CNS - Nausea & Labyrinth

Question 1

motion sickness

Answer 1

hyiscine hydrobromide

cinnarzine

cyclizine

promethazine (sedative)

Question 2

Gi and biliary disease

Answer 2

metoclopramine

Question 3

underlying conditions - antihistamines

Answer 3

e.g. cinnarizine

cyclizine

promethazine

Question 4

chemotherapy

Answer 4

dopamine antagonist

prochlorperazine

ondansetron

dexamethasome

aprepitant

nabilone

Question 5

palliative care

Answer 5

antipsychotic e.g.

haloperidol and levomepromazine

Question 6

post op - 5HT-receptor antagonists

Answer 6

e.g. ondansetron, dexamethasone and haloperidol

Question 7

post op N& V caused by opoids and GA

Answer 7

cyclizine

Question 8

other treatments for N& V

Answer 8

metoclopramide
domperidone
phenothiazines

Question 9

metoclopramide

Answer 9

acts directly on gastric smooth muscle stimulating gastric emptying - can cause dystonia in young females

Question 10

domperidone

Answer 10

acts at the chemoreceptor trigger zone (acts peripherally), less likely to cause central effects like sedation and dystonic reactions

Question 11

in parkinsons disease how can domperidone be used?

Answer 11

at LOW doses

Question 12

phenothiazines

Answer 12

act centrally by blocking the chemoreceptor trigger zone (risk of dystonic reactions)

e,g,. chloropromazine, prochlorperazine

trifluoperazine

Question 13

what to do with N&V with a pregnant patient?

Answer 13

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

Question 14

what treatments to offer a pregnant lady?

Answer 14

persistent hypermesis gravidarum

opffer - antimetics

via parenteral or rectal route

offer THIAMINE supplements to reduce wernicke’s encephalopathy

Question 15

metoclopramide

Answer 15

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

Question 16

dopeperidone

Answer 16

not for children <12 yrs or those weighing <35kg
use lowest effective dose for shortest length

max treatment duration should not exceed 1 wk

Question 17

what are the side effects of domeperidone?

Answer 17

induce scute dystonic reactions, facial and skeletal muscle spasms

contra indications - cardiac disease, Gi obstruction or haemorrhage

Question 18

What is the dose of donepezil for mild to moderate dementia in Alzheimer’s disease

Answer 18

5mg OD for 1 month, then increased up to 10mg daily, taken at bedtime.

Question 19

When is a prescription for donepezil for an elderly potentially inappropriate?

Answer 19

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).

Question 20

Counsel patients on the use of donepezil orodispersible tablets

Answer 20

Tablet should be placed on the tongue, allowed to disperse, and swallowed.

Question 21

What are the cognitive and non-cognitive symptoms of dementia?

Answer 21

Cognitive Symptoms:
Memory loss
Lack of concentration
Disorientated
Difficulty with speech

Non-Cognitive Symptoms:
Agitation
Aggression
Distress
Psychosis