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Flashcards in Vertigo Tx Deck (18)
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1
Q

Irreversibly vestibulotoxic drugs are?

A
  • Aminoglycosides
  • Cisplatin
  • Ototoxicity caused by loop diuretcs may be reversible
2
Q

Amonoglycosides enter into outer hair cells and result in cell death via ……

A

Caspase dependent or Caspase independent mechanisms

3
Q

The steps involved in aminoglycoside ototoxicity

A
  • AG enters via mechanoelectrical transducer channels
  • Formation of an AG- iron complex
  • AG- Iron interacts with electrical donors to form ROS.
  • ROS then activate JNK which can translocate to the nucleus and activate teh cell death pathway
  • genes from cell death pathway go to mitochondria which causes the release of cyt c. which can trigger apoptosis via caspases
4
Q

Cisplatin results in what type of cell deathw

A

caspase dependent

Steps basically the same except that once CP enters through the mechano-transducer channels and it can form a monohydrate complex

5
Q

Short term tx of vertigo is accomplished by drugs which act primarily where?

A

H1 and M1 (Histamine and Muscarinic) receptors on the cerebellum

6
Q

WHich vertigo drugs act via H1 and M1 blockade

A
  • Diphenhydramine
  • Meclizine
  • Promethazine
7
Q

OF the three H1 and M1 blcokers, which are CYP2D6 inhibitors

A

Diphenhydramine and Promethazine

Di and Pro

8
Q

All H1 and M1 blockers undergo what type of metabolism

A

hepatic

9
Q

H1 and M1 blockers cause side-effects that are serious enough to prevent use in

A

old ppl

10
Q

What are the serotonin antagonists used for?

A

Anti-emesis. They block serotonin in the stomach and small intestine.

  • Called “setrons”
11
Q

Where do the serotonin antagonists work?

A

In the CTZ (chemotherapeutic Trigger zone- monitors blood and CSF for toxic substances) and the STN (solitary tract nucleus).

12
Q

AE of setrons

A

Hepatic metabolism (Ondansetron needs a dose adjustment)

All have ppotential for CV issues by action on cardiac cycle

13
Q

What are the two anti-dopaminergics that we need to know?

A

Chlorpromazine
Prochlorperazine

  • These also have a problem with the cardiac cycles
  • Risk of QT prolongation and torsades de pointes
14
Q

Aprepitant/ fosaprepitant

A

Substance P and NK1 antagonists. Used for adjunct chemo, crosses BBB so it acts centrally

  • CYP3A4
15
Q

KNOW that corticosteroids like dexamethasone and methyl prednisilone can increase the anti-emetic effect of other drugs and lower the adverse effects. May also have their own anti-emetic effect by lowering prostaglandins

A

ok

16
Q

Benzodiazepines (Diazepem) and vomitting?

A

They are used in anticipatory vomitting (prior to chemo) because tehy cause somnolence and amnesia lasting for hours.

17
Q

Dronabino

A

stimulates cannabinoid receptors. Used in chemo pts when all other possibilities fail

18
Q

What is Scopalamine

A

anti-cholinergic

  • blocks M1 and stimulation of CNVIII that fires cholinergic stimulation to the VC

Used to treat motion sickness

Can cause drowsiness and dry mouth