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BNF > CHAPTER 4: CNS: Nausea > Flashcards

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

A

True

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?

A

1 week

25
Q

In which 4 circumstances is domeperidone contraindicated?

A
  1. Impaired cardiac conduction
  2. With drugs that prolong QT interval
  3. Potent CYP3A4 inhibitors
  4. Severe hepatic impairment
26
Q

What is the MHRA alert associated with metoclopramide?

A

Risk of neurological side effects

27
Q

Which indications have the MHRA specified use of metoclopramide in?

A
  1. PONV
  2. Radiotherapy induced N&V
  3. Chemotherapy induced N&V
  4. N&V in migraines
28
Q

How long should metoclopramide only be prescribed for?

A

5 days

29
Q

Which metoclopramide, in which group of the population are EPSEs especially common in?

A

Young women 15-19

30
Q

What is a side effect of hyoscine hydrobromide that may occasionally occur?

A

Anticholinergic syndrome

31
Q

Which effects does hypscine hydrobromide enhance?

A

Alcohol

BNF (28 decks)

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