disorder in the provided content?
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Which of the following is most likely to cause nausea and vomiting by mechanisms that are classified as pharmacotherapy or other metabolic disorders, according to the table?
Which of the following is most likely to cause nausea and vomiting by mechanisms that are classified as pharmacotherapy or other metabolic disorders, according to the table?
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What is the initial physiological change that allows gastric contents to be propelled into the esophagus during emesis?
What is the initial physiological change that allows gastric contents to be propelled into the esophagus during emesis?
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Which of the following best describes the recommended approach for antiemetic administration when treating recurrent vomiting?
Which of the following best describes the recommended approach for antiemetic administration when treating recurrent vomiting?
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Besides the vomiting center, where else are 5-HT3, NK1, and dopamine receptors found that play a key role in emesis?
Besides the vomiting center, where else are 5-HT3, NK1, and dopamine receptors found that play a key role in emesis?
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Why is it recommended to use one antiemetic agent first, prior to adding a second agent?
Why is it recommended to use one antiemetic agent first, prior to adding a second agent?
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What is the primary information gathered during initial assessment of a patient presenting with nausea and vomiting?
What is the primary information gathered during initial assessment of a patient presenting with nausea and vomiting?
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Which of the following neurotransmitter receptors is NOT a target of Cinnarizine?
Which of the following neurotransmitter receptors is NOT a target of Cinnarizine?
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Dimenhydrinate is indicated for the treatment of which condition?
Dimenhydrinate is indicated for the treatment of which condition?
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Which of the following receptor types is NOT directly associated with the integration phase of emetic stimulus processing?
Which of the following receptor types is NOT directly associated with the integration phase of emetic stimulus processing?
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Which type of antagonist is shared between Cinnarizine and Dimenhydrinate?
Which type of antagonist is shared between Cinnarizine and Dimenhydrinate?
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A patient experiencing nausea and vomiting related to motion sickness would likely benefit from a drug that targets which of the following pathways?
A patient experiencing nausea and vomiting related to motion sickness would likely benefit from a drug that targets which of the following pathways?
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Which of the following best describes the primary effect of Aminoglycosides as presented in the diagram?
Which of the following best describes the primary effect of Aminoglycosides as presented in the diagram?
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Which of the following mechanisms represents the effect of emetics such as Opioids, Cholinomimetics, and L-DOPA?
Which of the following mechanisms represents the effect of emetics such as Opioids, Cholinomimetics, and L-DOPA?
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Which of these antiemetic drugs functions primarily as a neurokinin antagonist?
Which of these antiemetic drugs functions primarily as a neurokinin antagonist?
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A medication targeting the 5-HT3 receptor would be MOST effective for which of the following causes of nausea and vomiting?
A medication targeting the 5-HT3 receptor would be MOST effective for which of the following causes of nausea and vomiting?
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What is the main difference between first and second generation H1 receptor antagonists, as explained in the context of Cinnarizine and Dimenhydrinate?
What is the main difference between first and second generation H1 receptor antagonists, as explained in the context of Cinnarizine and Dimenhydrinate?
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According to the provided diagrams, what is the common effect of both Cinnarizine and Dimenhydrinate on the cerebellum?
According to the provided diagrams, what is the common effect of both Cinnarizine and Dimenhydrinate on the cerebellum?
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In the context of antiemetic treatment, where do granisetron and ondansetron exert their effect beyond the solitary tract nucleus?
In the context of antiemetic treatment, where do granisetron and ondansetron exert their effect beyond the solitary tract nucleus?
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A patient is experiencing vertigo and vestibular symptoms. Which of the following drugs would be MOST appropriate to treat the symptoms?
A patient is experiencing vertigo and vestibular symptoms. Which of the following drugs would be MOST appropriate to treat the symptoms?
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Which of the following areas or signals does NOT directly contribute to the vomiting reflex according to the information provided?
Which of the following areas or signals does NOT directly contribute to the vomiting reflex according to the information provided?
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Which of the following drug classes is LEAST associated with the direct input stage of the emetic pathway as it is defined in the text?
Which of the following drug classes is LEAST associated with the direct input stage of the emetic pathway as it is defined in the text?
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A patient undergoing cancer chemotherapy is experiencing severe nausea and vomiting. Based on the text, activation of which of the following receptors is LEAST likely to be involved?
A patient undergoing cancer chemotherapy is experiencing severe nausea and vomiting. Based on the text, activation of which of the following receptors is LEAST likely to be involved?
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What is the primary mechanism of action of cinnarizine in reducing blood viscosity?
What is the primary mechanism of action of cinnarizine in reducing blood viscosity?
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Which of the following describes the dual mechanism of action of Dimenhydrinate?
Which of the following describes the dual mechanism of action of Dimenhydrinate?
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How does cinnarizine exert its anti-vasoconstrictor effect?
How does cinnarizine exert its anti-vasoconstrictor effect?
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A patient presents with symptoms of delirium, hallucinations, and violence after an overdose. Which medication is most likely the cause?
A patient presents with symptoms of delirium, hallucinations, and violence after an overdose. Which medication is most likely the cause?
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Which primary receptor type is targeted by ondansetron to prevent nausea and vomiting?
Which primary receptor type is targeted by ondansetron to prevent nausea and vomiting?
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Which of these is NOT primarily a mechanism of action of cinnarizine?
Which of these is NOT primarily a mechanism of action of cinnarizine?
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Which structure is NOT directly part of the labyrinth?
Which structure is NOT directly part of the labyrinth?
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A person taking an anti-vertigo medication reports experiencing drowsiness, headache, and nausea. Which of the following medications is most likely the culprit?
A person taking an anti-vertigo medication reports experiencing drowsiness, headache, and nausea. Which of the following medications is most likely the culprit?
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Aprepitant is thought to modulate the effects of chemotherapeutic agents primarily within which area?
Aprepitant is thought to modulate the effects of chemotherapeutic agents primarily within which area?
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Which of the following best describes the mechanism of action of dronabinol at Cannabinoid receptors?
Which of the following best describes the mechanism of action of dronabinol at Cannabinoid receptors?
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Which of the following is NOT an identified target receptor within the Chemoreceptor Trigger Zone (Area Postrema)?
Which of the following is NOT an identified target receptor within the Chemoreceptor Trigger Zone (Area Postrema)?
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Which of the following is NOT a blood-borne emetic listed?
Which of the following is NOT a blood-borne emetic listed?
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Beyond its action on cannabinoid receptors, dronabinol's action against nausea and vomiting is proposed to involve which of the following?
Beyond its action on cannabinoid receptors, dronabinol's action against nausea and vomiting is proposed to involve which of the following?
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Which of the following is NOT considered a local irritant that can induce vomiting?
Which of the following is NOT considered a local irritant that can induce vomiting?
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Which of the following pathways or receptors listed is directly associated with the mechanism of action of Aprepitant, according to the diagram?
Which of the following pathways or receptors listed is directly associated with the mechanism of action of Aprepitant, according to the diagram?
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Which of the following accurately describes the metabolic pathway of Dronabinol?
Which of the following accurately describes the metabolic pathway of Dronabinol?
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Study Notes
Nausea and Vomiting Treatment
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Nausea is an unpleasant sensation associated with an imminent urge to vomit, characterized by cutaneous pallor and sialorrhea (increased saliva). It is triggered by serotonin (5-HT) release from enterochromaffin cells in the digestive tract lining. Serotonin activates 5-HT3 receptors on vagal afferent nerves, signaling the vomiting reflex in the solitary tract nucleus and chemoreceptor trigger zone (CTZ).
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Vomiting (emesis) is the violent expulsion of stomach contents, often accompanied by diaphoresis (sweating). It involves a coordinated series of contractions in the stomach, esophagus, and abdominal/respiratory muscles.
Causes of Nausea and Vomiting
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Intraperitoneal Causes: Infections (pylorus, duodenum, colon, enteric infections), inflammatory bowel disease, motility disorders.
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Extraperitoneal Causes: Cardiovascular conditions (myocarditis, infarction), motion sickness (kinetosis), cancer, hemorrhages, abscesses, hydrocephalus, eating disorders (anorexia nervosa, bulimia), psychological factors, depression, metabolic disorders (uremia, ketoacidosis), pregnancy, hepatic insufficiency, alcohol, radiation therapy, and chemotherapy.
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Pharmacotherapy/Other: Chemotherapy agents, oral hypoglycemic agents, oral contraceptives, pregnancy, hepatic insufficiency, alcohol, and radiation therapy.
Vomiting Center
- The vomiting center is located in the nucleus of the tractus solitarius.
- It coordinates the intricate process of vomiting, involving contractions of the pharynx, gastrointestinal tract, and abdominal muscles, to expel stomach contents.
- The center can be stimulated by signals from the gut, chemoreceptor trigger zone (CTZ), cerebral cortex, and vestibular system.
Phases of Vomiting
- Pre-expulsion: Gastric relaxation and retrograde peristalsis (reverse movement).
- Retching: Rhythmic action of respiratory muscles (contraction of abdominal and intercostal muscles, diaphragm) against a closed glottis to increase intra-gastric pressure.
- Expulsion: Intense abdominal muscle contraction and relaxation of the upper esophageal sphincter, thereby expelling the stomach contents.
Treatment
- A thorough medical history and physical examination are essential to pinpoint the underlying cause.
- Treat the underlying disease or condition inducing nausea and vomiting.
- Correct metabolic imbalances (e.g., hypokalemia, hypochloremia, metabolic alkalosis).
- Administer targeted antiemetic therapy based on the cause.
Antiemetic Therapy
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5-HT3 Receptor Antagonists (Ondansetron, Granisetron): Block serotonin receptors, primarily used for chemotherapy-induced nausea and vomiting (CINV), postoperative nausea and vomiting (PONV), and radiation therapy-induced emesis. Potential side effects include headache, constipation, QT interval prolongation, and serotonin syndrome.
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D2-receptor antagonists (Prochlorperazine, Metoclopramide): Block dopamine receptors and in the case of Metoclopramide, increase gastric emptying and lower esophageal sphincter (LES) tone. Used for nausea and vomiting, and gastroparesis (e.g., diabetic gastroparesis), and persistent GERD. Side effects can include extrapyramidal symptoms, hyperprolactinemia, anxiety, drowsiness, restlessness, depression, and GI distress.
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NK1 Receptor Antagonists (Aprepitant, Fosaprepitant): Block substance P/neurokinin 1 receptors, primarily used for CINV. Side effects include fatigue and gastrointestinal distress.
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H1 Receptor Antagonists (Cinnarizine, Dimenhydrinate): Block histamine receptors, utilized for motion sickness, nausea, and vomiting prevention and treatment. Side effects include drowsiness, fatigue, parkinsonian symptoms, and headache. Overdose can cause delirium, hallucinations, and violence.
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Serotonin 5-HT3 antagonists (Ondansetron—Palonosetron): These are selective serotonin receptor antagonists, used for CINV, PONV. They can cause QT interval prolongation. Overdose cases in Ondansetron are associated with "sudden blindness" (amaurosis).
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Anticholinergic drugs (Scopolamine): Block acetylcholine receptors, often used as a skin patch for motion sickness and PONV prevention. Side effects include dry mouth, dizziness, drowsiness, agitation, dilated pupils, and low blood pressure.
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Neurokinin Antagonists (Aprepitant): Block substance P receptors (NK1), particularly used for CINV. Side effects include fatigue, anorexia, and various gastrointestinal symptoms.
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Cannabinoids (Dronabinol): Synthetic THC, used for anorexia in AIDS patients and CINV. Side effects include headache, nausea, appetite changes, pain reduction, and cognitive changes. Cannabinoid hyperemesis syndrome is a rare, adverse reaction to chronic cannabis use, leading to severe vomiting and dehydration.
Chemotherapy-Induced Nausea and Vomiting (CINV) Treatment Strategies
- Various risk categories (low, moderate, high) of emetogenicity exist in chemotherapy. Treatment strategies are adjusted based on the risk profile.
- Strategies incorporate multiple antiemetic classes for effective prevention.
Treatment During Pregnancy
- H1 antagonists are considered a safe option for nausea and vomiting.
- Doxylamine, with pyridoxine, and Meclizine are used for vertigo and morning sickness during pregnancy.
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Description
This quiz covers the mechanisms and treatment strategies for nausea and vomiting, including the physiological processes involved and the various causes such as intraperitoneal and extraperitoneal factors. Test your understanding of the reflex actions and medical conditions related to these symptoms.
