treatment of vomiting and gut motility disorders Flashcards by Susannah Bath

what two brain units control vomiting

vomiting centre

chemoreceptor trigger zone

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what are the two main divisions of the medulla oblongata

vital centre and non vital centre

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where is the vomiting centre

lateral reticular formation of the medulla

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what stimulates the vomiting centre

CTZs

vagal afferents from the gut

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where is the CTZ

floor of the fourth ventricle (pons/ upper medulla)

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describe the stimuli of the CTZ

chemical stimuli
site of action of drugs that inhibit or stimulate drugs
stimulated by motion sickness which is stimulated by vestibular apparatus

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what are the 3 phases of vomiting

nausea + autonomic effects
retching (unproductive)
vomiting- expulsion of gastric contents

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what can trigger vomiting

Stimulation of sensory nerve endings in stomach & duodenum
Stimulation of vagal sensory endings in pharynx
Drugs or endogenous emetic substances
Disturbances of vestibular apparatus
Stimulation of certain sensory nerves of the heart and viscera
Rise in intracranial pressure
Nauseating smells, repulsive sights, emotional factors
Endocrine factors
Migraine

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what are the types of vomiting

Large volumes
Projectile vomiting
Suggestive of gastric outlet or upper GI obstruction
Small amounts
Nausea
Frequent regurgitation of small amounts of gastric contents
Usually psychogenic
Haematemesis
Vomiting fresh or altered blood “coffee-grounds”)
Early-morning
Pregnancy
Alcohol dependence
Metabolic disorders e.g. uraemia

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what drug can stimulate vomiting

IPECACUANHA, emetine, cephaline

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what are the names of histamine receptor antagonists

CINNARAZINE
CYCLIZINE
PROMETHAZINE
DIPHENHYDRAMINE &amp; DIMENHYDRINATE
Marked sedative effects

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what are muscarinic receptor antagonist used for

motion sickness e.g. hyoscine

can cause drowsiness and dry mouth

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what are the names of some phenothiazines

CHLORPROMAZINE
PROCHLORPERAZINE
TRIFLUOPERAZINE

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what phenothiazines used for

CTZ triggered vomiting

act as dopamine antagonist

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what is metoclopromide

dopamine antagonist

used to treat diabetic gastroparesis and reflux

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what are cannabinoids used for

decrease nausea associated with cytotoxic drugs

TETRAHYDROCANNIBINOL (THC)
NABILONE

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what steroids are used to treat chemo induced emesis

dexamethasone

methylprednisolone

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what is the name of a 5-hydroxytryptamine antagonist which is a serotonin antagonist used as an anti emetic

ondansetron

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what is a neuroleptic

a substance that depresses nerve activity

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what neuroleptics are used to treat emesis (dopamine antagonist)

haloperidol
droperidol
domperidone

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name some osmotic laxatives

saline
magnesium sulphate
hydroxide
lactulose

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name some faecal softeners

dioctyl sodium sulphosuccinate

liquid paraffin

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name some stimulant purgatives

castor oil
senna
bisocadyl
sodium picosulphate

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what other drugs can be used for gut motility disorders

MUSCARINIC AGONISTSANTICHOLINESTERAES
DOMPERIDONE
METOCLOPROMIDE

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how can diarrhoea be treated

maintain fluid and electrolyte balance use of an anti-infective agent inflammatory anti diarrhoeal agents

what opiates can be used as anti motility agents

LOPERAMIDE (MORPHINE) (CODEINE)

what adsorbants can be used as antimotility agents

``` Adsorbants KAOLIN PECTIN CHALK CHARCOAL METHYL CELLULOSE ACTIVATED ATTAPULGITE ```

what drugs can be used to dissolve non calcified cholesterol gallstones

CHENODEOXYCHOLIC ACID (CDCA) | URSODEOXYCHOLIC ACID (UDCA)

what painkillers can be used for biliary colic

morphine | buprenone or pethidine are better because they do not constrict the sphincter of Oddi

what can be used to relieve biliary spasm

atropine

what processes are involved in emesis

stomach opens muscle contracts sphincters need to open

where is the fourth ventricle

behind the brain stem | this is where the CTZ is

where is the vomiting centre

lateral reticular formation of the medulla

what causes motion sickness

vestibular apparatus stimulate the CTZ. a mismatch between the eyes and vestibular apparatus in the ear cannals

what is the other part of the brain that can stimulate vomiting

higher cortical centres eg in fear,

what are some unusual causes of nausea

lowered intracranial pressure infection and inflammation around the heart or viscera endocrine factors eg dopamine, progesterone and oestrogen

what is emetine and cephaline

induce vomiting

what are diphenhydramine and dimenhydrinate

histamine 1 receptor antagonists that are anti emetic and also are sedatives

what are histamine antagonists also used for

allergies and hayfever

what is cinnarazine, cyclizine and promethazine

histamine 1 antagonists

what is hyoscine

motion sickness | drowsiness and dry mouth

what do phenothiazines do

decrease dopamine in the brain

what are phenothiazines also used for

anti psychotics endocrine sickness e.g. morning sickness, radiotherapy, gastroenteritis dopamine 2 antagonist

what is chlopromazine

a phenothiazine which is an antiemetic D2 antagonist which acts in CTZ hence good for chemically induced emesis but not stomach

what is prochlorperazine

a phenothiazine which is an antiemetic D2 antagonist which acts in CTZ hence good for chemically induced emesis but not stomach

what is trifluoperazine

a phenothiazine which is an antiemetic D2 antagonist which acts in CTZ hence good for chemically induced emesis but not stomach

what might be the symptoms of uraemia

vomiting and headaches

what is metoclopramide

dopamine 2 antagonist also used in schizophrenia same type of nausea and emesis and phenothiazines

what is tetrahydrocannibol (THC)

a cannabinoid

what is nabilone

a synthetic derivative of THC | decreases chemo associated sickness

what is dexamethasone and methylprednisone

``` steroid used in emesis reduces intra cranial pressure used for severe vomiting immunosuppressive many side effects ```

what is ondansetron

serotonin receptor antagonist for severe and prolonged vomiting it is a 5HT3 antagonist

what is haloperidol

neuroleptic dopamine antagonist

what is droperidol

neuroleptic dopamine antagonist

what is domperidone

neuroleptic dopamine antagonist

what is a side effect of opiates

decreased gut motility

what are methyl cellulose, stercula, agar, bran and ispaghula husk

bulk laxatives | not digested

what is saline, magnesium sulphate, hydroxide, lactulose

osmotic laxatives | they retain water and trigger peristalsis

what is dioctyl sodium sulphosuccinate and liquid paraffin

faecal softeners | break up faeces

what is castor oil, senna, bisocadyl and sodium picosulphate

stimulant purgatives tiggers bowel evacuation acts when it is in the stomach

what is the problem with muscarinic agonists and anticholinesterases

toxic

what are these drugs: muscarinic agonists, anticholinesterases, domperidone, metoclopromide

speeds up the passage of food through the stomach and into the intestine helps with paralysis

what is loperamide

Antimotility agent opiate

what is kaolin, pectin, chalk, charcoal, etc

antimotility adsorbants used in diarrhoea

what is cholelithiasis

gall stones

what is chenodeoxycholic acid

used to dissolve non calcified cholesterol gallstones

what is ursodeoxycholic acid

used to dissolve non calcified cholesterol gallstones

what is buprenone and pethidine

morphine like pain killer

what is atropine

used to relieve billary spasm

what are neuroleptics

sedatives antipsychotics dopamine antagonist

what is uraemia

urine in blood causes vomiting

what are phenothiazines used for apart from CTZ vomiting

antipsychotic in larger doses | D2 antagonist

metochlopramide

schistophrenia and CTZ emesis and gut motility

treatment of vomiting and gut motility disorders Flashcards

(73 cards)