Lecture 8 - Nausea, Vomiting, Diarrhea Flashcards
Drugs that target Cerebral Cortex
H1
Drugs that target Vestibular system
Ach-M
H1
Drugs that target GI tract
5-HT3,4
Substance P
Drugs that target Area Posterna (Chemoreceptor trigger zone)
5-HT3
D2
NK1
Complications of Vomiting
** Dehydration Electrolyte disturbances Malnutrition Aspiration Mallory-Weiss Syndrome = Esophageal tears
Self-care vomiting
Goal: ID + resolve underlying cause, prevent or eliminate N/V
Non-harm treatment of N/V
Acupuncture Acupressure wristbands Breathing and other relaxation techniques ID and avoidance of potential triggers Hypnosis Guided imagery
4 common causes of N/V
Viral Gastroenteritis in children
Pregnancy
Motion sickness
Excessvie eating
Txm for children dehydration
Pedialyte, Infalyte, Naturalyte
dont use sport drinks, plain water, carbonated Bev
dont use sugar-water or salt-water
Mild-moderate dehydration calc
50-100ml/kg over 2-4hrs + additional ORS for ongoing losses (10mL/kg for each stool and 2mL/kg for each emesis episode)
Admin slowly by caregiver at a rate of 5ml every 1-2min
Severe dehydration treatment
Medical emergency
bolus 20-30ml/kg lactated ringer or normal saline over 60min, followed by continuous infusion of 70ml/kg LR or NS over 5hrs ( < 12mnth) or 2.5 hrs ( > 12mnth)
once normalized, rehydration with ORS
Algorithm for Txm of children.
sxs severe dehydration - yes = refer
No = ORS, avoid antiemetics, stop feeding X 1hr..restard feeding with light solids/formula/boob milk as tolerated….restart ORS if vomiting occurs
If dont resolve, Refer to PCP
Prevention of Gastroenteritis
Wash hands
Vaccines
rotarix = 2 dose at 2/4 months
RotaTeq = 3 dose at 2/4/6 month
If RotaTeq or unknown, 3 dose series
“morning sickness”
N/V + missed menstrual cycle = refer to primary care provider
Severe vomiting resulting in hypovolemia + weight loss -> hyperemesis/gravidarum = refer to PCP/OB
~ 90% ppl pregnant
Related to HCG increase
Non-pharm is preferred
Non-pharm morning sickness treatment
Small snack before bed cold, clear,carbonated fluids eat multiple, small meals/snacks slowly rise from bed fresh air avoid greasy eat chilled v hot foods try ginger containing foods
Pharm morning sickness treatment
OTC: Pyridoxine = B6, antihistamines, ginger
Rx: DA agonist, Diclegis/Bonjesta, Serotonin antagonists
DA antagonist SE
Dizziness drowsiness anxiety sleep disturbances insomnia strange dreams urinary retention dry mouth movement disorders
Diclegis
N/V in preg in women who dont respond to conservative management
Doxylamine 10mg/pyridoxine 10mg DR tab
Diclegis Schedule
Initial: 2 tabs PO on empty stomach at bedtime on days 1/2
If symptoms persist: 1 qAM, 2 qHS on day 3
If symptoms persist: 1 qAM, 1 afternoon, 2 qHS on day 4 ( max 4/day)
Diclegis SE
somnolence
drowsiness
constipation
Bojesta
same as diclegis but its 20mg/20mg ER
Bojesta schedule
Initial: 1 tab po at Bedtime
If symptoms persist: 1 tab in morning, 1 tab at bedtime (2 max per day)
Ondansetron, Granisetron, Dolasetron MOA
Blocks serotonin on peripheral vagal nerve terminals and centrally on CTZ
Ondansetron uses
controversial in pregnancy, due to CV risks, oral cleft/septal defects
When to try ondansetron?
after failing 10 agents before 10 weeks of gestation
