Emsis

Question 1

What’s the drug of choice for vomiting during pregnancy

Answer 1

Antihistamine e.g. promethazine

Prochlorperazine or metoclopramide are alternatives

Question 2

Hyperemesis gravidarum during pregnancy requires what type of treatment

Answer 2

Antiemetic
Intravenous fluid and electrolyte
Thiamine to prevent Wenickes encephalopathy

Question 3

What are the drugs used in post operative nausea and vomiting

Answer 3

5HT3 antagonist eg granisetron, droperidol
Dexamethasone
Phenothuazides e.g. prochlorperazine
Antihistamines e.g. cyclizine

Question 4

The most effective drug for prevention of motion sickness

Answer 4

Hyoscine hydrobromide

Question 5

A sedating anti-emetic for motion sickness but what are others that are preferred

Answer 5

Promethazine (The only phenothiazine that is effective in motion sickness)
Preferred Cyclizine or cinnarizine

Question 6

Ménière’s disease

Symptoms and treatment

Answer 6

Vertigo, tinnitus, hearing loss (buildup of fluid in endolymphatic, burst membrane)
Betahistine
Salt to restriction (reduce fluid)
Diuretic
Cinnarizine or prochlorperazine (reserved for acute symptom)

Question 7

What Antiemetic are used in terminal illness

Answer 7

Haloperidol

Levopromazine

Question 8

What is the advantage of domperidone over metoclopramide and phenothiazine?

Answer 8

Less likely to cause central affect such as sedation and EPSE as not crossing BBB. Used in Parkinson’s

Question 9

What are the antiemetics preferred for patients receiving cytotoxics and are post operative

Answer 9

Granisetron and ondasetron
Palonosetron (with netupitant) for prevention of delayed vomiting asso. W moderate to high emetogenic cisplatin-based chemotherapy

Question 10

What are the indications of neurokinin 1 receptor antagonist

Answer 10

Prevention of nausea and vomiting associated with this moderately and highly emetogenic chemotherapy

Question 11

What is the add on therapy for chemotherapy induced vomiting and responsive to others

Answer 11

Nabilone

Synthetic cannabinoids

Question 12

MOA of Metoclopramide

Answer 12

D2 antagonist (in CTZ brain, gut)
Prokinetic (gastric emptying)

Question 13

The gastric emptying affect of metoclopramide make it useful in what type of disease

Answer 13

Gastroduodenal, liver biliary disease

Question 14

What is the common dosage and duration of metocloperamide

Answer 14

10mg TDS for FIVE days Max

Question 15

MHRA warning about Metoclopramide

Answer 15

Risk of neurological adverse effects- acute dystonic muscle in face and body muscle spasms EPSE - restricted dose and duration
More pronounced in young women or very old
Procyclidine (Dopamine analogue) aborts attacks

Question 16

Drug Interactions of metoclopramide

Answer 16

1. Antipsychotics: increase EPSE

2. C/I Parkinson’s disease

Question 17

MOA of Domperidone

Answer 17

D2 antagonist (in gut ONLY)
Prokinetic gut

Question 18

MHRA warning about Domperidone

Answer 18

Risk of cardiac effect - prolong QT - arrhythmia- TdP - cardiac arrest - death
Report syncope, Palpitations

Question 19

The dose and duration of domeprodone (35kg+)

Answer 19

10mg TDS for SEVEN days

Question 20

The age restriction of metoclopramide and domperidone

Answer 20

18

12

Question 21

Drug interactions with Domperidone

Answer 21

CYP3A4 inhibitors: amiodqrone ketoconazole erythromycin

QTP: quinolone SSRI Li amiodarone other antipsychotics

Question 22

Main SE of 5HT3 antagonists

Ondasetron (in post op/ chemo)

Answer 22

QTP (ANTIpsychs, Li, SSRI, amiodarone)- TdP - hypoK (DIBTCLA)
Serotonin syndrome (SSRI, 5HT1 antagonist - sumatriptan, MAOi)