Acute Illness II

Question 1

What are the causes of nausea and vomiting?

Answer 1

-GI Tract-related (stimulation of visceral nerve), often gastroenteritis
-CNS disorders, often Vestibular disorders (motion sickness)
-Overeating
-Pregnancy

Question 2

Symptoms and complications of nausea and vomiting:

Answer 2

-Pale skin, cold sweats, dizziness, headache, increased BP and HR

-Complications: Dehydration, electrolyte imbalances, aspiration, malnutrition, tears

Question 3

How can motion sickness be treated?

Answer 3

With antihistamines, bc Histamine is one of the neurotransmitter involved in that pathway

Question 4

What are the causes of diarrhea?

Answer 4

Diarrhea: increase in stool frequency, liquidity, weight, or volume

-often infectious diarrhea (gastroenteritis; viral, bacterial)
-travelers diarrhea
-Food-induced or Food intolerance (lactose)

Question 5

Where to pay attention in patients with diarrhea?

Answer 5

-Dehydration, electrolyte imbalances

-Self-limiting, clears out itself

Question 6

How to assess if diarrhea is self-treatable:

SCH

Answer 6

Symptoms: Severity of abdominal pain (it could also be due to injury or GI ulcer), Vomiting, or fever?; Signs of dehydration? Fluid and Food intake?

-Characteristics: Description of stool (color, consistency?) Blood?
Frequency and volume of diarrhea?

-History: Recent travel? What have you eaten? Happened before?
Medication? Pregnant? Diabetic or cardiovascular disease?

Question 7

What causes diarrhea?

Answer 7

-Absorption
-Target of the drug: opioid receptor in the small intestine

Question 8

What causes intestinal Gas?

Answer 8

-it is a disruption in the normal physiologic digestive process -> belching, flatulence

-Diet: carbs, oligosaccharides - vegetables, beans
-Carbohydrate malabsorption (lactase deficiency/lactose
intolerance, gluten intolerance (celiac disease))
-swallowing air
-intestinal flora altered
-drug-induced

-Symptoms: are often discomfort of abdomen -> MILD and often self-treatable

Question 9

How to assess if intestinal gas is self-treatable:

SCHO

Answer 9

Symptoms: abdominal discomfort/pain? change in bowel function? Diarrhea? Constipation?
Characteristics: GI bleeding (dark, tarry stools), fatigue, unintentional weight loss
History: How often do symptoms occur?
Onset: Do symptoms correspond with any particular food
consumption? How long do symptoms persist?

Question 10

Where does the gas in the stomach come from?

Answer 10

-200ml of gas in the GI tract
-Swallowedair
-Bacteria-producing
-metabolized diet, neutralization of acids in the small intestine

Question 11

What are the causes of acute heartburn?

Answer 11

-a burning sensation in the stomach or behind the breastbone
-radiates up towards the neck and throat bc of acid reflux

-often bc of overeating and certain meals -> stimulating the trigger
-obesity
-pregnancy, the child pushing organs
-smoking and stress
-drug-induced

Question 12

Symptoms of heartburn

Answer 12

Symptoms: Belching, bloating, nausea
-> when related to food, it will be depending on what and how much you have eaten (1hr after meal)

Question 13

Which issue can also be interpreted as heart burn?

Answer 13

-heart attack, bc the pain is at the same location
-screen well!

Question 14

Assess if heart burn is self-treatable:

Answer 14

Symptoms: pain on swallowing solid foods? unexplained weight loss? anemia or blood loss? Vomiting blood or passing black tarry stools? Nausea, vomiting, diarrhea?
Characteristics: Looking for severe symptoms -> refer
History: Duration: it could cause damage to the esophagus due to acid
Onset: Does it come from a certain food? How long do symptoms persist? Is it overnight?
Remitting factors: Has the patient tried any medication before?

Question 15

Pathophysiology/cause of heartburn:

Answer 15

Low functionality of the lower esophageal sphincter, allowing the acid to go up the esophagus

-distention of the proximal stomach by food or gas
-positioning after eating (lying down)
-delayed gastric emptying due to overeating

Question 16

How to evaluate dehydration:

Answer 16

-anyone with severe symptoms of dehydration needs to be referred and needs IV fluid

-increased heart rate, but low blood pressure bc there is not much blood flow
-mentally unconscious -> drinks poorly
-deep breath, dry tongue, sunken eyes

-check skin turgor: Severe dehydration = recoil in > 2 sec

Question 17

Nausea and vomiting:
Which drugs are suitable for motion sickness?

Answer 17

-Antihistamines

Question 18

Nausea and vomiting:
Which drugs are suitable for overeating?

Answer 18

-Bismuth subsalicylate
-Phosphorated carbohydrate solution
-Antacids
-Histamine type 2 (H2) receptor antagonists (H2RAs)

Question 19

Nausea and vomiting:
Which drugs are suitable for pregnancy?

Answer 19

Pyridoxine (Vitamin B6)

Question 20

Which drugs are suitable for diarrhea?

Question 21

Which drugs are suitable for Intestinal Gas?

Question 22

Which drugs are suitable for Heartburn and Dyspepsia?

Question 23

How can fluid be replenished after episodes of vomiting or diarrhea?

Answer 23

-Oral rehydration fluids (ORS): Pedialyte - they contain electrolytes (for osmotic pressure, and appropriate absorption), and they are not sugar-heavy
-Gatorade, juices, Cola, but take it with something salty to balance the sugar (diarrhea-promoter) out
-Soups

Question 24

What diet to consider after diarrhea and vomiting?

Answer 24

-bland diet: soft, not very spicer, low in fiber (beans, broccoli, avocado, apple)
-BRAT diet: bananas, rice, apple sauce, and toast -> complex carb and binding -> in high amounts would cause constipation, so opposite effect to stop diarrhea

Question 25

Treatment of motion sickness:

Answer 25

-Antihistamines: CAUTION -> cause drowsiness Brand names: Bonine (meclizine), Marezine (Cyclizine), Dramamine (dimenhydrinate) active ingredients: cyclizine, dimenhydrinate, diphenhydramine, meclizine -alternatives: Seaband, if someone is on a trip and doesn't want to get drowsy -take 30 min before travel, bc it takes until it works

Question 26

How is Meclizine different from the other active ingredients?

Answer 26

It is the longest acting, so use only for longer trips, due to side-effect of drowsiness

Question 27

How to treat overeating related to nausea and vomiting?

Answer 27

Bismuth subsalicylate -> Pepto Bismol -similar to Aspirin: so don't use it for kids, elderly people, pregnant women, aspirin allergies, asthma -harmless black staining of stool and darkening of the tongue -Mild tinnitus indicative of overdosage -not take within 6 weeks of receiving varicella or influenza vaccine

Question 28

Why is there Children Pepto, when it Pepto Bismol is not for children?

Answer 28

It is a different product (product line extension), it has Ca CO3 (Tums, antiacid) -CAUTION: patients might tend to use Pepto Bismol and use a little dose for their children

Question 29

How does Emetrol work?

Answer 29

for nausea and vomiting related to overeating -It calming to the stomach: Decreases smooth muscle contractions and delays gastric emptying -it contains sugar: not for DIABETIC -Side-effect: diarrhea, bc sugar can worsen diarrhea -taken in 15 intervals until symptoms reduce up to max dose, without food

Question 30

How are nausea and vomiting related to PREGNANCY treated morning sickness

Answer 30

-often in the morning -Pyridoxine (Vitamin B6), -short-acting Antihistamines: Dimenhydrinate, diphenhydramine Complementary therapy: Ginger, peppermint (calms stomach muscle)

Question 31

How to treat Diarrhea?

Answer 31

-Loperamide -Bismuth subsalicylate -Probiotics -Lactase replacement

Question 32

Moa of Loperamide:

Answer 32

Brand name: Immodium -it slows down the motility of the GI tract and increases water absorption of water and electrolytes -only for 48h, symptoms should be gone by that time -not for kids -drug interactions -it can cause constipation (caution in the elderly) -first dose is often higher, followed by a lower dose up to the max dose

Question 33

How to treat intestinal Gas?

Answer 33

-Anti-flatulent medications * Simethicone * Activated charcoal -Digestive enzymes * Alpha-galactosidase * Lactase replacement -Probiotics

Question 34

MoA for Simethicone:

Answer 34

-It works for any kind of gases -Defoaming agent, reducing the surface tension of gas bubbles in the GI tract -> -no side-effects: so can be used for kids -after meal and at bedtime

Question 35

MoA for Activated Charcoal:

Answer 35

-it has an adsorbent effect and is binding and eliminated through the feces -> causing dark stools -doesn't taste great -best used for sulfur-based gases (from dietary causes)

Question 36

How can gas produced by complex carbohydrates and oligosaccharides be treated?

Answer 36

-Beano, active ingredient: alpha-galactosidase enzyme -common in high-fiber food: beans, broccoli, cabbage -take it with food, food should not be too hot bc it the drug is an enzyme -the enzyme helping to break down the food more effectively so it doesn't produce gas

Question 37

Treatment of gas due to Lactose-intolerance:

Answer 37

Lactaid, active ingredient: lactase enzyme -break down lactose more effectively -no side-effects -supplementation with calcium and Vitamin D for patients with lactose intolerance -dose varies with the amount of lactose-containing food

Question 38

Treatment of heart burn:

Answer 38

-Antacids -Bismuth subsalicylate -Histamine type 2 (H2) receptor antagonists (H2RAs) -Proton pump inhibitors (PPIs)

Question 39

Moa of Antacids:

Answer 39

-Tums (CaCO3), Rolaids (Mg), Gaviscon, Alka-Seltzer -active ingredients: calcium carbonate; magnesium hydroxide; aluminum hydroxide; sodium bicarbonate -Act as buffering agents and increase intragastric pH -> reduce symptoms -may impact the absorption of other drugs like antibiotics, bc Antacids are chelator and charged -Side-effects depending on the salt: Diarrhea: Mg Constipation: Al, Ca Belching, flatulence: Ca, Na

Question 40

How do Histamine blocker work to help with heartburn?

Answer 40

-Brand Name: Pepcid (famotidine), Tagamet -Active ingredients: famotidine, cimetidine (a lot of drug interactions) -Reduce gastric acid secretion by inhibiting histamine on the H2-receptor of the parietal cell -side-effects: well tolerated -may be used when symptoms start or ahead of symptoms