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Clinical Pharmacy 1 - Term 1 > 9 - Nausea & Vomiting > Flashcards

9 - Nausea & Vomiting Flashcards

1
Q

What is retching?

A

Strong, involuntary and unsuccessful effort to vomit

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2
Q

What is the area of the brain that coordinates vomiting and what does it do?

A
  • Vomiting center
  • Receives and integrates afferent impulses and stimuli and then sends efferent impulses to salivation centre, respiratory centre, pharyngeal, GI, and abdominal muscles
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3
Q

What are the NTs and receptors involved in vomiting?

A
  • Dopamine
  • Histamine
  • Acetylcholine
  • Vasopressin
  • Serotonin
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4
Q

What is important pathophysiology for motion sickness?

A

Vestibular function disturbances

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5
Q

What is mismatched vestibular function?

A

When what the body is expecting and what the body actually feels don’t match up

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6
Q

What are some causes of nausea and vomiting?

A
  • Visceral afferent stimulation (mechanical obstruction, motility disorders, peritoneal irritation, infections)
  • CNS disorders (increased intracranial pressure, infections, psychogenic)
  • Irritation of chemoreceptor trigger zone (initiated or withdrawn drugs, systemic disorders)
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7
Q

What are some complications of vomiting?

A
  • Dehydration
  • Aspiration
  • Malnutrition
  • Electrolyte or acid-base imbalance
  • Dental caries
  • Esophageal rupture
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8
Q

What are signs and symptoms of dehydration in adults?

A
  • Increased thirst
  • Decreased urination
  • Feeling weak or light-headed
  • Dry mouth/tongue
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9
Q

What are signs and symptoms of dehydration in children?

A
  • Dry mouth and tongue
  • Decreased urine output
  • Dark urine
  • Increased heartbeat
  • Decreased skin turgor (when pinched, skin returns to normal very slowly)
  • Weight loss
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10
Q

What are the 2 classifications of nausea and vomiting and what are symptoms of each?

A

1) Simple
- Occasional episodes
- Self-limiting or relieved by minimal use of anti-emetic
- Not related to administration/exposure to noxious agent
2) Complex
- Symptoms not adequately or readily relieved by single anti-emetic
- Consequences severe
- Caused by noxious agents or psychogenic events

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11
Q

When is the greatest incidence of motion sickness?

A

3-12 years old (under 2 are immune)

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12
Q

What are risk factors for motion sickness?

A
  • Type of travel (boat worst and train least)
  • Stimulus intensity and frequency
  • Duration of directional change
  • Poor ventilation
  • Individual predisposition
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13
Q

What are the goals of therapy for nausea and vomiting?

A
  • Eliminate or decrease symptoms of nausea
  • Prevent or decrease frequency of vomiting
  • Prevent complications of nausea and vomiting
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14
Q

What is the mechanism of action of dimenhydrinate and diphenhydramine?

A
  • Blocks ACH and H1 receptors centrally

- Acts on H1 receptors in vomiting centre

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15
Q

What is the dosing of dimenhydrinate for treatment of motion sickness in adults?

A

50-100 mg every 4 hours if necessary to a maximum of 400 mg per day

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16
Q

What are side effects to dimenhydrinate and diphenhydramine?

A
  • Sedation, blurred vision
  • Dry mouth
  • Constipation, urinary retention
  • Paradoxical excitation in children
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17
Q

What is the mechanism of action of scopolamine?

A

Blocks ACh in vestibular apparatus

18
Q

What is scopolamine used for?

A

Prevention of motion sickness

19
Q

What is the dosing for scopolamine?

A
  • Apply 1 patch to dry hairless area of post-auricular skin
  • Should be applied 4-12 hours before departure
  • Disc should not be left on more than 72 hours and can reapply to other eye
  • Treatment should not exceed 6 days
20
Q

Is scopolamine recommended in children?

A

No

21
Q

Is ginger recommended in children?

A

Only over 12 years old

22
Q

What are side effects to scopolamine?

A
  • Sedation, dizziness, blurred vision
  • Constipation
  • Rash
  • Elderly at increased risk of CNS effects
23
Q

What is the dosing for ginger root?

A
  • Prevention – 2 tablets/lozenges 30 minutes before departure
  • Treatment – 2 tablets/lozenges 1-3 times per day (do not exceed 6 per day)
24
Q

What is a side effect to ginger root?

A

Can exacerbate symptoms in patients w/ acute inflammatory skin diseases and can cause contact dermatitis

25
Q

What are contraindications for dimenhydrinate, diphenhydramine, and scopolamine?

A

Use under Dr. supervision if px has:

  • Seizure disorder
  • Respiratory condition (COPD, asthma)
  • Difficulty w/ urination from BPH
  • Narrow angle glaucoma
  • Obstructive bowel disease
26
Q

What is the best treatment for motion sickness for children aged 2-12?

A

Dimenhydrinate or diphenhydramine

27
Q

Should breastfeeding women use pharm treatment for motion sickness?

A

No

28
Q

Can pregnant women use pharm treatment for motion sickness?

A

Can use gravol, ginger root or promethazine under doctor supervision

29
Q

What is the dosing of diphenhydramine for patients 12 years and over?

A

25-50 mg 3-4 times per day (maximum 4 doses per day)

30
Q

When is promethazine used?

A
  • Treatment and prevention of motion sickness

- Usually used if patient has refractory nausea or if DMH is ineffective

31
Q

What is the dosing of promethazine for adults?

A

25 mg with first dose 30 minutes before departure and second dose 8-12 hours later if needed

32
Q

What is the dosing of promethazine for children?

A

0.5 mg/kg (max. 25 mg) w/ first dose 30-60 minutes before departure and second dose 12 hours later if needed

33
Q

What drugs dose promethazine interact with?

A

CNS depressants and alcohol

34
Q

What is a contraindication for promethazine?

A

Lower respiratory tract symptoms

35
Q

What are side effects to promethazine?

A
  • Sedation, somnolence
  • Dry mouth
  • Extrapyramidal symptoms
  • Constipation
36
Q

What are some non-pharms for motion sickness?

A
  • Avoid or decrease exposure to precipitating factors
  • Avoid eating large meals w/in 3 hours of travel
  • Avoid smoking, alcohol and disagreeable odours
  • Improve ventilation
  • Avoid visual stimuli
  • While travelling, focus on stable external object or the horizon
  • While on a boat, stay in a central location least susceptible to motion
  • While in a vehicle, sit in front seat w/ clear forward view and minimize head movement
37
Q

What is the endpoint of therapy for nausea and vomiting?

A

Minimal or no nausea and no vomiting

38
Q

What should be done if the endpoint of therapy isn’t reached?

A
  • Increase dose
  • Make sure dose is taken 30-60 minutes before departure
  • Refer
39
Q

What should be done if patient experiences intolerable symptoms from treatment?

A
  • Decrease dose
  • Switch products
  • Rely on non-pharms alone
40
Q

What are some red flags for adults?

A
  • Fever and/or diarrhea
  • Suspected food poisoning that is severe and doesn’t clear up in 12 hours
  • Severe abdominal pain
  • Lasting more than 3 days
  • Severely dehydrated
  • Blood in vomit
  • Significant weight loss
  • Pregnant or breastfeeding
41
Q

What are some red flags for children?

A
  • Younger than 2 years old
  • Signs of dehydration
  • Vomiting lasting longer than 6 hours
  • Lack of urination in past 8-12 hours
  • Stiff neck
  • Weight loss
  • Vomit is red, black, or green
  • Vomiting after each meal
  • Poisoning or head trauma suspected

Clinical Pharmacy 1 - Term 1 (18 decks)

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