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Therapeutics II > Block 1: Nausea/Vomiting > Flashcards

Block 1: Nausea/Vomiting Flashcards

1
Q

What are the causes of N/V?

A
  1. GI
  2. Drugs
  3. Chemo
  4. Pregnacy
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2
Q

What are the general N/V sx?

A

Mild-severe distress
Simple: Queasiness or discomfort
COmplex: weight loss, fever, ab pain

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3
Q

What is nausea?

A

Subjective feeling of needing to vomit

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4
Q

What is retching?

A

involuntary rhythmic diaphragmatic and abdominal contractions

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5
Q

What is vomiting?

A

Rapid, forceful expulsion of GIT contents

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6
Q

What are the signs of dehydration?

A
  1. Dry mouth
  2. Decreased skin turgor
  3. Excessive thirst
  4. Little or no urination
  5. DZ/Lightheaded fainting
  6. Decreased BP
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7
Q

What are the exclusions for N/V self care?

A
  1. Abdominal pain or distention
  2. Dehydration
  3. Blood in vomit
  4. Decrease alertness
  5. Tachycardia
  6. Vomiting over 24 hr
  7. Poisoning
  8. Pregnancy
  9. Head trauma
  10. Children
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8
Q

What are the goals of N/V treatment?

A
  1. Provide symptomatic relief
  2. Identify underlyign cause
  3. Prevent and correct complication
  4. Prevent future occurrences
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9
Q

What are the non-pharms for N/V?

A
  1. Oral rehydration
  2. Premade solutions or can use 6 teaspoons of sugar and ½ teaspoon of salt in a liter of water
  3. Caution with high sugar content electrolytes
  4. Rehydration solution based on weight
  5. 5 ml q15 mins for small children and 15 ml q15 mins for older children and adults
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10
Q

What is vestibular nausea?

A
  1. Motion sickness
  2. Inner ear disorder (vertigo, neuritis, idiopathic)
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11
Q

First line for motion sickness?

A

Scopolamine: transdermal patch -> tolerability and adherence -> +2 hr before activity

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12
Q

OTC for motion sickness?

A

First-generation antihistamine:
1. Meclizine (may be less sedating)
2. Diphenhydramine
3. Doxylamine – off label use

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13
Q

How do counsel on motion sickenss?

A
  1. Avoid reading
  2. Focus straight ahead
  3. Sit in the front
  4. Avoid strong odors
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14
Q

What is the ADR of motion sickness med?

A
  1. anticholinergic effects
  2. CNS/psychiatric effects (scopolamine)
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15
Q

Treatment of nausea from food and drinks?

A
  1. Antacids
  2. H2RAs
  3. BSS
  4. Phosphorated carbohydrate solution (PCS)
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16
Q

What is PCS?

A
  1. dextrose, levulose, and phosphoric acid
  2. Hyperosmolar solution that relieves N/V by acting on GI tract to decrease smooth muscle contraction and delay gastric emptying
  3. Each 5 ml contains 3.74g of sugar -> caution in diabetics
17
Q

Sally applies a scopolamine patch 2 hours prior to a deep-sea fishing expedition to prevent sea-sickness.

Which of the following side effects is she likely to experience?

Diarrhea
Xerostomia
Rash
Insomnia

A
18
Q

Lifestyle mod for pregnancy?

A
  1. Smaller, more frequent meals
  2. Bland foods (avoid trigger smells)
  3. BRAT (bananas, rice, applesauce, toast)
19
Q

Counseling for pregnacy nausea?

A
  1. Taking a multivitamin daily for 3 months prior to conception
  2. Pyridoxine with or without doxylamine as first line therapy
  3. Ginger
20
Q

Tx for hyperemesis gravidarum in pregnancy?

A

Ondansetron, promethazine, or metoclopramide

21
Q

What is hyperemesis gravidarum?

A

Starvation, dehydration, electrolyte abnormalities – likely requires hospitalization

22
Q

What is PONV?

A
  1. Usually within 24 hours after undergoing anesthesia
  2. Can use prophylaxis
  3. Moderate risk (1-2 risk factors): 2 drug regimen
  4. High risk ( > 2 risk factors): 3-4 drug regimen
23
Q

How do you treat PONV?

A
  1. Scopolamine patches 2H before
  2. NK1 antagonists during induction
  3. Agents after surgery (Ondansetron is “gold standard” for use at end of surgical procedures)
24
Q

ADRs of promethazine?

A

Necrosis, gangrene, IV harms

25
Q

How should promethazine be given?

A
  1. IM
  2. SubQ is CI
  3. Dilution/central line if required IV
26
Q

What is the beers criteria?

A

Medications that may be considered potentially inappropriate in the older adults due to the risks outweighing the benefits.

27
Q

What are common medications of Beers?

A
  1. Antihistamine
  2. Pormethazine
  3. Scopolamine
    (sedation, confusion, urinary retention)
  4. Metoclopramide (EPS)
28
Q

What is the tx of N/V in geriatrics?

A

Ondansetron

QTC prolongation

29
Q

Tx of N/V in pediatrics?

A
  1. Antiemetics
  2. Dehydration correction
  3. ORS
  4. Promethazine in CI in patients less than 2 and caution in older children -> fatal respiratory depression

Therapeutics II (30 decks)

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