Nausea And Vomiting

Question 1

Vomiting

Answer 1

Forceful expulsion of gastric contents from the mouth

Question 2

What physical actions create vomiting

Answer 2

Powerful sustained contraction of abdo muscles
Diapragm descent
Opening of LOS
Gastric Retropulsion

Question 3

Which muscles contract during vomiting

Answer 3

Abdominal muscles
Diapragm

Question 4

Nausea

Answer 4

Unpleasant sensation and awareness of urge to vomit

Question 5

What are effects of prolonged nausea

Answer 5

Dehydration
Anorexia
Broken ribs - repetitive vomiting
Refusal of medications

Question 6

Cyclic vomiting syndrome

Answer 6

Rapid fire Projectile vomiting lasting a few hrs to several days abt 10 times a yr followed by asymptomatic periods

Question 7

Gastroparesis symptoms

Answer 7

Early satiety after eating
Postprandial fullness
Nausea
Vomiting
Belching
Bloating

Question 8

What can cause nausea and vomiting

Answer 8

Chemo
Radiotherapy
GI disease
Infections
Severe pain
Intra cranial disease
Labyrinthine/vestibular disorder
Pregnancy
Psychological
Migraine
Circulatory syncope
Exogenous emetic substances

Question 9

Which nucleus receives sensory inputs and coordinates motor outputs for vomiting

Answer 9

Nucleus tractus solitarius

Question 10

What nuclei cause vomiting

Answer 10

Nucleus ambiguus
Ventral resp group of neurones
Dorsal motor vagal nucleus

Question 11

Which type of drugs are commonly used for motion sickness

Answer 11

Muscarinic receptor agonists

Question 12

How does diphenhydramine work

Answer 12

H1 receptor antagonist
M2 receptor antagonist

Question 13

What molecule is diphenhydramine usually combined with and why

Answer 13

8-chlorotheophylline -> dramamine
Counteract drowsiness

Question 14

What is a side effect of diphenhydramine

Answer 14

Drowsiness

Question 15

What type of drug is cyclizine

Answer 15

H1 receptor antagonist

Question 16

What can cyclizine be used to treat

Answer 16

Vertigo
Motion sickness
Labyrinthine disorders

Question 17

What type of drugs are phenothiazines, metoclopramide, and domperidone

Answer 17

Dopamine d2 receptor antagonists

Question 18

Side effects of D2 receptor antagonists

Answer 18

Pseudoparkinsonism
Acute distonia
Akathisia
Tardive dyskinesia

Question 19

What is the only drug to treat gastroparesis

Answer 19

Metoclopramide

Question 20

What is metoclopramide used to treat

Answer 20

Post operative care
Gastritis
Migraine
Dysmenorrhea
Drug/treatment induced emesis inc anaesthesia radio and chemo
GE reflux
Gastroparesis
Functional dyspepsia

Question 21

Can domperidone cross the BBB

Answer 21

no

Question 22

Can diphenhydramine cross the BBB

Answer 22

Yes

Question 23

Why can domperidone not be used when cardiac function is impaired or pt has underlying cardiac disease

Answer 23

Can cause ventricular arrhythmia

Question 24

What drug types reduce vestibular system signalling to the NTS to prevent nausea and vomiting

Answer 24

M3/5 receptor antagonists
H1 receptor antagonists

Question 25

Are anti emetic drugs disease specific

Answer 25

No except for motion sickness

Question 26

What are effects of the severe nausea and vomiting experienced by chemotherapy patients without anti emetic treatments

Answer 26

Treatment refusal Tears in oesophag-gastric mucosa Vertebral collapse Metabolic alkalosis Hypokalaemia Hypocholoraemia Extracellular fluid depletion Dehydration - exacerbates nephrotoxicity Malabsorption Anorexia Stress Incapacitation

Question 27

What are the 3 types of vomiting

Answer 27

Acute Delayed Anticipatory

Question 28

Cannabinoid hyperemesis syndrome

Answer 28

Some chronic cannabis users develop severe cyclic vomiting and abdo pain starting in 3rd decade

Question 29

Can THC be used to treat mild moderate or severe emesis

Answer 29

Mild or moderate

Question 30

What are 5-HT3 receptor antagonists used to treat

Answer 30

Acute chemotherapy and radiation induced emesis

Question 31

How does chemo cause vomiting

Answer 31

Chemo causes 5HT to be released from upper GI enterochromaffin cells which activates and sensitises the vagus nerve, cell breakdown releases inflammatory mediators

Question 32

Are 5-HT3 receptor agonists effective against acute or delayed emesis

Answer 32

Acute

Question 33

What causes acute emesis after chemo

Answer 33

5HT released from enterochromaffin cells activates 5HT3 receptors on vagus

Question 34

What causes delayed emesis after chemo

Answer 34

Cell breakdown produces inflammatory mediators

Question 35

What is given with 5HT receptor agonists for moderately severe emesis

Answer 35

Dexamethasone

Question 36

What are NK1 receptor antagonists used for

Answer 36

Further control when given with other antiemetics

Question 37

What part of the brain do dopamine receptor antagonists act on

Answer 37

Area postrema

Question 38

Are NK1 receptor agonists better for acute or delayed emesis

Answer 38

Delayed

Question 39

How do NK1 receptor antagonists work

Answer 39

Block actions of substance P - a NT used by vagus and some brainstem nerves

Question 40

What combination of drugs is given for severe emesis

Answer 40

5HT3 receptor antagonist + NK1 receptor antagonist + Dexamethasone

Question 41

What can cause vomiting in palliative patients

Answer 41

Opiate medications Reflux Gastric stasis Intestinal obstruction

Question 42

How is partial bowel obstruction treated

Answer 42

Stim GI propulsion - metoclopramide prucalopride

Question 43

How is total bowel obstruction treated

Answer 43

Reduce inflammation - dexamethasone Reduce fluid build up in bowel - octreatide, nasogastric tube, venting, gastronomy tube

Question 44

Types of anti emetics

Answer 44

5HT3 antagonists NK1 antagonists D2 antagonists H1 antagonists Anticholinergic Corticosteroid Naturals Adjuncts

Question 45

What type of drug is olanzapine

Answer 45

Atypical antipsychotic Antagonises loads of receptors

Question 46

What can olazapine be used for

Answer 46

Nausea (given w 5HT3 NK1 and Dexamethasone) Breakthrough vomiting

Question 47

Interoception

Answer 47

Sensations of all tissues of the body, of physiological conditions or internal states, and of self awareness

Question 48

Which brain areas have sustained activation during nausea

Answer 48

Interoceptive Limbic Somatosensory Cognitive

Question 49

What conditions cause gastric dysrhythmia

Answer 49

Gastroparesis Functional dyspepsia GERD Motion sickness Cycling vomiting syndrome Nausea of pregnancy Abdominal malignancy Chronic renal failure Anorexia Chronic intestinal pseudo obstruction Ischemic gastropathy

Question 50

What is the only anti emetic used for gastroparesis

Answer 50

Metoclopramide

Question 51

Tachygastria

Answer 51

Electrical activity in stomach in random uncontrolled pattern