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Cpt > Antemetis Nd Antidiarrhoeals > Flashcards

Antemetis Nd Antidiarrhoeals Flashcards

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1
Q

What is vomiting

A

Involuntary, forceful expulsion of gastric contents through the mouth

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2
Q

What is the difference between vomiting and regurgitation

A

S

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3
Q

What are teh process that occur in vomiting

A

Vomiting Centre in Medulla signals to vomit
1. Nausea, salivation, sweating
Ss

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4
Q

What us the CTZ and what triggers it?

A

Chemoreceptor Trigger Zone (CTZ)

Sensory afferent s, vestibular nuclei, direct triggers, visceralal afferent s from gut

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5
Q

What are some anti emetic drugs

A

Ss

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6
Q

What drugs act on the vestibular nuclei

A
  • Muscarinic receptor Antagonists - H1 receptor antagonists
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7
Q

Describe muscaring receptor antagonists

A

• Competitive blockade of muscarinic acetylcholine receptors
• In the vestibular nuclei
• Also at the CTZ
• Remember these receptor are all over the
body – part of the parasympathetic nervous system!!
• Good for :-
• People who can’t take tablets
• Motion sickness
• Bowelobstruction

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8
Q

What are the side effects os muscariic antagonists

A 
Side effects
• Sedation
• Memoryproblems
• Glaucoma
• Dry mouth and
constipation
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9
Q

What are the effects h1 antagonists

A

• Centrally
• Acts on the vestibular nuclei
• Inhibits histaminergic signals from the vestibular system to
the CTZ in medulla

  • Good for :-
  • Motion sickness – long plane journeys
  • Promethazine – morning sickness in pregnancy
  • Not good for:-
  • Cyclizine – little old ladies and children
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10
Q

What are the side effects of h1 antagonists

A 
Side effects
• Sedation
• Excitation
• Antimuscarinic–dry
mouth, constipation,
urinary retention,
• Cardiactoxicity(longQT
interval)
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11
Q

What are agents acting on visceral afferent s

A
  • 5HT3 receptor Antagonists - D2 receptor antagonists
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12
Q

Descrive serotonin in the gut

A
  • 95% serotonin in the body is located in the gut
  • Produced by the enterochromaffin cells
  • In response to parasympathetic stimulation, serotonin excited enteric neurones
  • Smooth muscle contraction increases motility (except in the stomach)
  • Increases gut secretions
  • Regulates appetite
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13
Q

How to 5ht3 receptor antagonists acts

A
  • Peripherally
  • ReducesGImotility
  • ReducesGIsecretions
  • Centrally
  • Acts to inhibit the CTZ
  • Goodfor:-
  • Almost everyone – it’s often the 1st line treatment
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14
Q

What are the side effects o 5ht3 receptor antagonists

A 
Side effects - uncommon
• Constipation
• Headache
• Elevated liver enzymes
• Long QT syndrome
• Extra-pyramidal
effects – dystonia, parkinsonism
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15
Q

Describe d2 receptor antagonists

A

Metaclopramide
• Increases acetylcholine at muscarinic receptors in the gut
• Promotesgastricemptying
• ↑ tone at lower oesophageal sphincter so it
closes
• ↑ tone and amplitude of gastric contractions
• ↓ tone of pylorus so it opens
• Increases peristalsis • Goodfor:-
• GORD • Ileus

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16
Q

What are the side effects ofetaclopramide

A

Side effects
• Galactorrhoeavia prolactin release
• Extra-pyramidal effects – dystonia, parkinsonism

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17
Q

What is domperidone

A

Domperidone
• Similar mechanism as metoclopramide
• Used to be used very frequently BUT new
evidence and a few high profile cases showed an increased risk of significant cardiac side effects.
• Goodfor:-
• Improvinglactationinbreastfeeding
mothers

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18
Q

What are the side effects of domperidone

A

Side effects
• Sudden cardiac death (long QT and VT)
• Galactorrhoea

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19
Q

What agents act on the ctz

A
  • 5HT3 receptor antagonists
  • H1 receptor antagonists
  • Muscarinic receptor antagonists
  • D2 receptor antagonists
  • Corticosteroids
  • Cannabinoids
  • NK1 receptor antagonists
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20
Q

Descrube “the zines” action and usage

A 
D2 antagonists 
• The ‘zine’s =
• Act on the CTZ
• May also block H1 and Muscarinic receptors
• Good for - Motion sickness, vertigo.
Prochlorperazine in pregnancy
Prochlorperazine
Chlorpromazine
Levomepromazine
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21
Q

What is haloperidol and when is it used?

A

D2 antagonist
• Haloperidol
• Act on the CTZ
• Good for :- chemotherapy and palliation

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22
Q

What are the side effects of “the zines” and haloperidol?

A

Side effects
• Extra-pyramidal effects – dystonia, parkinsonism - USE WITH CAUTION
• Sedation
• hypotension
haloperidol also - sick, anxious, agitated

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23
Q

Describe the action and usage of corticosteroids

A 
Dexamethasone
Methylprednisolone
• Assumed to act on the CTZ
• May also have properties of D2 receptor
antagonists
  • Good for:-
  • Perioperative nausea and vomiting
  • Chemotherapy
  • Palliation
24
Q

What are the side effects of corticosteroids

A

Side effects
• Insomnia
• ↑ appetite - ive if people dont eat bc nausea
• ↑ blood sugar

25
Q

What are cannabinoids

A 
syntehitc analouge of cannabis 
NAbilone 
• Assumed to act on the CTZ
• Good for chemotherapy
- used as last line
26
Q

What are the side effects of cannabinoids

A

Side effects
• Dizziness
• Drowsiness

27
Q

What are neurokinin 1 antagonists

A

Aprepitant
Fosaprepitant
Netupitant

• Prevent the action of substance P (excitatory neurotransmitter) at CTZ and in
peripheral nerves
• Boosts effects of 5HT3 receptor antagonists - synergistic, useful in chemo)
• Anxiolytic and antidepressant properties
• Good for chemotherapy – particularly for delayed
emesis (good fot anxiety and depression)

28
Q

What are some other random drugs used as anti emetics

A

ss

29
Q

Whats is typically used to treat motion sickness

A

Hyoscine hydrobromide is 1st line (but potentially sedating)
Cinnirazine typically has fewer side effects
Pick the drug based on side effet profile

30
Q

When is a nasogastric tube used?

A

Drain stomach and decrompress without them needing to vomit

31
Q

What are prokinetics?

A

Prokinetic agents, or prokinetics, are medications that help control acid reflux. Prokinetics help strengthen the lower esophageal sphincter (LES) and cause the contents of the stomach to empty faster.
Domperidone
Metaclopramide
Chewing gum can mimic eating and stimulate gut

32
Q

When are prokinetics used?

A

Useful for • GORD • Ileus

Don’t use • Obstruction • Risk of perforation due to inrceased peristalsis

33
Q

What are drugs used to trreat nausea and vomiting due to GI pathology

A

Ondansetron

and/or
Cyclizine

then add

Dexamethasone

34
Q

What are direct triggers of the ctz

A 
Hormones – hyperemesis gravidarum
• Drugs
• Chemotherapy
• Anaesthetics
• Opiates
• Many others!
35
Q

What is hyperemesis gravidarum

A
  • Rapid rise in ẞhcg stimulates the CTZ
  • Typically weeks 4-16 but may continue beyond
  • Higher risk with multiple pregnancies

• More than just ‘morning sickness’ – dehydration, 5%
weight loss, electrolyte imbalance, urinary ketones

Causes nausea and comiting, common in first trimester
True hyperemesis gravidarum can come with dehydration and weight loss - using drugs can be helpful. Normal morning sickness - oral rehydreation

36
Q

What drugs are typicallly used in hyperemesis gravidarum

A

Promethazine - H1 receptor antagonist

or

Prochlorperazine - D2 receptor antagonist

then add

Metaclopramide - D2 receptor antagonist

then add
Ondansetron - 5HT3 receptor antagonist

37
Q

what are some chemo drugs that can cause emesis

A

ss

38
Q

what drugs are used for different risks of emesisi with chemotherapy

A

ss

39
Q

What are some patient factor which increase wisk of post opertaive nausea and vomiting

A

Female, history of ponv or motion sickness, younger age, non smoker

40
Q

What are some anaesthetic risk factors in post operatove nausea and vomititng

A

general > regiona, use of volatile anaesthetic gases or nitrous oxide, post operative opioids

41
Q

What are some risk factors for post operative NV to do with the nauture of the surgert

A

duration of operation, laparoscopic surgery

42
Q

What drusg are used for PONV

A

Low Risk
Wait and see!

Moderate Risk
Pick 1 or 2 antiemetic agents

High Risk
pick more than 2 antiemetic agents

If prophylaxis fails – use an antiemetic from another class

43
Q

What is diarrhoea

A

Diarrhoea is defined as the passage of three or more loose or liquid stools per day
Consider consistency, frequencyy, comparison to normal

44
Q

What is infective gastroenteritis

A

Viral, bacterial or protozoal
May be toxin mediated

Osmotic or Secretory

45
Q

What are the mechanisms by which diarrhoea can be treated

A

Treat the cause!

Increase transit time - stool has more ocntact with gut - better hydration, better comfort

Comfort

Prevent incontinence (looser stool - more prone to incontinence)

46
Q

name a class of drugs used as antidiarrhoeals, and give 3 examples

A

opiod receptor antagonist - loperamide, codeine, morphine

47
Q

Describe the action of loperamide

A

Opioid receptor agonist

Loperamide – specific to μ receptors in the myenteric plexus

• Decreases tone of longitudinal and circular smooth muscle
• Reduces peristalsis but increases segmental contractions
• Decreases colonic mass movement by supressing gastrocolic reflex.
Different people need different doses

48
Q

Describe teh actions of codeine and morphine as anti diarrhorals

A

Codeine and morphine - μ and δ receptors
Similar effects to loperamide
More often used when patients have pain also

49
Q

What are teh side effects of opioid receptor agonists

A 
Side effects
• Paralytic ileus
• Nausea and vomiting
• Sedation and
Addiction (codeine and morphine)
50
Q

What is the constipatign diet

A

For those with long term loose stools
- IBS, IBD, short bowel, hypermotility, drug side effect

Bananas - High in potassium and fibre (fibre bulks the stool)
White Rice - Binds stool
White bread/pasta - Low in fibre
Limit fruit to 3 portions per day
Avoid caffeine, sorbitol, fatty or spicy foods and fizzy drinks
Consider Probiotics Re-instate a balanced intestinal flora

51
Q

What are some diet and lifestyle changes to help constipation

A

14% Prevalence of Chronic Idiopathic Constipation
Drink more water!
Increase fibre intake
- wholegrain foods, fruit & veg, nuts, pulses.
Regular exercise
Toilet routine and positioning

52
Q

What are some medications ofr constipation

A 
LAxatives:
Osmotic (mush)
stimulants (push)
bulk forming
stool softeners

Enemas
Osmotic (Draw water in)
Stimulants (move contents though)

53
Q

What are osmotic laxatives

A

Lactulose, movicol, cosmocol

Increase the amount of water in the large bowel

Osmotically raw fluid in Lactulose

OR

Retain the fluid they came with Macrogols - needs to be enough fluid around

54
Q

Describe stimualnt laxatives

A 
Bisacodyl
Sodium Picosulphate
Senna
Co-Danthromer
Docusate Sodium
(Glycerin)

Increase intestinal motility

May be given orally or per rectum

Docusate sodium acts as stimulant and stool softener

Glycerin suppositories cause rectal irritation and lubrication

55
Q

What are bulk forming laxatives

A

Ispaghula husk
Methylcellulose

They are medicinal fibres

56
Q

What are stool softeners

A

Decrease surface tension of stool
Increase penetration of fluid into stool

Docusate sodium
Glycerin suppository
Arachis oil
Liquid paraffin

Cpt (24 decks)

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