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Nausea/Vomiting Flashcards

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1
Q

What are the types of non-pharmacologic therapy

A

Dietary
Physical
Psychological changes

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2
Q

What are dietary therapies for N/V?

A

Frequent small meals, avoid spicy or fatty foods, eat high-protein snacks

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3
Q

What are dietary therapies for NVP?

A

Normal dietary therapies plus:
Eat bland/dry foods first thing in the morning
Some evidence that taking a multivitamin at the time of conception may result in less likelihood of seeking medical treatment

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4
Q

What is a natural dietary therapy for motion sickness and dyspepsia?

A

Peppermint oil

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5
Q

What is a natural dietary therapy for motion sickness and NVP?

A

Ginger

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6
Q

What are physical therapies for N/V?

A

Acupuncture

Sea-Band

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7
Q

How do physical therapies work for N/V?

A

P6 (neiguan) point on the inside of the wrist
Results conflicting
Acupuncture wrist bands may be effective in preventing PONV or motion sickness

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8
Q

What are psychological therapies for N/V?

A

Hypnosis - may be effective for severe NVP

Psychotherapy - may be effective for hyperemesis gravidum

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9
Q

What are the types of phenothiazines?

A

Promethazine

Prochlorperazine

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10
Q

What is the MOA of promethazine?

A

D2 dopaminergic receptor blocker
Muscarinic-1 receptor blocker
Histamine-1 receptor blocker

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11
Q

What are the typical uses of promethazine?

A

General use

Acute vomiting of central origin (notion sickness, migraine)

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12
Q

What are ADRs of promethazine?

A

Sedation is common
May cause EPS
Injection site irritation (don’t use SQ)
-IV formulation should be diluted b/c of risk of tissue necrosis

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13
Q

What is the MOA of Compazine?

A

Mainly D2 dopaminergic receptor blocker

Some Muscarinic-1 and H-1 blockade

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14
Q

What are the typical uses of Compazine?

A

General use

Acute vomiting of central origin (motion sickness, migraine)

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15
Q

What are the ADRs of Compazine?

A

May cause EPS

Injection site irritation (don’t use SQ)

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16
Q

What are the serotonin antagonists?

A

Zofran
Granisetron (Kytril)
Palonosetron (Aloxi)
Dolasetron (Anzemet)

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17
Q

What is the MOA of serotonin antagonists?

A

5-HT3 receptor antagonist

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18
Q

What are the typical uses for serotonin antagonists?

A

General use

PONV, CINV, RINV, refractory nausea

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19
Q

What are the ADRs of Zofran and Dolasetron?

A

Contraindicated with apomorphine

Associated with QT prolongation; correct hypoMG and hypoK

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20
Q

What are the ADRs of granisetron?

A

Associated with QT prolongation

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21
Q

What are the ADRs of antihistamines

A

Risk of sedation and anticholinergic effects

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22
Q

What are the butyrophenones?

A

Haloperidol

Droperidol

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23
Q

What is the MOA of butyrophenones?

A

D2 dopaminergic receptor blocker

M1 receptor blocker

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24
Q

What is the typical use for butyrophenones?

A

PONV

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25
What is the typical use for antihistamines?
Motion sickness
26
What are the ADRs of butyrophenones?
Risk of EPS BBW for risk of QT prolongation and Torsades Requirement for baseline ECG and 2-3 hr postdose cardiac monitoring
27
What are the NK1 antagonists?
Aprepitant (oral) & Fosaprepitant (Injection) (Emend) Netupitant/palonsetron (Akynzeo) Rolapitant (Varubi)
28
What is the typical use of NK1 antagonists?
CINV
29
What are the ADRs Emend?
Fatigue, hiccups Reduces efficacy of warfarin and oral contraceptives Dose-dependent inhibitor of CYP 3A4
30
What are the ADRs of Akynzeo?
Avoid in severe renal or hepatic disease
31
What is the antimuscarinic agent?
Scopolamine
32
What are the typical uses of scopolamine?
Motion sickness | PONV
33
What are cannabinoids?
Dronabinol (Marinol) | Nabilone (Cesamet)
34
What are the cannabinoids MOA?
CB1 and CB2 receptor agonists (Antiemetic effect d/t CB1 agonist activity)
35
What are the typical uses of cannabinoids?
CINV | Refractory vomiting
36
What are the ADRs of cannabinoids?
May cause appetite stimulation, euphoria, cognitive impairment, hypotension, psychotropic reactions
37
What is Metoclopramide's MOA?
D2 receptor blocker
38
What are the typical uses of metoclopramide?
Prokinetic agent used most often for gastroparesis | Also used for PONV, CINV, RINV
39
What are the ADRs of Metoclopramide?
BBW for tardive dyskinesia (if used for more than one month) | Restlessness, anxiety, somnolence, EPS, QT prolongation
40
What are the typical uses of phosphorylated carbohydrate solution?
Upset stomach that occurs with GI virus or food indiscretions
41
What are the clinical pearls associated with phosphorylated carbohydrate solutions?
Avoid in diabetes and fructose intolerance | Safe in pregnancy
42
What is MOA of erythromycin?
Motilin receptor agonist
43
What are the typical uses of erythromycin?
Gastroparesis
44
What are the ADRs of erythromycin?
GI upset Diarrhea N/V
45
What are the typical uses of medrol and dexamethasone?
CINV RINV PONV
46
What are the ADRs of medrol and dexamethasone?
GI upset Anxiety Insomnia
47
What is the MOA of lorazepam?
GABA agonist
48
What are the typical uses of lorazepam?
Anticipatory | N/V
49
What are the ADR of lorazepam?
Sedation | Amnesia
50
What are the typical uses of antacids/H2RAs?
Nausea associated with gastric acid
51
What is the MOA of doxylamine/pyridoxine (Diclegis)
H1 receptor blocker
52
What is the MOA of Sea-Bands?
Stimulates the pericardium (P6) point
53
What are the typical uses of Sea-Bands?
All types of nausea
54
What are the common diseases associated with gastroparesis?
Diabetes | Hypothyroidism
55
What is the 1st step in treatment of gastroparesis?
Diagnosis: 4H gastric emptyping by scintigraphy
56
What is the 2nd step in treatment of gastroparesis?
Exclude iatrogenic disease: Dietary: low fat, low fiber diet Glycemic control among diabetics
57
What is the 3rd step in treatment of gastroparesis?
Pharmacological Rx: Prokinetics: metoclopramide, erythromycin, demperidone Antiemetics: antihistamines, 5-HT3 receptor antagnoists
58
What is the 4th step in treatment of gastroparesis?
Nutritional support: Enteral formula
59
What is the 5th step of treatment of gastroparesis?
``` Non-pharmacological rx: Pyloric injection of botulinum toxin Venting gastrostomy, feeding jejunostomy Parenteral nutrion Gastric eletrical stimulation Pyloroplasty Partial gastrectomy ```
60
What will decrease the occurence of NVP if taken at the time of conception?
vitamins
61
What are the non-pharmacologic therapies for NVP?
Rest Avoidance of provoking stimuli Frequent and small meals, avoiding spicy or fatty foods Powdered ginger capsules 250mh qid
62
What are the pharmacologic therapies for NVP?
``` Multivitamins at time of conception Diclegis Phenothiazines (in refractory cases) Corticosteroids (last resort therapy in hyperemesis gravidum) IV hydration Enteral nutrion/TPN Zofran (preg cat B) ```
63
Who receives prophylaxis for PONV?
Only necessary with patients at moderate to high risk for PONV
64
What are risk factors for PONV?
``` Female Non-smoker h/o motion sickness h/o PONV Volatile anesthetics NO Opioids ```
65
What is the treatment for PONV if no prophylaxis was given?
any agent is useful
66
What is the treatment for PONV if prophylaxis was given?
``` If < 6 hours post-op: select therapy from a different drug class If > 6 hours post-op: any agent is acceptable except dexamethasone or scopolamine ```

GI/Hepatic (7 decks)

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