Nausea Flashcards
(23 cards)
Name common drugs that cause N&V:
Opiates
Antibiotics (doxy)
Digoxin
Levodopa
Aminophylline/theophylline
Chemo
What are the symptoms of Ménière’s disease?
Incapacitating attacks characterised by:
-giddiness, vertigo, N&V
-hearing loss
-functional paralysis
-tinnitus
Sudden onset, lasts 20mins to several hours
Migraine present in 30%
What is BPPV?
Benign Paroxysmal Positional Vertigo
Movement of naturally occurring calcium salts
Name some vestibular toxic drugs:
Aminoglycosides e.g gentamicin
Anticonvulsants
Furosemide- max rate 4mg/min- ototoxicity
NSAIDs
Quinine
Name a severe form of morning sickness:
Hyperemesis Gravidarum
Describe the severity of symptoms of N&V that would require referral:
Projectile vomiting- pyloric stenosis
Sour smelling vomiting- pyloric stenosis
Blood in vomit
What are the CI for promethazine:
Glaucoma and other muscarinic/ dopaminergic
What are the SEs of anticholinergics?
Drowsiness, dry mouth, dry skin, decreased gut motility
Increased IOP and HR
What are the CI of anticholinergics aka muscarinics?
Glaucoma and urinary retention
Name SEs of prochlorperazine:
Anti-dopaminergic- extrapyramidal e.g dystonia, dyskinesia, Parkinsonism- all more than chlorpromazine
Anti-cholinergic- drowsiness, blurred vision, dry mouth
What are the counselling points for chlorpromazine?
More sedative effects than prochlorperazine
Used in palliative care
Contact senitisation- carer don’t touch them
What is the dosing of metoclopramide and why?
Max 30mg/day for 5 days (10mg QDS)
Lowest dose for shortest time
Neurological adverse effects- acute dystolic reactions, movement disorders
What are the SEs of metoclopramide?
10% experience transient SEs; drowsiness dizziness, anxiety
Extrapyrmidal SEs e.g dystonia, tardive dyskinesia, oculogyric crisis) more common in 12-19 yrs and females
What are the interactions with metoclopramide?
Cyp2D6 inhibitor
Fluoxetine, paroxetine
Causes increase in metoclopramide
What is the dosing of domperidone and why?
Lowest dose for shortest time- max 1 week due to CV risk
What are the CI of domperidone?
Cardiac disease (irregular HR, QT) or any meds that cause QT prolongation e.g methadone, citalopram, amiodarone
Not in children and those less than 35kg
What are the interactions of domperidone?
CYP3A4 inhibitors e.g macrolides, azoles
Leads to higher doses of domperidone
What are CIs of ondansetron?
QT prolongation drugs or abnormality as can increase risk of ventricular arythmias- congenital long QT syndrome
What are the common SEs of ondansetron?
Constipation, feeling hot, headache, hypotension
QT prolongation
What are the interactions with ondansetron?
Many CYP enzymes such as inducers which increases clearance of ondansetron
What are the first line treatments for morning sickness?
Promethazine
Prochloperazine
Cyclizine
Doxylamine and pyridoxine
Chlorpromazine
What are the second line treatments for morning sickness?
Domperidone
Ondansetron- avoid in first 12 weeks due to orofacial cleafing
Metoclopramide
