Day 1- N/V/D/C and IBS Flashcards
What are your 4 sites of afferent impulses for N/V?
What is the CTZ stimulated by?
What is the vestibular system simulated by?
CTZ, Vestibular System, Cerebral Cortex, GI Tract.
Neurotransmitters, drugs, toxins.
Excessive stimulation of H1, M1 receptors.
What is the GI tract stimulated by?
What is the CNS stimulated by?
How does the Vomiting Center use the signals from the other 4?
Released by chemical or mechanical stimulation.(rich in 5-HT3 receptors).
sent to cerebral cortex for interpretation.
Formulates efferent impulses of GI, respiratory, pharyngeal, and vomiting reflex.
What is the difference between simple and complex N/V?
What are some non pharmacologic dietary things people can do to treat N/V?
What are some other non pharmacologic treatments for N/V?
Self limiting, requires only symptomatic therapy, no labs, usually treated with OTC agents for simple.
Minimize gastric distention, Minimize noxious stimuli.
Acupuncture, Acupressure(sea band hits neiguans point), cognitive behavioral therapies, relaxation techniques. Peppermint oil, ginger(limited evidence for these 2).
What are your anticholinergic drugs in N/V and how does it work?
What are your antihistamines and how does it work?
How do the phenothiazines work?
Blocks M1 in vestibular system. Used in motion sickness and PONV. Scopolamine patch.
Blocks H1 in vestibular system. Dimenhydrate, diphenhydramine, meclizine, hydroxyzine. Used for motion sickness and vertigo and PONV for hydroxyzine. Take dramamine 30 minutes before travel to be effective.
Chlorpromazine, Promethazine, Prochlorperazine. Inhibits D2 receptors in the CTZ and have some anticholinergic and antihistaminic effects. Used in any N/V.
What are the phenothiazines BBW?
What does Haloperidol work and when do you use it?
What is Haloperidol’s BBW?
Promethazine–> severe tissue injury with extravasation(DO NOT administer intra arterially or SQ). X-dumbbells are ADR’s.
Inhibits D2 receptors, Prevents PONV and used in palliative care.
Increased risk of death in elderly patients treated for dementia-related psychosis.
What is Metoclopramide’s MOA and when is it used?
What is Metoclopramide’s BBW?
When do you give ondansetron and Granisetron?
Inhibits DA2 in the CTZ and GI tract. Used in PONV(given near end of procedure) and diabetic gastroparesis.
Chronic used may lead to irreversible tardive dyskinesia(limit to <12 weeks), may add anticholinergics to treat/prevent.
before anesthesia for ondansetron, at end of surgery.
When do you give Dolasetron? Palonoestron?
What are the 5-HT3’s ADE’s?
What are the NK1 receptor antagonists MOA and use?
15 min before cessation of anesthesia, immediately before surgery for 10 seconds.
Headache, weakness.
Inhibits substance P or NK1. Used fore PONV prophylaxis. Interacts with Cyp’s.
What is 1st line medication for motion sickness treatment?
What is 2nd line treatment for motion sickness?
What are some risk factors for PONV?
Scopolamine patch(at least 4 hours before travel and change at least every 3 days) and antihistamines.
Benzo’s 1-2 hours before travel. Can use ginger 4 hours before.
Female sex, nonsmoking, history of PONV/motion sickness, metabolic disturbances(DM, uremia, electrolyte imbalance), Use of volatile anesthetics, nitrous oxide, intraoperative and postoperative opioids, duration of surgery and type of surgery.
How do you score PONV?
How do you do post operative NV treatment?
What is the difference between acute, persistent, and chronic diarrhea?
If patient is female, non smoker, history of PONV/motion sickness, posoperative opioid use all get 1 point. If 0-1 it’s low risk and no prophylaxis, if 2 1-2 agents, and 3-4 is 2-3 agents from different classes.
If no prophylaxis use low does 5-HT3. If used dual therapy add patient from different class. If used triple therapy then within 6 hours add agent from different class. 6 hours or more is repeat doses or add another drug(4).
Acute <14, Persistent >14, Chronic >30 days.
What causes osmotic diarrhea?
What are causes of secretory diarrhea?
What causes altered intestinal motility diarrhea?
Laxatives, lactose, celiac disease, over ingestion of high fructose corn syrup. Alleviated by fasting.
infections, unabsorbed dietary fats, tumors, medications(castor oil, quinidines). not relieved by fasting.
Surgery, bacterial toxins, laxatives, medications.
What causes exudative diarrhea?
What medications cause diarrhea?
When do you refer patients with diarrhea?
IBD and infections.
Antacids containing Magnesium, Antibiotics, Antidepressants, Antineoplastic, Cholinergics, Laxatives, Metformin, Misoprostol, NSAIDS, PPI’s, Colchicine.
Enduring despite of treatment, blood in stools, pus or greasy stool, high fever(>101), severe dehydration, hypotensive, neurological changes, unintentional weight loss of >5kg in last 6 months.
Do you always need to treat diarrhea?
What are your anti motility agents for diarrhea?
What are the adsorbents and what are they used for?
NO.
Loperamide(give big 1st dose and the half dose)., Diphenoxylate and atropine. Used for acute, chronic, and travelers diarrhea. If diarrhea lasts longer than 48h they need to see a doctor.
Polylcarbophil, Kaolin-pectin mixture OTC. Used for both diarrhea and constipation.
When can you use antisecretory and what special things to know about them?
When can you use probiotics?
When is Lactase used?
Diarrhea, travelers diarrhea, H.Pylori. CI’d in hx of GI bleed, <12 yo and viral infection due to reyes syndrome. Watch for discoloration of tongue and stool and tinnitus.
Reintroduce non pathogenic bacteria. Antibiotic induced and infectious diarrhea. Mixed efficacy.
Osmotic diarrhea secondary to lactose intolerant.
What is the definition of constipation?
Can constipation be primary(idiopathic) or secondary?
What medications can cause constipation?
Less than 3 bowel movements per week.
YES. Most common type is functional.
Analgesics, Anticholinergics, Ca and AI antacids, Iron supplements, CCB’s, Antidiarrheals.
When do you refer a patient to a doctor for constipation?
What are the non pharmacologic treatments for constipation?
When are the bulk forming agents used, their MOA and what are their CI’s?
Blood in stool, unintentional weight loss, refractory, sig change in BM if older than 50, lasts more than 30 weeks, anemia, recent surgery.
Fiber, Water, Physical activity(titrate up slowly), surgical.
Increase water content in stool–> increase stool bulk–> improve frequency. 1st line agent for treatment and prevention. CI’d in fecal impaction or intestinal obstruction.
