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957 Block 2 > 6. Nausea and Vomiting > Flashcards

6. Nausea and Vomiting Flashcards

1
Q

What is nausea?

A

An inclination to vomit or a feeling in the throat or epigastric region alerting the individual that vomiting is imminent.

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2
Q

What is vomiting/emesis?

A

The ejection or expulsion of gastric contents through the mouth - often a forceful event.

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3
Q

What is the dynamic threshold?

A

An ever-changing point at which an individual experiences nausea.

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4
Q

What is regurgitation?

A

gastric or esophageal contents rise to the pharynx because of pressure differences caused by an incomplete lower esophageal sphincter, for example.

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5
Q

What is retching?

A

labored movement of abdominal and thoracic muscles before vomiting

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6
Q

What are the clinical consequences of vomiting?

A
  • dehydration
  • aspiration
  • electrolyte or acid/base imbalance
  • Mallory-Weiss Syndrome
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7
Q

Vomiting is controlled via central emesis in the __-____ _____.

A

mid-brain stem

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8
Q

What are the receptors involved with visceral stimulation?

A

serotonin and dopamine

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9
Q

What are the receptors involved with vestibular stimulation?

A

histamine and acetylcholine

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10
Q

What are the receptors involved with CTZ stimulation?

A

serotonin, dopamine, and substance P

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11
Q

What is the result of visceral stimulation?

A

GI tract upset

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12
Q

What is the result of vestibular stimulation?

A

motion sickness

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13
Q

What is the result of CTZ stimulation?

A

vomiting

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14
Q

What autonomic nervous system symptoms are present?

A
  • sweating
  • pale
  • hyper-salivation
  • high BP
  • tachycardia
  • decreased gastric motility
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15
Q

What endocrine system symptoms are present?

A

increased vasopressin (ADH) level

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16
Q

What GI system symptoms are present?

A

gastric dysrhythmias

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17
Q

When should you refer patients to seek other help?

A
  • severe dehydration
  • protracted vomiting (> 1-2 days)
  • infants or frail elderly
  • severe headache
  • recent head injury
  • blood in vomit
  • severe abdominal pain
  • ingestion
  • AMS
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18
Q

What symptomatic anomalies need to be corrected?

A
  • electrolyte abnormalities
  • dehydration
  • malnutrition
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19
Q

What recommendation should be given to a patient with mild symptoms and no alarm signs?

A
  • dietary modification

- symptomatic therapy with antiemetic or prokinetic

20
Q

What recommendation should be given to a patient with significant symptoms +/- warning signs or complications?

A
  • initiate symptomatic medication
  • lab testing
  • plain abdominal films
  • upper endoscopy
21
Q

If no diagnosis is determined in a patient with significant symptoms +/- warning signs or complications, what are the next steps?

A

consider

  • gastric scintigraphy
  • electrogastrography
22
Q

If a patient with significant symptoms +/- warning signs or complications has abnormal gastric scintigraphy or electrogastrography results, what is the next step?

A
  • prokinetic therapy

- consider cause of gastroparesis

23
Q

What is the mechanism of action of ondansetron (Zofran)?

A
  • primarily block central serotonin receptors in the CTZ

- also block peripheral receptors in vagal and spinal afferent nerves

24
Q

In what formulations is ondansetron available?

A

PO (IR and orally disintegrating tablet)
solution
IV

25
Q

What are ADRs of ondansetron?

A

QT-interval prolongation

serotonin syndrome

26
Q

What is the mechanism of action of metoclopramide (Reglan)?

A

centrally blocks the dopaminergic receptors in the CTZ

involves vagal and central serotonin and dopamine receptor antagonism with prokinetic properties

27
Q

What are the clinical results of metoclopramide?

A
  • increases lower esophageal sphincter tone
  • aids gastric emptying
  • accelerates transit through small bowel
28
Q

What are ADRs of metoclopramide?

A

dose-dependent irreversible tardive dyskinesia

29
Q

What is the mechanism of action for prochlorperazine (Compazine)?

A

antipsychotic which centrally blocks D1 and D2 receptors

30
Q

In what population is prochlorperazine contraindicated?

A

patients

31
Q

What is the mechanism of action for promethazine (Phenergan)?

A

centrally blocks the postsynaptic mesolimbic dopaminergic receptors in the brain

32
Q

In what formulations is promethazine available?

A

PO (IR and solution)
IM
IV
rectal

33
Q

In what population is promethazine contraindicated?

A

patients

34
Q

Promethazine is _______ protein bound.

A

highly

35
Q

What is the mechanism of action for diphenhydramine (Benadryl) or pyridoxine-doxylamine (Diclegis)?

A
  • H1 receptor antagonist on effector cells in the GI tract, blood vessels, and respiratory tract
  • anticholinergic effects are also seen
36
Q

What are the most common uses of antihistamines in NV?

A

motion sickness

pregnancy

37
Q

What is the mechanism of scopolamine?

A

anticholinergic

38
Q

What benzodiazepine is used for NV?

A

lorazepam

39
Q

What cannabinoid is used for NV?

A

Dronabinol

40
Q

What is the mechanism of Aprepitant?

A

substance P antagonist

41
Q

What is first line therapy for NV in pregnant patients?

A

non-pharmacological

42
Q

What is second line therapy for NV in pregnant patients?

A

antihistamine or possibly ginger

43
Q

What is first line therapy for NV in pediatrics?

A

non-pharmacological

44
Q

What is second line therapy for NV in pediatrics?

A

ondansetron

45
Q

What medications do we avoid in pediatric patients?

A

metoclopramide
prochlorperazine
promethazine
antihistamines

957 Block 2 (14 decks)

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