Block 1: Nausea/Vomiting Flashcards
What are the causes of N/V?
- GI
- Drugs
- Chemo
- Pregnacy
What are the general N/V sx?
Mild-severe distress
Simple: Queasiness or discomfort
COmplex: weight loss, fever, ab pain
What is nausea?
Subjective feeling of needing to vomit
What is retching?
involuntary rhythmic diaphragmatic and abdominal contractions
What is vomiting?
Rapid, forceful expulsion of GIT contents
What are the signs of dehydration?
- Dry mouth
- Decreased skin turgor
- Excessive thirst
- Little or no urination
- DZ/Lightheaded fainting
- Decreased BP
What are the exclusions for N/V self care?
- Abdominal pain or distention
- Dehydration
- Blood in vomit
- Decrease alertness
- Tachycardia
- Vomiting over 24 hr
- Poisoning
- Pregnancy
- Head trauma
- Children
What are the goals of N/V treatment?
- Provide symptomatic relief
- Identify underlyign cause
- Prevent and correct complication
- Prevent future occurrences
What are the non-pharms for N/V?
- Oral rehydration
- Premade solutions or can use 6 teaspoons of sugar and ½ teaspoon of salt in a liter of water
- Caution with high sugar content electrolytes
- Rehydration solution based on weight
- 5 ml q15 mins for small children and 15 ml q15 mins for older children and adults
What is vestibular nausea?
- Motion sickness
- Inner ear disorder (vertigo, neuritis, idiopathic)
First line for motion sickness?
Scopolamine: transdermal patch -> tolerability and adherence -> +2 hr before activity
OTC for motion sickness?
First-generation antihistamine:
1. Meclizine (may be less sedating)
2. Diphenhydramine
3. Doxylamine – off label use
How do counsel on motion sickenss?
- Avoid reading
- Focus straight ahead
- Sit in the front
- Avoid strong odors
What is the ADR of motion sickness med?
- anticholinergic effects
- CNS/psychiatric effects (scopolamine)
Treatment of nausea from food and drinks?
- Antacids
- H2RAs
- BSS
- Phosphorated carbohydrate solution (PCS)
What is PCS?
- dextrose, levulose, and phosphoric acid
- Hyperosmolar solution that relieves N/V by acting on GI tract to decrease smooth muscle contraction and delay gastric emptying
- Each 5 ml contains 3.74g of sugar -> caution in diabetics
Sally applies a scopolamine patch 2 hours prior to a deep-sea fishing expedition to prevent sea-sickness.
Which of the following side effects is she likely to experience?
Diarrhea
Xerostomia
Rash
Insomnia
Lifestyle mod for pregnancy?
- Smaller, more frequent meals
- Bland foods (avoid trigger smells)
- BRAT (bananas, rice, applesauce, toast)
Counseling for pregnacy nausea?
- Taking a multivitamin daily for 3 months prior to conception
- Pyridoxine with or without doxylamine as first line therapy
- Ginger
Tx for hyperemesis gravidarum in pregnancy?
Ondansetron, promethazine, or metoclopramide
What is hyperemesis gravidarum?
Starvation, dehydration, electrolyte abnormalities – likely requires hospitalization
What is PONV?
- Usually within 24 hours after undergoing anesthesia
- Can use prophylaxis
- Moderate risk (1-2 risk factors): 2 drug regimen
- High risk ( > 2 risk factors): 3-4 drug regimen
How do you treat PONV?
- Scopolamine patches 2H before
- NK1 antagonists during induction
- Agents after surgery (Ondansetron is “gold standard” for use at end of surgical procedures)
ADRs of promethazine?
Necrosis, gangrene, IV harms
