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PHM 604- GI Therapeutics > Nausea/Vomiting > Flashcards

Nausea/Vomiting Flashcards

(54 cards)

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1
Q

General N/V can be caused by what two conditions?

A

Gastroenteritis and pancreatitis

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2
Q

Disorders of balance can be caused by what three conditions?

A

Motion sickness, dizziness, vertigo

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3
Q

Post-operative N/V can be caused by what?

A

Opioids and anesthetics

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4
Q

Arfal’s Risk Score is used for what?

A

Determining treatment for post-op N/V

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5
Q

Four factors that go into in Arfal’s Risk Score

A

Female
Smoker
History of motion sickness or previous post-op N/V
Expected use of post-op opioids

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6
Q

Rx therapies for general N/V (the drug classes)

A

Metoclopramide (prokinetic), phenothiazine, 5-HT antagonists

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7
Q

Therapy for disorders of balance (the drug class)

A

Antihistamines

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8
Q

Therapies for N/V with pregnancy (OTC, Rx, CAM)

A

Doxylamine, B6, acupressure bands, ginger, Emetrol, sea bands, 5HT-3 antagonists (ondansetron), metoclopramide, prochlorperazine

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9
Q

Therapy for post-op N/V with an Arfal Risk Score of 4

A

Scopolamine patch 2h before anesthesia
IV dexamethasone after anesthesia induction
5HT-3 antagonist after surgery

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10
Q

Therapy for post-op N/V with an Arfal Risk Score of 2-3

A

5HT-3 antagonist after surgery

Other antiemetics PRN

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11
Q

Therapy for post-op N/V with an Arfal Risk Score ≤1

A

No therapy needed

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12
Q

Complications of N/V

A

DEHYDRATION, electrolyte imbalances, esophageal tears, aspiration, malnutrition

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13
Q

Where are H1 antagonists used in N/V treatment?

A

N/V in pregnancy, disorders of balance, rescue therapy for post-op N/V when alternate treatment is needed

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14
Q

H1 antagonist drugs

A

Dimenhydrinate (Dramamine), diphenhydramine (Benadryl), meclizine, doxylamine, scopolamine, hydroxyzine

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15
Q

H1 antagonists that are available OTC

A

Dimenhydrinate, diphenhydramine, meclizine, doxylamine

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16
Q

H1 antagonists available Rx

A

Doxylamine (when in combination with B6 in one tablet), scopolamine, hydroxyzine

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17
Q

Which brands of doxylamine are available OTC?

A

Unisom, Diclegis (delayed-release with B6)

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18
Q

Which brand of doxylamine is available Rx?

A

Bonjesta (ER with B6)

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19
Q

Route of administration for scopolamine

A

Transdermal (place patch behind the ear)

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20
Q

How often is scopolamine dosed?

A

Every 72 hours

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21
Q

Side effects of H1 antagonists

A

SEDATION, dry mouth, constipation with frequent use, paradoxical effect in kids

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22
Q

H2 antagonists

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A

Ranitidine, cimetidine

23
Q

Where are H2 antagonists used?

24
Q

Where are phenothiazines used?

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A

General N/V, post-op N/V as rescue therapy, lower-line in N/V with pregnancy

25
Phenothiazine drugs
Promethazine, prochlorperazine, chlorpromazine
26
Formulations of the phenothiazine drugs
PO, IM, IV
27
Which formulation of phenothiazine drugs is preferred?
Deep IM
28
Side effects of phenothiazines and when they happen
Tissue damage, hypotension, QT prolongation, dystonia, EPS symptoms ALL OCCUR WITH CHRONIC USE
29
Where are 5HT-3 antagonists used?
General N/V, post-op N/V, N/V in pregnancy as a lower line option
30
5HT-3 antagonist drug
Ondansetron (Zofran)
31
Side effects of 5HT-3 antagonist drug
Well tolerated overall, but may have constipation, headache, and QT prolongation
32
Where are corticosteroids used in N/V?
Post-op N/V
33
Corticosteroid used in N/V
Dexamethasone
34
Side effects of corticosteroids
agitation, insomnia, increased appetite, hyperglycemia, Cushing's, adrenal suppression
35
Where are prokinetics used?
General N/V (gastroparesis in diabetic patients), lower line in pregnancy N/V (after OTC, Rx doxylamine and B6, ondansetron)
36
Prokinetics drugs
Metoclopramide, erythromycin
37
Side effects of metoclopramide
EPS, dystonia (IV > PO), QT prolongation, diarrhea
38
Side effects of erythromycin
N/V/D, QT prolongation
39
Self-care therapies for general N/V
Oral rehydration solution (Pedialyte) Pepto Bismol Phosphorated carbohydrate solution (Emetrol)
40
Age minimum for Pepto Bismol
>12 years old
41
Age minimum for Emetrol
>2 years old
42
ADEs of Pepto Bismol
Tongue discoloration, fecal discoloration, chelation with quinolones
43
ADEs of Emetrol
Stomach pain and diarrhea
44
Nonpharm care for overeating
Eat 4-5 small meals/day, don't drink fluids or eat soups at mealtime, avoid greasy/fatty foods, eat chilled food
45
Self-care therapies for overeating (pharmacologic treatment)
Pepto Bismol, ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet)
46
H2 receptor antagonists ADEs
Headache, dizziness, diarrhea, constipation, abdominal discomfort
47
Non-pharm care for motion sickness
Avoid reading during travel, focus on line of vision straight ahead, avoid excess food or alcohol before and during extended travel, stay where motion is least experienced (wings of plane or front of car), avoid strong odors, drive if possible
48
Self-care for motion sickness
Meclizine (Bonine), dimenhydrinate (Dramamine), Sea Band, BioBand, ReliefBand
49
ADEs of meclizine and dimenhydrinate
Dry mouth, confusion (in elderly), constipation, dizziness
50
Age minimum to use Dramamine
>2 years old
51
Non-pharm care for pregnancy
Get fresh air, eat crackers and lay in bed for 10-15 minutes before getting up, get up out of bed slowly, eat 4-5 small meals/day, don't drink fluids or eat soup at meals, avoid greasy/fatty foods
52
Self-care for pregnancy
Pyridoxine (B6) and doxylamine taken SEPARATELY, Emetrol, ginger, acupressure bands
53
What does Vitamin B6 not have an effect on in N/V during pregnancy?
The vomiting
54
ADEs of doxylamine
Dry mouth, constipation, dizziness

PHM 604- GI Therapeutics (10 decks)

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