Motion sickness Flashcards

1
Q

Briefly describe the pathophysiology of motion sickness

A
  • Conflicting motion stimuli fed by vestibular labyrinth, eyes and proprioreceptors to the vestibular nuclei
  • Stimuli goes through cerebellum to vomiting centre in medulla oblongata and other areas in CNS
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2
Q

Which age group(s) is/are likely to develop motion sickness?

A

Children 2-12 yo

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3
Q

Patient factors that may contribute to motion sickness

A
  • Menstruation
  • Pregnancy
  • History of migraines
  • Sleep deprivation
  • Tobacco smoking
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4
Q

Early signs of motion sickenss

A
  1. Pallor
  2. Restlessness
  3. Cold sweat

(late stages: nausea and vomiting)

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5
Q

Key treatment principle of motion sickness

A

Prevention

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6
Q

Three general non-pharmacological principles to prevent motion sickness

A
  1. Reduce vestibular motion: choose locations of vehicle that minimise motions
  2. Synchronise visual and motion: view outside, choose window seat, or close eyes while holding head still
  3. Actively synchronize the body with motion: such as actively tilting head
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7
Q

State the mechanism of action of cinnarizine. Describe its dosing regimen for motion sickness

A
  • MoA: Antihistamine-1, with anticholinergic effects
  • Dosing: 25 mg at least 30 min before travel, then q4-6h
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8
Q

State the mechanism of action of promethazine. Describe its dosing regimen in motion sickness

A
  • MoA: H1 antihistamine with strong anticholinergic effect
  • Dosing: 25 mg 30-60 mins before travel, then q8-12h
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9
Q

State the mechanism of action of scopolamine patch. Describe its dosing regimen in motion sickness

A
  • MoA: Antimuscarinic with anticholinergic properties
  • Dose: 1 patch at a hairless area behind the ear 5-6h before travel, then q72h (one patch lasts 72h)
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10
Q

State the mechanism of action of dimenhydrinate. Describe its dosing regimen in motion sickness

A
  • MoA: H1 antihistamine with anticholinergic effect. Metabolised to diphenhydramine
  • Dosing: 50-100 mg 30-60 mins before travel, then q6-8h
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11
Q

State the mechanism of action of diPHENhydramine. Describe its dosing regimen in motion sickness

A
  • MoA: H1 antihistamine with anticholinergic properties
  • Dose: 25-50 mg at least 30 mins before travel, then q4-6h
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12
Q

Describe the dosing regimen of ginger pills in motion sickness

A

2-3 tablets at least 30 mins before travel, then 1 tab q2h

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13
Q

What kind of symptoms should you refer a patient to the doctor in nausea and vomiting?

A
  1. Severe abdominal pain
  2. Blood in vomitus
  3. Head injury, or other neuropathy (e.g. numbness, visual disturbances)
  4. Signs and symptoms of dehydration
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14
Q

Describe the dose of domperidone for NNV. State the forensic classification and the indication for supplying domperidone if applicable, as well as the maximum supply

A
  • Dose: 10 mg TDS (max 30 mg/day)
  • Forensic classification: POM w exemption for 14 days for gastric symptoms (e.g. bloating, belching) or nausea (not vomiting) for patients at least 12yo
  • Max supply: 14 days (42 tabs)
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15
Q

Besides ginger, what is/are the complementary treatment(s) that can be used to prevent motion sickness?

A

Sea band (attached to P6 of meridian system, somewhere around the wrist area)

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16
Q

Non-pharmacological management for patients who experiences mild headache at high altitudes?

A
  1. Sleep upright
  2. Stay hydrated
  3. Rest
  4. Avoid alcohol
  5. Descend if symptoms persist for 24h