Case Study: Nausea + Vomiting

Question 1

What is nausea?

Answer 1

The feeling of the need to vomit

Question 2

What is vomiting?

Answer 2

Forceful expulsion of stomach contents through the mouth

Question 3

What are the causes?

Answer 3

Medication
Anxiety
Pregnancy
Migraines
Infection
Motion sickness
Blockage in GI tract

Question 4

What are the complications with vomiting?

Answer 4

Dehydration
Malnutrition
Aspirational pneumonia
Oesophageal tear

Question 5

Who is most likely to get dehydration?

Answer 5

Old people + babies

Question 6

How do you treat dehydration?

Answer 6

ORT

Question 7

What is aspirational pneumonia?

Answer 7

Stomach contents go into lungs
= DON’T eat before surgery

Question 8

When should anti-emetics only be prescribed?

Answer 8

When the cause of vomiting is known

Question 9

What is motion sickness?

Answer 9

Disagreement between visual perceived movement + vestibular system’s sense of movement

Question 10

Why can anticholinergic agents + antihistamines treat motion sickness?

Answer 10

Cross BBB = reach dopamine + histamine receptors

Question 11

What are the side effects of anticholinergic side effects?

Answer 11

Drowsiness
Blurred vision
Dry mouth
Constipation
Urinary retention
Dementia

Question 12

What is the main drug for motion sickness?

Answer 12

Hyoscine

Question 13

What are the treatment options for motion sickness?

Answer 13

Tablets
Chewable tablets
Patches
Elixir

Question 14

What is problem with hyoscine?

Answer 14

Has 2 forms
One form has a butyl salt = cannot cross BBB

Question 15

What can the butyl salt version of hyoscine treat?

Answer 15

GI spasms at high dose

Question 16

What are the different kinds of chemotherapy induced nausea + vomiting (CINV)?

Answer 16

Acute
Delayed
Anticipatory

Question 17

What is anticipatory CINV?

Answer 17

Association with sight + smells that make them be sick
Hard to treat

Question 18

Who is more likely to get CINV?

Answer 18

Females
Those with motion sickness
Drink less alcohol

Question 19

What is metoclopramide?

Answer 19

D2 antagonist = effects dopamine
= has side effects on movement

Question 20

What is ondansetron?

Answer 20

5HT antagonist

Question 21

Why do you need to be careful with high doses of metoclopramide?

Answer 21

Cause movement disorders

Question 22

What is the normal MAX dose of metoclopramide?

Answer 22

10mg 3X

Question 23

What are some movement disorders?

Answer 23

Akathesia = reversible
Dystonia = reversible
Tardive dyskinesia = irreversible

Question 24

What are some drugs used for CINV?

Answer 24

Ondansetron = 5HT3 antagonist
Metoclopramide = D2 antagonist
Aprepitant = NK1 antagonist
Dexamethasone = corticosteroid

Question 25

When is postoperative nausea + vomiting (PONV) more common?

Answer 25

Increased hospital stay
Stress on surgical closure
Aspirational pneumonitis

Question 26

When is postoperative nausea + vomiting (PONV) more common?

Answer 26

Increased hospital stay
Stress on surgical closure
Aspirational pneumonitis

Question 27

How do you manage PONV?

Answer 27

“Wait + see” = 1 risk factor
Moderate risk = 2/3 risk factors
High risk = 4 or more risk factors

Question 28

If there is a high risk of PONV, what do you do?

Answer 28

1 or 2 drugs = D2 + 5HT antagonist

Question 29

What can be the causes of nausea + vomiting in palliative care?

Answer 29

Chemicals
Gastric stasis
Bowel obstruction
Raised intracranial pressure
Psychological factors

Question 30

What is problem with patients with nausea + vomiting?

Answer 30

Absorb drugs poorly by oral route

Question 31

What should you do with patients with nausea + vomiting?

Answer 31

Prescribe subcutaneously for at least 24hrs