CHAPTER 4: CNS: Nausea Flashcards
Which class of antiemetics is valuable for treating N&V associated with; neoplastic disease, radiation or emesis caused by drugs (e.g) opioids
Phenothiazines
What is a side effect of phenothiazines?
Severe dystonic reactions - dopamine antagonists
Which class of antiemetics is used to treat N&V associated with terminal illness?
Antipsychotics - haloperidol and levomepromazine
Related to phenothiazines, which class of antiemetics is useful in gastroduodenals, hepatitis and billiary disease causing N&V?
Metoclopramide
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?
Domeperidone
Which class of antiemetic is valuable in management of N&V in patients receiving cytotoxics or PONV?
5-HT3 antagonists
Give an example of a 5-HT3 antagonist
Ondansetron
Aprepitant is an NK-1 inhibitor licensed for acute and delayed N&V associated with what?
Cisplatine-based chemotherapy
Which other drugs is aprepitant usually given with? (2)
- Dexamethasone
2. Ondansetron
Which synthetic cannabinoid may be used for N&V caused by cytotoxic chemotherapy unresponsive to conventional anti-emetics?
Nabilone
If severe, which antiemetic can be used for vomiting during pregnancy?
Promethazine
What are the alternatives to promethazine for vomiting during pregnancy?
- Prochlorperazine
2. Metoclopramide
What is a more serious condition that stems from N&V in pregnancy?
Hyperemesis gravidarum
How is hyperemesis gravidarum treated? (4)
- IV fluids
- electrolyte replacement
- anti-emetics
- nutritional support
Which classes of drug are used for PONV? (4)
- Antihistamines
- 5HT3 antagonists
- Dexamethasone
- Prochlorperazine
True or False: A combination of 2 drugs from different classes can be used for PONV
True
When is the best time to give an antiemetic for motion sickness?
BEFORE it has developed
What is the most effective treatment for motion sickness?
Hyoscine hydrobromide
After hyoscine, what is next in line for motion sickness? (2)
- Cinnarizine
2. Promethazine
Which drugs are ineffective in motion sickeness?
- Domeperidone
- Metoclopramide
- 5HT3 antagonists
- Phenothiazines - apart from promethazine
What is betahistine licensed for?
- Tinnitus
- Vertigo
- Hearing loss
What is a significant side effect of older antihistamines such as cyclizine and cinnarizine?
Drowsiness
What is the MHRA alert associated with domperidone?
Risk of cardiac side effects
What is the maximun duration for the use of domeperidone due to the cardiac side effects?
1 week
In which 4 circumstances is domeperidone contraindicated?
- Impaired cardiac conduction
- With drugs that prolong QT interval
- Potent CYP3A4 inhibitors
- Severe hepatic impairment
What is the MHRA alert associated with metoclopramide?
Risk of neurological side effects
Which indications have the MHRA specified use of metoclopramide in?
- PONV
- Radiotherapy induced N&V
- Chemotherapy induced N&V
- N&V in migraines
How long should metoclopramide only be prescribed for?
5 days
Which metoclopramide, in which group of the population are EPSEs especially common in?
Young women 15-19
What is a side effect of hyoscine hydrobromide that may occasionally occur?
Anticholinergic syndrome
Which effects does hypscine hydrobromide enhance?
Alcohol
