Nausea/Vomiting Flashcards Preview

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Flashcards in Nausea/Vomiting Deck (66):
1

What are the types of non-pharmacologic therapy

Dietary
Physical
Psychological changes

2

What are dietary therapies for N/V?

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

3

What are dietary therapies for NVP?

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

4

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

Peppermint oil

5

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

Ginger

6

What are physical therapies for N/V?

Acupuncture
Sea-Band

7

How do physical therapies work for N/V?

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

8

What are psychological therapies for N/V?

Hypnosis - may be effective for severe NVP
Psychotherapy - may be effective for hyperemesis gravidum

9

What are the types of phenothiazines?

Promethazine
Prochlorperazine

10

What is the MOA of promethazine?

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

11

What are the typical uses of promethazine?

General use
Acute vomiting of central origin (notion sickness, migraine)

12

What are ADRs of promethazine?

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

13

What is the MOA of Compazine?

Mainly D2 dopaminergic receptor blocker
Some Muscarinic-1 and H-1 blockade

14

What are the typical uses of Compazine?

General use
Acute vomiting of central origin (motion sickness, migraine)

15

What are the ADRs of Compazine?

May cause EPS
Injection site irritation (don't use SQ)

16

What are the serotonin antagonists?

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

17

What is the MOA of serotonin antagonists?

5-HT3 receptor antagonist

18

What are the typical uses for serotonin antagonists?

General use
PONV, CINV, RINV, refractory nausea

19

What are the ADRs of Zofran and Dolasetron?

Contraindicated with apomorphine
Associated with QT prolongation; correct hypoMG and hypoK

20

What are the ADRs of granisetron?

Associated with QT prolongation

21

What are the ADRs of antihistamines

Risk of sedation and anticholinergic effects

22

What are the butyrophenones?

Haloperidol
Droperidol

23

What is the MOA of butyrophenones?

D2 dopaminergic receptor blocker
M1 receptor blocker

24

What is the typical use for butyrophenones?

PONV

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