Nausea/Labrinyth disorders, Pain Flashcards
(29 cards)
Which anti-emetics are used for nausea and vomiting in palliative care?
levomepromazine
haloperidol
What are the rules for metoclopramide?
10mg TDS
> 18 years
max 5 days use
What are the rules for domperidone?
10mg TDS
> 12 years
> 35kg
max 7 days
Which anti-emetics are used for motion sickness?
hyoscine hydrobromide
cyclizine
cinnarizine
promethazine
Which anti-emetics are used for chemotherapy or post operative nausea and vomiting?
5-HT3 antagonists: ondansetron, granisetron
dexamethasone
When is aprepitant?
severe nausea in chemotherapy alongside dexamethasone + 5-HT3 antagonist
What is a major side effects of domperidone?
QT prolongation
arrhythmias (risk of cardiac side effects): report syncope, palpitations
What are the treatment options for Meniere’s disease?
betahistine: reduces frequency of attacks, reduces severity of symptoms
antihistamines and phenothiazines: prochlorperazine, cinnarizine
What is a major side effect of metoclopramide? How is it treated?
acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crises
- common in the young (especially girls and young women) and the very old
antiparkinsonian drug such as procyclidine will abort dystonic attacks.
What are side effects of 5-HT3 antagonists?
QT prolongation
What analgesics are useful in
musculoskeletal pain
dental pain
moderate to severe visceral pain
period pain
neuropathic pain
nerve compression by tumour
bone metases
musculoskeletal pain: non-opioids - NSAIDs, paracetamol
dental pain: NSAIDs
moderate to severe visceral pain: opioids
period pain: oral contraceptives, anti-spasmodics, non-opiods
neuropathic pain: TCAs, anti-epileptics
nerve compression by tumour: dexamethasone
bone metases: bisphosphonate, strontium
What is the pain ladder?
step 1: paracetamol, aspirin, NSAIDs
step 2: codeine, dihydrocodeine, tramadol
step 3: morphine, diamorphine, methadone, fentanyl, buprenorphine
What is a major caution for paracetamol?
hepatotoxicity if <50kg
- dose limit is 1g TDS
What pain medication should be avoided in sickle cell disease?
pethidine: can cause seizures
When is aspirin CI?
< 16 years: Reye’s syndrome
active ulceration
bleeding disorder
Which opioids are NOT Schedule 2 CDs?
codeine tablets - Schedule 5
meptazinol - POM
tramadol - Schedule 3
buprenorphine - Schedule 3
pentazocine - Schedule 3
How is break through pain dosing calculated?
1/6 - 1/10 of total daily dosing of strong opioids, every 2-4 hrs PRN
What are the symptoms of opioid overdose? What is the treatment?
coma
pinpoint pupils
respiratory depression
treatment: naloxone, can be supplied without a prescription
What are the side effects of opioids?
MORPHINE
miosis (pinpoint pupils), muscle rigidity
out of it (sedation, confusion, reduced concentration)
respiratory depression
postural hypotension
hyperalgesia, hallucinations
infrequency (urinary retention, constipation)
nausea and vomiting (esp morphine)
euphoria (morphine s/e)
What are long term side effects of opioids?
hypogonadismL reduced fertility, amenorrhoea, erectile dysfunction
adrenal insufficiency
hyperalgesia
When are opioids CI?
comatose patient: neurological depression
risk of paralytic ileus: opioids reduce GI motility
respiratory depression: opioids reduce respiratory drive
head injury or raised intracranial pressure: opioids interfere with pupillary responses
How should morphine dosing be increased? What is the equivalent parenteral dose to oral? What is the equivalent dose of diamorphine to oral morphine?
increased by 1/3-1/2 of the total daily dose per 24hrs
half oral dose = parenteral dose
1/3 oral morphine = diamorphine
When is codeine CI?
ultrametabolisers: CYP2D6
breastfeeding mothers: passes to babies through breast milk
children < 12 years
What is the counselling for transdermal patches?
avoid the same site: depends on patch timing
avoid for 3 weeks if 7 day patches
avoid for 7 days if 3-4 day patches
avoid heat and saunas: can increased absorption
remove if SOB, drowsiness, confusion, drowsiness, dizziness
