CHAPTER 4: CNS: Nausea Flashcards

1
Q

Which class of antiemetics is valuable for treating N&V associated with; neoplastic disease, radiation or emesis caused by drugs (e.g) opioids

A

Phenothiazines

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2
Q

What is a side effect of phenothiazines?

A

Severe dystonic reactions - dopamine antagonists

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3
Q

Which class of antiemetics is used to treat N&V associated with terminal illness?

A

Antipsychotics - haloperidol and levomepromazine

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4
Q

Related to phenothiazines, which class of antiemetics is useful in gastroduodenals, hepatitis and billiary disease causing N&V?

A

Metoclopramide

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5
Q

Metoclopramide and phenothiazines are contra-indicated in N&V in patients with Parkinson’s disease. Which drug can be used as it does not cross the BBB?

A

Domeperidone

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6
Q

Which class of antiemetic is valuable in management of N&V in patients receiving cytotoxics or PONV?

A

5-HT3 antagonists

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7
Q

Give an example of a 5-HT3 antagonist

A

Ondansetron

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8
Q

Aprepitant is an NK-1 inhibitor licensed for acute and delayed N&V associated with what?

A

Cisplatine-based chemotherapy

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9
Q

Which other drugs is aprepitant usually given with? (2)

A
  1. Dexamethasone

2. Ondansetron

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10
Q

Which synthetic cannabinoid may be used for N&V caused by cytotoxic chemotherapy unresponsive to conventional anti-emetics?

A

Nabilone

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11
Q

If severe, which antiemetic can be used for vomiting during pregnancy?

A

Promethazine

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12
Q

What are the alternatives to promethazine for vomiting during pregnancy?

A
  1. Prochlorperazine

2. Metoclopramide

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13
Q

What is a more serious condition that stems from N&V in pregnancy?

A

Hyperemesis gravidarum

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14
Q

How is hyperemesis gravidarum treated? (4)

A
  1. IV fluids
  2. electrolyte replacement
  3. anti-emetics
  4. nutritional support
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15
Q

Which classes of drug are used for PONV? (4)

A
  1. Antihistamines
  2. 5HT3 antagonists
  3. Dexamethasone
  4. Prochlorperazine
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16
Q

True or False: A combination of 2 drugs from different classes can be used for PONV

17
Q

When is the best time to give an antiemetic for motion sickness?

A

BEFORE it has developed

18
Q

What is the most effective treatment for motion sickness?

A

Hyoscine hydrobromide

19
Q

After hyoscine, what is next in line for motion sickness? (2)

A
  1. Cinnarizine

2. Promethazine

20
Q

Which drugs are ineffective in motion sickeness?

A
  1. Domeperidone
  2. Metoclopramide
  3. 5HT3 antagonists
  4. Phenothiazines - apart from promethazine
21
Q

What is betahistine licensed for?

A
  1. Tinnitus
  2. Vertigo
  3. Hearing loss
22
Q

What is a significant side effect of older antihistamines such as cyclizine and cinnarizine?

A

Drowsiness

23
Q

What is the MHRA alert associated with domperidone?

A

Risk of cardiac side effects

24
Q

What is the maximun duration for the use of domeperidone due to the cardiac side effects?

25
In which 4 circumstances is domeperidone contraindicated?
1. Impaired cardiac conduction 2. With drugs that prolong QT interval 3. Potent CYP3A4 inhibitors 4. Severe hepatic impairment
26
What is the MHRA alert associated with metoclopramide?
Risk of neurological side effects
27
Which indications have the MHRA specified use of metoclopramide in?
1. PONV 2. Radiotherapy induced N&V 3. Chemotherapy induced N&V 4. N&V in migraines
28
How long should metoclopramide only be prescribed for?
5 days
29
Which metoclopramide, in which group of the population are EPSEs especially common in?
Young women 15-19
30
What is a side effect of hyoscine hydrobromide that may occasionally occur?
Anticholinergic syndrome
31
Which effects does hypscine hydrobromide enhance?
Alcohol