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Nervous System FT > Anti-Emetics > Flashcards

Anti-Emetics Flashcards

1
Q

What dose and patient factor is considered with Domperidone?

A

10 mg TDS/7 days for adults weighing 35 kg or more.

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2
Q

What are the indications for domperidone?

A

Relief of nausea and vomiting
GI pain in palliative care

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3
Q

What are the side effects associated with domperidone?

A

Dry mouth is common

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4
Q

What dose of metoclopramide is used for nausea?

A

> 18 years of age, 5-10 mg TDS/5 days.

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5
Q

What are the side effects associated with metoclopramide?

A

Acute dystonic reactions: facial and skeletal muscle spasms, and oculogyric crisis (usually bilateral dsystonic elevation of visual gaze lasting from seconds to hours)
Tardive dyskinesia
Neonatal extrapyramidal side effects

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6
Q

What dose of prochlorperazine is used for nausea?

A

5-10 mg PO TDS
Buccal: 3-6 mg BD

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7
Q

What are the side effects associated with prochlorperazine?

A

Antimuscarinic effects: dry mouth, constipation, urinary retention, blurred vision

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8
Q

Which antiemetic does not cause extrapyramidal side effects and is first choice in treating nausea in Parkinson’s Ptx?
A. Domperidone
B. Metoclopramide
C. Ondansetron
D. Prochlorperazine

A

(A) Domperidone because it doesn’t cross the BBB preventing extra-pyramidal S/E.

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9
Q

Which antiemetic requires patient to weigh more than 35 kg?
A. Domperidone
B. Metoclopramide
C. Ondansetron
D. Prochlorperazine

A

(A)

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10
Q

Which antiemetic has dual histamine and D2 effect?
A. Domperidone
B. Metoclopramide
C. Ondansetron
D. Prochlorperazine

A

(D)

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11
Q

What are the contraindications associated with dopamine antagonist antiemetics?

A

Gastrointestinal haemorrhage, obstruction or perforation (prokinetics so this becomes dangerous if they are in use when the gut is damaged)
CVD disease: QT prolongation, congestive heart failure (domperidone particularly important)
Prolactinoma (domperidone)
Hepatic impairment (d2 antagonist are hepatically cleared)
Pheochromocytoma (tumour in adrenal gland, dopamine may aggravate this condition due to its catecholamine effects)
Epilepsy

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12
Q

Which anti-emetic causes neonatal extrapyramidal adverse effects in the third trimester of pregnancy ?
A. Domperidone
B. Metoclopramide
C. Ondansetron
D. Cyclizine

A

(B)

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13
Q

What is common side effect seen with all D2 antagonist anti-emetics?

A

Cardiac - bradycardia, QT prolongation
GI disturbances
CNS: Drowsiness

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14
Q

Which D2 antagonist anti emetic is responsible for blurred vision, dry mouth and urinary retention S/E?
A. Domperidone
B. Metoclopramide
C. Prochloperazine
D. Cyclizine

A

C.

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15
Q

Which agent when interacting with Prochlorperazine causes hypotension ?
A. Alcohol
B. Lithium
C. Alprazolam
D. Bromocriptine

A

A

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16
Q

Which agent when interacting with metoclopramide potentiates EPS and neurotoxicity?
A. Alcohol
B. Lithium
C. Alprazolam
D. Bromocriptine

A

(B)

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17
Q

Which drug when given with metoclopramide would experience decreased therapeutic effect?
A. Alcohol
B. Lithium
C. Alprazolam
D. Bromocriptine

A

(D) Metoclopramide reduces D2 agonist efficacy.

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18
Q

Which drug when given with metoclopramide would experience decrease in drug concentration?
A. Levodopa
B. Lithium
C. Alprazolam
D. Bromocriptine

A

(A)

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19
Q

What dose and patient factor is considered with Ondansetron?

A

4-6 mg 6-8 hourly

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20
Q

What are the indications for Ondansetron?

A

Ematogenic Chemotherapy
Prevention of post operative nausea and vomiting

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21
Q

What are the side effects associated with Ondansetron?

A

Constipation (antagonism of 5HT3 receptors in the gut)
Dizziness, QT prolongation
Myocardial ischemia

22
Q

Which antiemetic has MHRA warning on small increased risk of oral clefts following use in the first 12 weeks of pregnancy?
A. Domperidone
B. Metoclopramide
C. Ondansetron
D. Prochlorperazine

A
23
Q

When is ondansetron indicated in pregnancy and at what stage?

A

Last line for hyperemesis in pregnancy and it is advised to AVOID in first trimester of pregnancy due to small increased risk of congenital abnormalities such as orofacial clefts.

24
Q

What are the contraindications associated with Ondansetron?

A
25
Q

Which agent when given with Ondansetron causes torasade de pointes and why?
A. Apomorphine
B. Fluoxetine
C. Carbamazepine
D. Aminophylline

A

(D) Aminophylline causes Hypokalemia potentially increasing the risk of torsade de pointes when given with ondansetron.

All drugs that cause Hypokalemia when given with ondansetron will potentiate the risk of arrythmia and the fatal torsade pointes.

26
Q

What is the dose for cyclizine to be used in nausea?

A

50 mg TDS

27
Q

What is the indication for cyclizine?

A

Nausea
Vomiting
Vertigo
Labryrinthine disorders
Motion sickness

28
Q

What is the dose for Promethazine to be used in nausea?

A

25 mg ON (any thing higher is unlicensed dose).

29
Q

What are the adverse effects associated with Cyclizine?

A

Drowsiness
Depression
Angle closure glaucoma (rare)
Neonatal irritability

30
Q

What are the adverse effects associated with Promethazine?

A
  • CVD: Arrythmias, Phenothiazine derivatives may potentiate QT prolongation.
    • Skin: urtitica, rash
    • GI: Epigastric discomfort
    • Neonatal irritability
    • Neurological: Anxiety, dizziness, drowsiness
31
Q

What is the dose for Cinnarizine?

A

30 mg TDS // Motion sickness: 30 mg initially then 15 mg every 8 hours.

32
Q

What is the indication for cinnarizine?

A

Vestibular disorders, nausea and vomiting in Meniere’s disease
Motion sickness

33
Q

What is the dose of Hyoscine?

A

150-300 micrograms 30 minutes before the start of journey up to QDS.

34
Q

What is the indication for hyoscine?

A

Motion sickness
Hypersalivation associated with clozapine therapy
Excessive respiratory secretion in palliative care.
Bowel colic in palliative care
Premedication before induction anaesthesia

35
Q

What is the mechanism of cyclizine?

A

Increase lower oesophageal sphincter tone and reduce sensitivity of labyrinthine apparatus. It is histamine anatgonist

36
Q

What contraindications are associated with cyclizine, Promethazine, Hyoscine bromide?

A

Hepatic impairment
Urinary retention
Susceptibility to angle-closure glaucoma
Pyloroduodenal obstructions
Hepatic disease
Epilepsy
Severe Heart Failure
Porphyria

37
Q

Which antiemetic is indicated for relief of vomiting in Meniere’s disease and Motion sickness ?
A. Domperidone
B. Metoclopramide
C. Cinnarizine
D. Prochlorperazine

A

C

38
Q

Why does hyperthermia occur if anticholinergic effects are blocked?

A
39
Q

Which anti-emetic had an MHRA warning issued about the use of transdermal patch exerting anticholinergic side effects including hyperthermia?
A. Hyoscine bromide
B. Metoclopramide
C. Ondansetron
D. Prochlorperazine

A
40
Q

Which anti-emetic is licensed for use in children aged 12 years in buccal form.
A. Promethazine
B. Prochlorperazine
C. Hyoscine Bromide
D. Metoclopramide

A

(B) Prochlorperazine is licensed in buccal tablet >12 years and is less sedating.

41
Q

Which anti-emetic is licensed for use in nausea and vomiting in palliative care.
A. Haloperidol
B. Prochlorperazine
C. Hyoscine Bromide
D. Metoclopramide

A

(A) Haloperidol (and also Levomepromazine)

42
Q

Which anti-emetic is second line option in prevention of delayed chemotherapy induced nausea and vomiting
A. Haloperidol
B. Prochlorperazine
C. Hyoscine Bromide
D. Metoclopramide

A

D

43
Q

Which anti-emetic is first line in children receiving cytoxic drug to manage nausea and vomiting
A. Ondansetron
B. Prochlorperazine
C. Hyoscine Bromide
D. Metoclopramide

A

(A) 5-HT3 antagonist

44
Q

Which anti-emetic is neurokinin-1 receptor antagonist use to prevent nausea and vomiting associated with chemotherapy?
A. Ondansetron
B. Prochlorperazine
C. Aprepitant
D. Metoclopramide

A

C

45
Q

What corticosteroid has antiemetic properties and can be used in the management of chemotherapy induced nausea and vomiting

A

Dexamethasone

46
Q

What antiemetics can be used in pregnancy and what is the potential harm to neonate

A

Antiemetic options include: cyclizine, prochlorperazine, promethazine hydrochloride, promethazine teoclate, and ondansetron.
With anti-histamines there is risk of neonatal irritability especially in the third trimester whereas ondansetron is associated with small risk of cleft palet in the first 12 weeks of pregnancy.
Monitor for first 24-48 hours then give ondansetron for 5 days and the antihistamines for 7 days.

47
Q

For hyperemesis gravidarum what supplementation is recommended and why?

A

Thiamine to reduce the Wernicke’s encephalopathy

48
Q

First line antiemetic for postoperative nausea and vomiting associated with opioid and general anaesthetics?
A. Ondansetron
B. Droperidol
C. Aprepitant
D. Cyclizine

A

D. [Prochlorperazine is also licensed]

49
Q

First line for opioid induced nausea and vomiting

A

Cyclizine
Ondansetron
Prochlorperazine

50
Q

First line for motion sickness

A

Hyoscine hydrobromide licensed to prevent motion sickness symptoms such as nausea vomiting and vertigo.

51
Q

For patient aged of X and over experiencing motion sickness what agent can you give

A

Hyoscine hydrobromide 6 YEARS TABLETS/UNDER THAT AGE IV IM OR PO

52
Q

Which anti-emetic is less sedating and can be used for motion sickness
A. Ondansetron
B. Droperidol
C. Cinnarizine
D. Cyclizine

A

(C and D)

Nervous System FT (4 decks)

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