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MPharm Y3S2 > Clincal CNS Nausea/GA > Flashcards

Clincal CNS Nausea/GA Flashcards

1
Q

Name the GI causes of vomiting:

A

Gastro-enteritis
Appendicitis
Peptic ulceration
Gastric carcinoma
Infection (common)

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2
Q

Name organic diseases that cause vomiting:

A

Renal failure (uraemia)- high levels of this toxin
Diabetic ketoacidosis
Myocardial infarction- occur on inferior wall more likely

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3
Q

Name CNS causes that can cause vomiting:

A

Migraine
Meningitis
Vestibular disease (Meniere’s)

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4
Q

Name post-op causes that can cause vomiting:

A

Complex and multifactorial e.g pain, surgery, anaesthesia

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5
Q

What causes motion sickness?

A

Conflicting info between eyes and body

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5
Q

What are the common ages for motion sickness?

A

Children less than 1- labyrinth not functional so rarely occurs
Children 3-12 most vunerable

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6
Q

Name common drugs that cause N&V:

A

Opiates
Antibiotics (doxy)
Digoxin
Levodopa
Aminophylline/theophylline
Chemo

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7
Q

Which methods are N&V caused by?

A

1 of 2 methods:
Mimicking the action of NT/ changing levels of NT
Activating the abdominal afferent system (peripheral)

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8
Q

Name different type of drugs that mimic/ change NT:

A

Mimicking action of NT:
Opioids, Ldopa
Changing levels:
5HT3 re-uptake inhibitors (for depression)

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9
Q

Describe how activating the abdominal afferent system can cause N&V:

A

Delaying gastric emptying
Direct activation of mucosal afferent system

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10
Q

What is Ménière’s disease?

A

Disorder of the inner ear
Excess fluid on labyrinth canals (hydros)

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11
Q

What is the epidemiology of Ménière’s disease?

A

0.1% of population, common between 20-50 years old

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12
Q

What are the symptoms of Ménière’s disease?

A

Incapacitating attacks characterised by:
-giddiness, vertigo, N&V
-hearing loss
-functional paralysis
-tinnitus
Sudden onset, lasts 20mins to several hours
Migraine present in 30%

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13
Q

What is vertigo?

A

Sensation of rotation or spinning
Patient (objective) or their surrounding (subjective)

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14
Q

What are the common causes of vertigo in different age groups?

A

Young people- labyrinthitis
Elderly- BPPV

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15
Q

What is BPPV?

A

Benign Paroxysmal Positional Vertigo
Movement of naturally occurring calcium salts

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16
Q

What are other causes of vertigo?

A

Head injury
Migraine
MS
Excess alcohol

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17
Q

When should a patient be referred if they have vertigo?

A

If they have N&V associated

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18
Q

Name some vestibular toxic drugs:

A

Aminoglycosides e.g gentamicin
Anticonvulsants
Furosemide- max rate 4mg/min- ototoxicity
NSAIDs
Quinine

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19
Q

When does morning sickness occur?

A

50-90% if women experience nausea during first trimester
Begins shortly after first missed period
Peaks weeks 10-14
Often disappears after 4th month

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20
Q

What is morning sickness due to?

A

High levels of HCG- human chorionic gonadotropin

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21
Q

Name a severe form of morning sickness:

A

Hyperemesis Gravidarum

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22
Q

Describe hyperemesis gravidarum:

A

Severe persistent N&V during pregnancy- can’t keep anything down
Weight loss, dehydration, acidosis, ketosis
1-3 per 1000 deliveries
Untreated can be fatal to mother/foetus/both

23
Q

What are the reasons for treating N&V?

A

Highly unpleasant for patient
Dehydration
Weight loss
Renal impairment
Electrolyte abnormalities

24
Q

Describe the severity of symptoms of N&V that would require referral:

A

Projectile vomiting- pyloric stenosis
Sour smelling vomiting- pyloric stenosis
Blood in vomit

25
Q

Describe other symptoms of N&V that would require referral:

A

Severe diarrhoea/ long duration
-gastro-enteritis, infection
Weight loss
Abdominal pain
-appendicitis, biliary colic, renal colic, hernias
Dizziness
-meningitis, head injury, Meniere’s disease

26
Q

Describe the onset of action of H1 receptor antagonists:

A

Act within 2 hours
Theoclate salts longer acting than hydrochloride

27
Q

Name the MOA of promethazine:

A

H1 receptor antagonist
Also some D2

28
Q

Name the SEs of H1 receptor antagonists:

A

Drowsiness, dizziness, tinnitus
Antimuscarinic, antidopaminergic (promethazine) SEs

29
Q

What are the CI for promethazine:

A

Glaucoma and other muscarinic/ dopaminergic

30
Q

How do antimuscarinics work?

A

Act on muscarinic (M1 receptors centrally)
Antispasmodic gut action

31
Q

What are the SEs of anticholinergics?

A

Drowsiness, dry mouth, dry skin, decreased gut motility
Increased IOP and HR

32
Q

What are the CI of anticholinergics aka muscarinics?

A

Glaucoma and urinary retention

33
Q

How does prochlorperazine work?

A

Inhibits D2r and also some M1 (muscarininc)

34
Q

Name SEs of prochlorperazine:

A

Anti-dopaminergic- extrapyramidal e.g dystonia, dyskinesia, Parkinsonism- all more than chlorpromazine
Anti-cholinergic- drowsiness, blurred vision, dry mouth

35
Q

How does chlorpromazine work?

A

D2r antagonist, H1, antimuscarininc

36
Q

What are the counselling points for chlorpromazine?

A

More sedative effects than prochlorperazine
Used in palliative care
Contact senitisation- carer don’t touch them

37
Q

How does metoclopramide work?

A

Blocks D2R and some 5HT3
Antimuscarininc
Peripherally and centrally
Antiemetic and prokinetic properties (stim gastric emptying)- not in physicsal gut obstruction

38
Q

What is the dosing of metoclopramide and why?

A

Max 30mg/day for 5 days (10mg QDS)
Lowest dose for shortest time
Neurological adverse effects- acute dystolic reactions, movement disorders

39
Q

What are the SEs of metoclopramide?

A

10% experience transient SEs; drowsiness dizziness, anxiety
Extrapyrmidal SEs e.g dystonia, tardive dyskinesia, oculogyric crisis) more common in 12-19 yrs and females

40
Q

What are the interactions with metoclopramide?

A

Cyp2D6 inhibitor
Fluoxetine, paroxetine
Causes increase in metoclopramide

41
Q

What is the dosing of domperidone and why?

A

Lowest dose for shortest time- max 1 week due to CV risk

42
Q

What are the CI of domperidone?

A

Cardiac disease (irregular HR, QT) or any meds that cause QT prolongation e.g methadone, citalopram, amiodarone
Not in children and those less than 35kg

43
Q

How does domperidone work?

A

D2R antagonist- outside BBB
Prokinetic
Antimuscarininc (periphery)

44
Q

What are the interactions of domperidone?

A

CYP3A4 inhibitors e.g macrolides, azoles
Leads to higher doses of domperidone

45
Q

How do 5HT3 antagonists work?

A

5HT3r located peripherally on vagal nerve endings and vomiting centre- endochromaffin

46
Q

What are CIs of ondansetron?

A

QT prolongation drugs or abnormality as can increase risk of ventricular arythmias- congenital long QT syndrome

47
Q

What are the common SEs of ondansetron?

A

Constipation, feeling hot, headache, hypotension
QT prolongation

48
Q

What are the interactions with ondansetron?

A

Many CYP enzymes such as inducers which increases clearance of ondansetron

49
Q

What are non pharmacological treatments for nausea and vomiting?

A

Acupressure
Transcutaneous Electrical Nerve Stimulation (TENS)

50
Q

What are the first line treatments for morning sickness?

A

Promethazine
Prochloperazine
Cyclizine
Doxylamine and pyridoxine
Chlorpromazine

51
Q

What are the second line treatments for morning sickness?

A

Domperidone
Ondansetron- avoid in first 12 weeks due to orofacial cleafing
Metoclopramide

52
Q

Describe doxylamine and pyridoxine:

A

Doxylamine- H1 r antagonist
Pyridoxine- VitB6
Anticholingeric
Only medicine licensed in N&V in pregnancy

53
Q

Name different antiemetics used for CINV:

A

Dexamethasone
5HT3 r antagonists for acute and delayed
NK1 antagonists- delayed but can be acute

54
Q

What are the SEs of dexamethasone?

A

If BD dosing insomnia SEs at night
Limited SEs as short amount of time used and low doses

55
Q

What are the SEs/ interactions with NK1 antagonists?

A

Diarrhoea, fatigue, nausea
Metabolised by CYP3A4

MPharm Y3S2 (22 decks)

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