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PRE-REG-Thuri > NERVOUS SYSTEM- NAUSEA + VOMITING > Flashcards

NERVOUS SYSTEM- NAUSEA + VOMITING Flashcards

1
Q

What is nausea?

A

Sensation before vomiting.

Vomiting is ejecting stomach contents

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2
Q

What 5 drugs classes target the chemoreceptor trigger zone to prevent vomiting?

A

Dopamine receptor antagonists e.g. antipsychotics

5HT3 antagonists

Neurokinin-receptors antagonists

Antimuscarinic

Antihistamine

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3
Q

What 2 drug classes target the GI tract to help with nausea/vomiting ?

A

Dopamine receptor antagonist - Prokinetic (e.g. Metoclopromide, domperidone).

5HT3 antagonist

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4
Q

List 2 Dopamine receptor antagonist - pro-kinetic drugs?

A

Metoclopromide

Domperidone

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5
Q

What 2 disorders affect the vestibular system?

A

Motion sickness

Labyrinth Disorder- vertigo

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6
Q

What 2 drug classes are used to target conditions affecting the vestibular system?

A

Antihistamines + antimuscarinics

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7
Q

What 2 drug classes are used to target conditions affecting the higher cortical centre?

A

Benzos + cannabinoid

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8
Q

What are the 5 drug classes of antiemetics?

A
  1. Dopamine receptor antagonists
    2- 1st generation antipsychotics
    3- Antihistamines
    4- Antimuscarinic
    5 5HT3 antagonists
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9
Q

List 2 common dopamine receptor antagonists which are used as anti-emetics?

A

Domperidone

Metoclopramine

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10
Q

What is another indication of domperidone?

A

PD treatment

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11
Q

List 3 antihistamines which are used as antiemetics?

A

Cinnarizine
Cyclizine
promethazine - sedating

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12
Q

What 2 conditions are antihistamines used for as anti-emetics?

A

Vertigo

Motion sickness

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13
Q

List 1 sedating antihistamine?

A

Promethazine

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14
Q

List 7 1st generation antipsychotics which are used as antiemetics?

A

Chlorpromazine

Perhenazine

Trifluoperazine

Prochlorperazine

Levomepromazine

Droperidol

Haloperidol

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15
Q

What 2 1st generation antipsychotics are used in palliative care in anti-emesis?

A

Haloperidol

Levomepromazine

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16
Q

What 1st generation antipsychotics is given buccally for migraine?

A

Prochlorperazine

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17
Q

List 1 ANTIMUSCARINIC drug which are used as antiemetic for motion sickness?

A

Hyoscine hydrobromide (most effective - in motion sickness)

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18
Q

List 3 5ht3 receptor antagonists?

A

Palonosetron

Ondansetron

Granistetron

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19
Q

What corticosteroid drug is used for Nausea + vomiting?

A

Dexamethasone

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20
Q

What cannabinoid drug is used for Nausea + vomiting?

A

Nabilone

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21
Q

What 3 neurokinin- receptor antagonist is used for N + V?

A

Aprepitant, Fosaprepitant, rolapitant

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22
Q

What 6 drugs can be used for vomiting during pregnancy?

A

Prochlorperazine, chlorpromazine , Metoclopramide, cyclizine, promethazine (if needed), ondansetron

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23
Q

What to do if vomiting in pregnancy lasts MORE than 24 hrs after drug tx?

A

Switch to different class

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24
Q

What to do if vomiting in pregnancy lasts MORE than 48 hrs?

A

Specialist opinion

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25
Q

Who are high risk patients with post-operative N + V? (6)

A

Female

Non smoker

History of vomiting

Motion sickness

Surgery type + duration

Opioids , anaesthetic

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26
Q

What is 1st line treatment for Post operative N+ V?

A

Antiemetic combo therapy e.g. ondansetron, dexamethasone, haloperidol.

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27
Q

What antiemetic is given for pre-op anticipatory vomiting?

A

Lorazepam

28
Q

List 5 examples of Antiemetic combo therapy for Post operative N+ V?

A

Dexamethasone
5HT3 antagonists
Domperidone
Cyclizine
Droperidol, haloperidol

29
Q

What is MOA of metoclopramide?

A

Blocks D2 receptors in chemoreceptor trigger zone

Acts directly on GI tract- prokinetic

30
Q

What is indication of metoclopramide?

A

Nausea + Vomiting

Prevention in Post op, chemo, radiography.

31
Q

What is metoclopramide dose for N + V?

A

10 mg TDS for 5 days (max 500mcg per kg)

32
Q

what is maximum metoclopramide dose for nausea + vomiting?

A

500mcg per kg

33
Q

What is minimum age in metoclopramide?

A

only 18+

used 2nd line in children if NEED to

34
Q

What is max days you can use metoclopramide?

A

5 days

35
Q

What is SE of metoclopramide?

A

Acute dystonic reactions e.g. oculogyric crisis

36
Q

In what condition if metoclopramide restricted in? (MHRA warning)

A

risk of neurological adverse effects e.g. EPS

37
Q

What drugs do metoclopramide interact with to increase EPS?

A

antipsychotics

38
Q

What drug classes can metoclopramide interact with to cause PD?

A

Dopaminergic drugs

39
Q

What is MOA of domperidone?

A

Blocks D2/D3 receptors in chemoreceptor trigger zone

Acts directly on GI tract

40
Q

What is indication of domperidone?

A

N + V relief

Also used in PD

41
Q

Why is domperidone good in PD + N+V?

A

does not cross BBB

42
Q

What is dose for domperidone in N +V?

A

10mg TDS for 1 week

43
Q

What is minimum age use of domperidone?

A

12 plus - if weight over 35kg

44
Q

What is max duration of usage of domperidone?

A

7 days

45
Q

What is weight limit to allow use of domperidone?

A

> 35kg

46
Q

What is MHRA warning regarding domperidone efficact?

A

Lack of efficacy in certain populations e.g. children under 12 years or anyone under 35kg

47
Q

What is SE of domperidone?

A

Increase QT prolongation

48
Q

What are CI of using domperidone?

A

Impaired cardiac function, CD, avoid in hepatic impairment

49
Q

What is counselling point for Domperidone use if cardiac related SEs?

A

Report arrhythmia signs

50
Q

What drugs can interact with Domperidone to cause QT prolongation?

A

antipsychotics, TCAs, SSRIs, Macrolides, Lithium , methadone, 5HT3 antagonists

Amiodarone, Azole antifungal, Rate limiting CCBs

51
Q

MOA of 5HT3 ANTAGONISTS?

A

Blocks 5ht3 receptors in chemoreceptor trigger zone + GI tract

52
Q

What is indication of 5HT3 ANTAGONISTS?

A

For post op chemo induced N + V

53
Q

What is SE of 5HT3 ANTAGONISTS?

A

QT prolongation

54
Q

Can 5HT3 ANTAGONISTS be used in pregnancy?

A

NO- teratogenic

55
Q

What is the risk of using Ondansetron in pregnanacy?

A

Oral clefts - if use in 1st trimester

56
Q

What drugs interact with 5ht3 antagonists to cause QT prolongation?

A

Antipsychotics, anti-arrythmias, TCAs, SSRIs, macrolides, domperidone, lithium, methadone. quinolone, ondansetron

57
Q

What drugs interact with 5ht3 antagonists to increase serotonin syndrome?

A

Anti-depressants, Amfetamine, Lithium, MAO-B inhibitor, methdone, st John’s wort, tramadol, sumatriptan

58
Q

What is a contraindication of metoclopramide?

A

Not to be used in parkinsons

59
Q

What is a recent MHRA warning for hyoscine hydrobromide patches?

A

risk of anticholinergic side effects more so in unlicensed use.

60
Q

What are the life threatening anticholinergic side effects of using hyoscine patches?

A

hyperthermia, urinary retention, delirium, hallucinations, seizures, respiratory paralysis, and coma

61
Q

How is hyperemesis gravidarum treated?

A

regular antiemetic therapy, intravenous fluid +electrolyte replacement.

62
Q

What supplement must be given in hyperemesis gravidarum to reduce risk of Wernicke’s encephalopathy?

A

Thiamine

63
Q

What is licensed for prevention + treatment of post-op N+V caused by opioids?

A

Cyclizine

64
Q

What 4 anti emetics are NOT effective in motion sickness?

A

Domperidone, metoclopramide hydrochloride, 5HT3-receptor antagonists, and the phenothiazines

65
Q

Which antihistamine phenothiazine works for motion sickness?

A

Promethazine

PRE-REG-Thuri (44 decks)

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