Nausea and vomiting

Question 1

Outline GI causes of vomiting

Answer 1

Gastroenteritis
peptic ulcers
appendicitis
Infection

Question 2

Outline Organic causes of vomiting

Answer 2

Renal failure
DKA
MI

Question 3

Outline CNS causes of vomiting

Answer 3

Migraine
Vestibular disturbances
Meningitis

Question 4

What is the reason for motion sickness

Answer 4

Conflicting information between eyes and body

Question 5

What age is most common for motion sickness

Answer 5

3-12 years

Question 6

What drugs can cause vomiting

Answer 6

Opiates
antibiotics
digoxin
theophylline
chemo

Question 7

Symptoms of Meniere’s disease

Answer 7

Vertigo
nausea and vomiting
tinnitus
hearing loss

Question 8

What causes Meniere’s disease

Answer 8

Excess fluid in labyrinth canals

Question 9

What are the causes of vertigo

Answer 9

Labyrinthtiis
benign paroxysmal positional vertigo (BPPV)

Question 10

When is morning sickness most common

Answer 10

first trimester

Question 11

What causes morning sickness

Answer 11

High levels of hCG

Question 12

What is hyperemesis gravidarum

Answer 12

Severe persistent N&V during pregnancy

Question 13

What are the symptoms of hyperemesis gravidarum

Answer 13

Weight loss
dehydration
ketone acidosis

Question 14

What are some of the reasons we treat N&V

Answer 14

Unpleasant
dehydration
renal impairment –> AKI
weight loss
electrolyte abnormalities

Question 15

What does projectile and sour smelling vomit could mean

Answer 15

Pyloric stenosis

Question 16

What is pyloric stenosis

Answer 16

Narrowing of pylori so food cant go down easily

Question 17

When do we refer N&V

Answer 17

Weight loss
blood
severe dehydration
dizziness
abdominal pain

Question 18

Give an example of a H1 receptor antagonist

Answer 18

Cinnarizine
Cyclizine

Question 19

What are the side effects of H1 antagonists

Answer 19

Drowsiness
dizziness

Question 20

Where do H1 antagonists work

Answer 20

In vestibular nuclei
H1 activation doesn’t happen and send signals to CTZ for the vomiting centre

Question 21

Give an example of an antimuscarinic drug

Answer 21

Hyoscine

Question 22

How do antimuscarinics work

Answer 22

On M1 receptors
In vestibular nuclei
H1 activation doesn’t happen and send signals to CTZ for the vomiting centre
antispasmodic gut action
Receptors in vomiting centre

Question 23

What are some side effects of antimuscarinics

Answer 23

decrease in parasympathetic activity
Drowsiness
dry mouth
decreased gut motility
Increased intraocular pressure

Question 24

When is hyoscine contraindicated

Answer 24

Glaucoma
urinary retention

Question 25

Give an example of D2 antagonist

Answer 25

Prochlorperazine Metoclopramide domperidone

Question 26

How does prochlorperazine work

Answer 26

CTZ --> cant send signals to vomiting centre Higher centres --> not in response to sights, smells, pain Mu receptors --> reduces dizziness and vestibular disturbances

Question 27

What are the side effects of prochlorperazine

Answer 27

Drowsiness blurred vision dry mouth parksinsons life effects

Question 28

How does metoclopramide work

Answer 28

Blocks D2 receptors --. CTZ, higher centres Blocks 5-HT --> vestibular disturbances, gut and enterochromaffin cells acts centerally and peripherally

Question 29

What is the max dosage for metoclopramide

Answer 29

30mg a day for 5 days

Question 30

What antipsychotics cant you give with D2 antagonists

Answer 30

Haloperidol Levomepromazine

Question 31

How is domperidone different to prochlorperazine and metoclopramide

Answer 31

Doesnt pass BBB

Question 32

What conditions are domperidone useful in

Answer 32

Parkinsons as it doesnt act centerally migraines GI disorders

Question 33

Give an example of a 5-HT3 antagonist

Answer 33

Ondasetron GranisetronHo

Question 34

How do 5-HT3 antagonists work

Answer 34

peripherally --> Enterochromaffin cells, vagal responses, centrally --> On CTZ, higher centres

Question 35

Give an example of an NK1 antagonist

Answer 35

Aprepitant

Question 36

How do NK1 antagonists work

Answer 36

Blocks NK-1 from substance P in higher centres

Question 37

When do we use corticosteroids for anti-emetics

Answer 37

Chemotherapy

Question 38

What cells are based in the GI tract

Answer 38

enterochromaffin

Question 39

What hormone do enterochromaffin cells release

Answer 39

serotonin by mechano and chemo receptors

Question 40

What receptors detect seretonin

Answer 40

5-HT3

Question 41

What are the hormones and their receptors in the higher centres

Answer 41

Dopamine --> D2 Substance P --. NK1 Seretonin --> 5-HT

Question 42

What does acivity from the higher centre come as a response from

Answer 42

emotional pain smell taste

Question 43

Where is the vomiting centre located

Answer 43

Medulla oblongata

Question 44

What type receptors are found within the vomit centre

Answer 44

Muscarinic

Question 45

Where is the CTZ located

Answer 45

Peripherally outside BBB

Question 46

Why is it good the CTZ being peripherally

Answer 46

Can detect toxins easier due t being extra permeable

Question 47

What receptors are found in the CTZ

Answer 47

D2 5-HT

Question 48

What does stimulation of CTZ do

Answer 48

Sends signals to vomting centre in medulla oblongata

Question 49

What part in the vestibular system detects balance and motion

Answer 49

Labyrinth

Question 50

What nerve sends electrical signals from the labyrinth to vestibular nuclei

Answer 50

Vestibular cochlea nerve

Question 51

What receptors are found in the vestibular nuclei

Answer 51

H1 5-HT

Question 52

List some autonomic responses to the vomiting centre

Answer 52

LOS relaxes Increased HR Increased sweating Increased saliva

Question 53

List some somatomotor responses to the vomiting cnetre

Answer 53

Diaphragm and abdominal muscle contractions Closure of glottis --> substances cant go back up