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GIR Test 2 > B5-067 Nausea and Vomiting > Flashcards

B5-067 Nausea and Vomiting Flashcards

1
Q
  • located in medulla
  • direct contact with blood through leaky capillaries
A

chemoreceptor trigger zone (CTZ)

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2
Q

what drugs are the most effective in treating nausea/vomiting?

A

serotonin (5-HT3) antagonists

-setron

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2
Q

what drug class is more effective for nausea/vomiting associated with chemotherapy?

A

NK-1 antagonists

-pitants

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3
Q

cytotoxic agents stimulated CTZ which releases […] to stimulate the receptors on the vomiting center

A

ACh

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4
Q

the vestibular nuclei contain what type of receptors?

2

A

H1 and M3

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5
Q

what drug class is most effective in treating motion sickness?

A

H1- antagonists

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6
Q

side effects include dry mouth, decreased saliva, blurry vision, and drowsiness

A

muscarinic antagonists

Hyoscine

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7
Q
  • inhibits 5-HT3 receptors
  • works at the level of stomach and CTZ
A

ondansetron

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8
Q

used for pre-surgical nausea prophylaxis

A

hyoscine

muscarinic antagonist

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9
Q

urge to vomit

A

nausea

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10
Q

vomiting leads to an electrolyte imbalance causing

A

metabolic alkalosis

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11
Q

most common causes of vomiting in adults

3

A
  • food poisoning
  • migraines
  • chemotherapy
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12
Q

most common causes of vomiting in infants

5

A
  • food allergies
  • viral gastroenteritis
  • milk intolerance
  • infections
  • blockage of GI tract

mostly localized to GI

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13
Q

GI causes of nausea and vomiting

3 general groups

A
  • mechanical/obstruction
  • motility/functional (ileus)
  • infectious/inflammatory (-itis)
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14
Q

non GI causes of nausea and vomiting

4 general categories

A
  • CNS
  • endocrine/metabolic
  • toxic/medication
  • other (stress, pain, anxiety, etc)
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15
Q

what is causing in the following disorders leading to N/V?

  • hyperthyroidism
  • hyperparathyroidism
  • adrenal insufficiency
  • diabetes
  • pregnancy
A
  • hyperthyroidism: increased T3, T4
  • hyperparathyroidism: increased PTH, Ca++
  • adrenal insufficiency: decreased cortisol
  • diabetes: increased glucose
  • pregnancy: increased hCG, P4, E2
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16
Q

nausea/vomiting with a duration of 1 week or less is

A

acute

more than 1 week is chronic

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17
Q

nausea onset 1-8 hours after meal indicates

4

A
  • food poisoining
  • gastritis
  • ulcer
  • bulimia
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18
Q

how does the “gag reflex” trigger vomiting?

A

pharyngeal stimulation -> NTS -> vomiting reflex

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19
Q

how do drugs/hormones activate the vomit reflex?

A

activate gastric mucosa and/or CTZ
-> NTS -> brainstem vomiting center

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20
Q

how does motion vertigo induce vomiting?

A

labyrinth -> cerebellum -> brainstem vomiting center

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21
Q

how does overeating cause vomiting?

A
  1. activation of stretch receptors triggers vagus to release ACh -> ACh stimulates vomiting center
  2. increased pressure on cardiac spinchter -> opens to allow vomit out
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22
Q

how does anxiety/stress induce vomiting?

A

adrenal gland releases catecholamines -> decreased digestive system activity -> gastroparesis

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23
Q
  • “pacemaker” cells of stomach
  • generate slow waves causing phasic contractions
A

interstitial cells of Cajal

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24
Q

[…] is a major cause of gastroparesis due to nerve damage

A

diabetes

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25
Q

what test can be used to assess gastroparesis?

A

gastric empyting study (nuclear scanning test)

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26
Q

how does motion sickness cause vomiting?

A

unfamiliar, unnatural motion stimuli -> vestibular labyrinth -> vestibular nuclei -> cerebullum -> ACh, H1 -> vomiting center

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27
Q

H1 antagonists that cause significant drowsiness

2

A

dimenhydrinate
diphenhydramine

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28
Q

H1 antagonists only for children 12 and over

anticholinergic

A

scopalamine

29
Q

irritability
tachycardia
postural tremor
heat intolerance

A

hyperthyroidism

30
Q

how does hyperthyroidism lead to nausea/vomiting?

A

increased T3/T4 -> increased B adrenergic recptors -> thyrotoxic and autonomic vomiting

also increases estrogen and decreases gastric motility

31
Q

nausea/vomiting occuring within 24 hrs of chemotherapy administration

32
Q
  • nausea/vomiting occurring at least 24 hours post chemo
  • peaks between 48 and 72 hours
33
Q
  • nausea/vomiting that occurs withing 5 days post chemo despite optimal anti-emetic regimen
  • requires rescue therapy
A

break through

34
Q

nausea/vomiting that occurs in subsequent chemo cycles despite max antiemetic protocol

A

refractory

35
Q

nausea/vomiting triggered by sensory stimuli in association with chemotherapy

A

anticipatory

36
Q

describe the acute pathway of chemotherapy induced nausea/ vomiting

A

chemo -> ECLs -> serotonin -> vagus -> vomiting

37
Q

describe the delayed pathway for chemo induced nausea/vomiting

A

chemo -> area postrema CTZ -> vagus -> substance P -> NK-1 receptors -> vomiting

38
Q

three drug regime given before chemo

A

5-HT3 antagonist
dexamethasone
NK-1 antagonist

steroid and NK-1 ant actually improve efficacy of 5-HT3

39
Q

what causes migraine associated nausea/vomiting?

A

serotonin is released from platelets at beginning of attack

40
Q

effective drugs for nausea and vomiting associated with migraines

2

A

pizotyline
amitriptyline

41
Q

drug for treatment of delayed phase CINV

A

aprepitant

NK-1 antagonist

42
Q

drug for prevention of migraine, abdominal migraine, cyclic vomiting syndrome

A

cyproheptadine

H1 and 5HT2 antagonist

43
Q

5 HT3 antagonist for CINV

A

dolasetron

44
Q

cannaboid drug for CINV

A

dronabinol

45
Q

drug for CINV post operative induced vomiting

A

droperidol

D2 antagonist

46
Q

drug for motion sickness, post op, presurgery nausea/vomiting

A

hyoscine

m1 antagonist

47
Q

drug for GERD, gastroparesis

2

A

cisapride (causes heart issues)
metoclopramide

48
Q

drug used for motion sickness in children

A

diphenhydramine

anti-histamine

49
Q

anticholinergic for motion sickness

A

scopolamine

not for under 12

50
Q

drugs that block […] are the most effective in treating nausea/vomiting

51
Q

[…] drugs must be able to cross the BBB to be effective in treating vomiting

2

A

anti-histamines, anti-cholinergics

52
Q

emotion, pain, and smell can trigger vomiting through […] receptors

A

muscarinic

53
Q

[…] antagonists are good for treating motion sickness/morning sickness but their use is associated with sedation

54
Q

[…] is released in response to cytotoxic agents from the CTZ

55
Q

describe the vomiting reflex

A
  1. LES relaxes
  2. diaphragm muscles contract and increase intra-abdominal pressure
  3. epiglottis closes
  4. autonomic symptoms (tachycardia, salivation, peristalsis)
  5. vomiting
56
Q

side effect of metoclopramide

A

GI disturbances

57
Q

gastroparesis is a contributing factor to nausea and vomiting in which conditions?

4

A
  • anxiety
  • endocrine disorders
  • stress
  • migraines
58
Q

what hormone responsible for morning sickness?

A

progesterone

59
Q

nausea/vomiting that occurs within 5 days post chemotherapy despite optimal antiemetic therapy

A

breakthrough

60
Q

nausea/vomiting occuring within 24 hrs of chemotherapy administration

61
Q

nausea/vomiting occuring at least 24 hrs post chemotherapy administration

62
Q

nausea/vomiting that occurs in subsequent chemotherapy cycles despite maximum antiemetic protocol

A

refractory

63
Q

nausea/vomiting triggered by sensory stimuli associated with chemotherapy administration

A

anticipatory

64
Q

slow gastric emptying

A

gastroparesis

65
Q

most common cause of vomiting in infants 3-4 months

66
Q

what is the first component triggered in the neural pathway leading to vomiting?

A

higher centers of brain

67
Q

blood, pain, and anxiety stimulate the [….] to induce vomiting

A

higher centers of brain

68
Q

most effective receptor antagonists in CINV

69
Q

what do emetic agents stimulate to induce vomiting?

2

A

GI tract
or
CTZ

GIR Test 2 (18 decks)

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