N/V

Question 1

3 general steps to evaluate N/V

Answer 1

1. recognize & correct consequences of sx (dehydration, electrolyte abnormality)
2. figure out underlying cause (H&P mostly; only order tests if based on suspicion); r/o emergencies
3. empiric therapy to tx any sx if no cause discovered

Question 2

differentiate vomiting, regurg and rumination

Answer 2

• vomiting: forceful expusion through involuntary contractions
• regurg: food going back to mouth w/o forceful contractions
• rumination: food returned to mouth through voluntary contractions

Question 3

which antiemetic is teratogenic in 1st trim?

Answer 3

ondansetron

Question 4

what are 4 treatments to manage N/V in pregnancy? whats first line?

Answer 4

• ginger– 1st line for mild sx
• seabands
• vit b6 (pyridoxine) for nausea
• promethazine for hyperemesis gravidarum

Question 5

what dietary change can pregnant people make to mange N/V

Answer 5

less fat, more carbs
smaller more frequent meals

Question 6

which two medicines have good efficacy for treating motion sickness

Answer 6

hyoscine & meclizine

Question 7

3 medications used in treating N/V d/t chemo?

Answer 7

ondansetron
cannabinoid
promethazine

Question 8

5 types of N/V that promethazine is good for?

Answer 8

hyperemesis gravidarum
chemo
post-op
migraine
gut stasis

Question 9

tx for post operative N/V

Answer 9

promethazine

Question 10

diarrhea & sick contacts after traveling. what do you suspect?

Answer 10

acute gastroenteritis

Question 11

two effective meds for migraine-induced N/V? why don’t we like to use one of them?

Answer 11

promethazine & ondansetron (causes HA as ADR)

Question 12

preferred med & formulation for opioid-induced N/V?

Answer 12

small IM dose of haloperidol

haloperidol is used to tx mental conditions

Question 13

delayed emptying w/o mechanical obstruction causing early satiety, bloating, N/V, anorexia, belly pain, wt loss

what is this and list 5 potential causes

Answer 13

gastroparesis (gut stasis)
- DM
- gastric surgery
- pseudoobstruction
- GI infection
- anorexia nervosa

Question 14

5 ways to diagnose gastroparesis

Answer 14

H&P
endoscopy
barium swallow
gastic emptying scintigraphy
gastroduodenal manometry

Question 15

tx goal & 3 dietary changes to help manage gastroparesis

Answer 15

goal: reverse/correct it
* less solid foods
* smaller, frequent meals
* less fiber & fat

Question 16

2 classes of meds and 1 surgical tx for gastroparesis

Answer 16

• prokinetics: metoclopramide(also anti-emetic), erythromycin, cisapride
• antiemetics: promethazine
• surgery: endoscopic decompressive gastrostomy

Question 17

acts on central (postrema/CTZ) dopamine D2 antagonist; also M1 and H1-receptor blocking activity

what is this med and what are 5 main SE?

Answer 17

Promethazine (a phenothiazinel)
* EPS
* gangrene
* high dose– resp depression
* sedation
* anti-SLUDGE effects

Question 18

what does sludge in anti-SLUDGE mean?

Answer 18

salivation
lacrimation
urination
defecation
gastritis
emesis

Question 19

which antiemetic is avoided in elderly male patients because it shouldnt be used in people with big prostates or BPH?

Answer 19

promethazine

Question 20

prokinetic, increases peristalsis in upper gut; acts as central & peripheral D2 receptor antagonist (low doses). Weak serotonin-receptor blocker (high doses)

what is this medication? what are SE and when should it be avoided?

Answer 20

metoclopromide
SE: EPS, sedation/depression, restlessness
avoid in GI tract obstruction

Question 21

blocks 5-HT3 receptor at CTZ and GI tract; antiemetic action d/t effect on abdominal vagal afferent nerve; also has CNS effect

what medication? SE? when should it be avoided?

Answer 21

ondansetron
* SE: HA, constipation, hiccups
* avoid w/ drugs that prolong QT & in 1st trim pregnancy

Question 22

which medication is great for N/V from surgery and chemo, can be used as prophylaxis and is also considered the cornerstone for acute emesis?

Answer 22

ondansetron

Question 23

patch work the night before motion sickness (prophylaxis) and lasts 3 days; an M1 antagonist

(1) what is this and what are the SE? (4)

Answer 23

hyosciene (an anticholinergic)
SE: dry mouth, visual issues, weird behavior in eldery, drowsiness

Question 24

D2 antagonist blocks action of ACh, improving N/V; commonly used in palliative care

what is this? list 3 SE and 1 indication

Answer 24

haloperidol
SE: EPS, tardive dyskinesia, sedation
Indication: N/V from chemical/drugs (includes opioids)

Question 25

when are canniboids best used?

Answer 25

when added to anti-emetic tx for chemo