CNS - Nausea & Labyrinth Flashcards
motion sickness
hyiscine hydrobromide
cinnarzine
cyclizine
promethazine (sedative)
Gi and biliary disease
metoclopramine
underlying conditions - antihistamines
e.g. cinnarizine
cyclizine
promethazine
chemotherapy
dopamine antagonist
prochlorperazine
ondansetron
dexamethasome
aprepitant
nabilone
palliative care
antipsychotic e.g.
haloperidol and levomepromazine
post op - 5HT-receptor antagonists
e.g. ondansetron, dexamethasone and haloperidol
post op N& V caused by opoids and GA
cyclizine
other treatments for N& V
metoclopramide
domperidone
phenothiazines
metoclopramide
acts directly on gastric smooth muscle stimulating gastric emptying - can cause dystonia in young females
domperidone
acts at the chemoreceptor trigger zone (acts peripherally), less likely to cause central effects like sedation and dystonic reactions
in parkinsons disease how can domperidone be used?
at LOW doses
phenothiazines
act centrally by blocking the chemoreceptor trigger zone (risk of dystonic reactions)
e,g,. chloropromazine, prochlorperazine
trifluoperazine
what to do with N&V with a pregnant patient?
common in 1st trim.
resolves in 16-20weeks
1) self care advice (hydration, rest and dietary changes)
2) avail support
3) antimetics - chlorpormazie, cyclizine, metoclopramide, prochlorperazine, promethazine and ondansetron
what treatments to offer a pregnant lady?
persistent hypermesis gravidarum
opffer - antimetics
via parenteral or rectal route
offer THIAMINE supplements to reduce wernicke’s encephalopathy
metoclopramide
should be prescribed for short term use (up to 5 days)
usual dose is 10mg, repeat up to 3 times daily; max dose is 500mcg/kg
dopeperidone
not for children <12 yrs or those weighing <35kg
use lowest effective dose for shortest length
max treatment duration should not exceed 1 wk
what are the side effects of domeperidone?
induce scute dystonic reactions, facial and skeletal muscle spasms
contra indications - cardiac disease, Gi obstruction or haemorrhage
What is the dose of donepezil for mild to moderate dementia in Alzheimer’s disease
5mg OD for 1 month, then increased up to 10mg daily, taken at bedtime.
When is a prescription for donepezil for an elderly potentially inappropriate?
In patients with a known history of persistent bradycardia (heart rate less than 60 beats per minute)
In patients with a heart block (risk of cardiac conduction failure, syncope and injury).
Counsel patients on the use of donepezil orodispersible tablets
Tablet should be placed on the tongue, allowed to disperse, and swallowed.
What are the cognitive and non-cognitive symptoms of dementia?
Cognitive Symptoms:
Memory loss
Lack of concentration
Disorientated
Difficulty with speech
Non-Cognitive Symptoms:
Agitation
Aggression
Distress
Psychosis