Case Study: Nausea + Vomiting Flashcards
What is nausea?
The feeling of the need to vomit
What is vomiting?
Forceful expulsion of stomach contents through the mouth
What are the causes?
Medication
Anxiety
Pregnancy
Migraines
Infection
Motion sickness
Blockage in GI tract
What are the complications with vomiting?
Dehydration
Malnutrition
Aspirational pneumonia
Oesophageal tear
Who is most likely to get dehydration?
Old people + babies
How do you treat dehydration?
ORT
What is aspirational pneumonia?
Stomach contents go into lungs
= DON’T eat before surgery
When should anti-emetics only be prescribed?
When the cause of vomiting is known
What is motion sickness?
Disagreement between visual perceived movement + vestibular system’s sense of movement
Why can anticholinergic agents + antihistamines treat motion sickness?
Cross BBB = reach dopamine + histamine receptors
What are the side effects of anticholinergic side effects?
Drowsiness
Blurred vision
Dry mouth
Constipation
Urinary retention
Dementia
What is the main drug for motion sickness?
Hyoscine
What are the treatment options for motion sickness?
Tablets
Chewable tablets
Patches
Elixir
What is problem with hyoscine?
Has 2 forms
One form has a butyl salt = cannot cross BBB
What can the butyl salt version of hyoscine treat?
GI spasms at high dose
What are the different kinds of chemotherapy induced nausea + vomiting (CINV)?
Acute
Delayed
Anticipatory
What is anticipatory CINV?
Association with sight + smells that make them be sick
Hard to treat
Who is more likely to get CINV?
Females
Those with motion sickness
Drink less alcohol
What is metoclopramide?
D2 antagonist = effects dopamine
= has side effects on movement
What is ondansetron?
5HT antagonist
Why do you need to be careful with high doses of metoclopramide?
Cause movement disorders
What is the normal MAX dose of metoclopramide?
10mg 3X
What are some movement disorders?
Akathesia = reversible
Dystonia = reversible
Tardive dyskinesia = irreversible
What are some drugs used for CINV?
Ondansetron = 5HT3 antagonist
Metoclopramide = D2 antagonist
Aprepitant = NK1 antagonist
Dexamethasone = corticosteroid
When is postoperative nausea + vomiting (PONV) more common?
Increased hospital stay
Stress on surgical closure
Aspirational pneumonitis
When is postoperative nausea + vomiting (PONV) more common?
Increased hospital stay
Stress on surgical closure
Aspirational pneumonitis
How do you manage PONV?
“Wait + see” = 1 risk factor
Moderate risk = 2/3 risk factors
High risk = 4 or more risk factors
If there is a high risk of PONV, what do you do?
1 or 2 drugs = D2 + 5HT antagonist
What can be the causes of nausea + vomiting in palliative care?
Chemicals
Gastric stasis
Bowel obstruction
Raised intracranial pressure
Psychological factors
What is problem with patients with nausea + vomiting?
Absorb drugs poorly by oral route
What should you do with patients with nausea + vomiting?
Prescribe subcutaneously for at least 24hrs
