CNS nausea and vomiting Flashcards
2 drug classes used for PROPHYLAXIS/TREATMENT OF N&V?
Antihistamines- Cyclizine/Promethazine
Phenothiazines- Prochlorperazine
how do Phenothiazines eg Prochlorperazine work
dopamine antagonists and act centrally by blocking the chemoreceptor trigger zone.
SE of phenothiazines that sometime occurs esp in childrn
Severe dystonic reactions
what phenothiazine can be used for chemotherapy-induced and radiation-induced nausea and vomiting. It is less sedating and available as a buccal tablet, which can be useful in patients with persistent vomiting or with severe nausea.
Prochlorperazine
PROPHYLAXIS/TREATMENT OF N&V
PREGNANCY?
SEVERE VOMITING?
PREGNANCY?
Nausea in first trimester- generally mild/does not require drug therapy
SEVERE VOMITING?
Short-term treatment-> anithistamine, e.g. promethazine/prochlorperazine/metoclopramide
POSTOPERATIVE N&V tx?
5HT-3 receptor antagonist (Ondansetron)/Dexamethasone
OD
PREOPERATIVE ANTICIPATORY N&V tx?
LORAZEPAM (short-acting)
MOTION SICKNESS tx?
hysocine HYDRObromide
patches MHRA risk of severe anticholinergic SEs
hyoscine BUTYLbromide (GI system) more for IBS
PALLIATIVE CARE N&V?
HALOPERIDOL/LEVOMEPROMAZINE
PARKINSON’S N&V?
DOMPERIDONE
Haloperidol/Levmepromazine-> antipsychotics, reduce dopamine levels, bad
HYPOTENSION RISK!
Metoclopramide` is an effective antiemetic and its activity closely resembles that of the phenothiazines. where does it act
directly on the gastric smooth muscle stimulating gastric emptying and it may be superior to the phenothiazines for emesis associated with gastro-intestinal and biliary disease.
which anti emetic acts at the chemoreceptor trigger zone. It has the advantage over metoclopramide and the phenothiazines of being less likely to cause central effects, such as sedation and dystonic reactions, because it does not readily cross the blood-brain barrier.
domperidone
The 5HT3-receptor antagonists, granisetron, ondansetron, and palonosetron, are used in the management of nausea and vomiting in patients receiving…
cytotoxics
why is domperidone suitable in parkinsons
does not cross bbb
domperidone dose (same as metoclopramide)
10mg tds
DOMPERIDONE
MINIMUM AGE?
12 yrs old (12 letters in it)
DOMPERIDONE
MAX. DAYS?
7
DOMPERIDONE
MINIMUM WEIGHT?
35kg+
DOMPERIDONE
SIDE-EFFECT?
QT prolongation
METOCLOPRAMIDE
SIDE-EFFECTS?
EPse, crosses BBB
METOCLOPRAMIDE
DOSE?
10mg TDS (same as dom)
METOCLOPRAMIDE
MINIMUM AGE?
18 years old
METOCLOPRAMIDE
MAX. DAYS?
5
what drug can be used in chemotherapy-induced n&v, alone or in combination with other antiemetics such as a 5HT3-receptor antagonist.
dexamethasone
