N/V Flashcards
3 general steps to evaluate N/V
- recognize & correct consequences of sx (dehydration, electrolyte abnormality)
- figure out underlying cause (H&P mostly; only order tests if based on suspicion); r/o emergencies
- empiric therapy to tx any sx if no cause discovered
differentiate vomiting, regurg and rumination
- vomiting: forceful expusion through involuntary contractions
- regurg: food going back to mouth w/o forceful contractions
- rumination: food returned to mouth through voluntary contractions
which antiemetic is teratogenic in 1st trim?
ondansetron
what are 4 treatments to manage N/V in pregnancy? whats first line?
- ginger– 1st line for mild sx
- seabands
- vit b6 (pyridoxine) for nausea
- promethazine for hyperemesis gravidarum
what dietary change can pregnant people make to mange N/V
less fat, more carbs
smaller more frequent meals
which two medicines have good efficacy for treating motion sickness
hyoscine & meclizine
3 medications used in treating N/V d/t chemo?
ondansetron
cannabinoid
promethazine
5 types of N/V that promethazine is good for?
hyperemesis gravidarum
chemo
post-op
migraine
gut stasis
tx for post operative N/V
promethazine
diarrhea & sick contacts after traveling. what do you suspect?
acute gastroenteritis
two effective meds for migraine-induced N/V? why don’t we like to use one of them?
promethazine & ondansetron (causes HA as ADR)
preferred med & formulation for opioid-induced N/V?
small IM dose of haloperidol
haloperidol is used to tx mental conditions
delayed emptying w/o mechanical obstruction causing early satiety, bloating, N/V, anorexia, belly pain, wt loss
what is this and list 5 potential causes
gastroparesis (gut stasis)
- DM
- gastric surgery
- pseudoobstruction
- GI infection
- anorexia nervosa
5 ways to diagnose gastroparesis
H&P
endoscopy
barium swallow
gastic emptying scintigraphy
gastroduodenal manometry
tx goal & 3 dietary changes to help manage gastroparesis
goal: reverse/correct it
* less solid foods
* smaller, frequent meals
* less fiber & fat
2 classes of meds and 1 surgical tx for gastroparesis
- prokinetics: metoclopramide(also anti-emetic), erythromycin, cisapride
- antiemetics: promethazine
- surgery: endoscopic decompressive gastrostomy
acts on central (postrema/CTZ) dopamine D2 antagonist; also M1 and H1-receptor blocking activity
what is this med and what are 5 main SE?
Promethazine (a phenothiazinel)
* EPS
* gangrene
* high dose– resp depression
* sedation
* anti-SLUDGE effects
what does sludge in anti-SLUDGE mean?
salivation
lacrimation
urination
defecation
gastritis
emesis
which antiemetic is avoided in elderly male patients because it shouldnt be used in people with big prostates or BPH?
promethazine
prokinetic, increases peristalsis in upper gut; acts as central & peripheral D2 receptor antagonist (low doses). Weak serotonin-receptor blocker (high doses)
what is this medication? what are SE and when should it be avoided?
metoclopromide
SE: EPS, sedation/depression, restlessness
avoid in GI tract obstruction
blocks 5-HT3 receptor at CTZ and GI tract; antiemetic action d/t effect on abdominal vagal afferent nerve; also has CNS effect
what medication? SE? when should it be avoided?
ondansetron
* SE: HA, constipation, hiccups
* avoid w/ drugs that prolong QT & in 1st trim pregnancy
which medication is great for N/V from surgery and chemo, can be used as prophylaxis and is also considered the cornerstone for acute emesis?
ondansetron
patch work the night before motion sickness (prophylaxis) and lasts 3 days; an M1 antagonist
(1) what is this and what are the SE? (4)
hyosciene (an anticholinergic)
SE: dry mouth, visual issues, weird behavior in eldery, drowsiness
D2 antagonist blocks action of ACh, improving N/V; commonly used in palliative care
what is this? list 3 SE and 1 indication
haloperidol
SE: EPS, tardive dyskinesia, sedation
Indication: N/V from chemical/drugs (includes opioids)
when are canniboids best used?
when added to anti-emetic tx for chemo
