N/V Flashcards
1
Q
Pathophysiology of vomiting? Mediated by what receptors?
A
- visceral stimuli (thru dopamine & 5HT3 receptors)
- chemoreceptor trigger zone (thru D2, 5HT3, H1 & M1 & substance P/neurokinin 1)
- vestibular labyrinths (thru H1 & M1) (motion sickness)
- cerebral cortex
2
Q
Medications that trigger CTZ?
A
- opiates
- dopamine agonist
- chemo
3
Q
First line treatment for N/V?
A
- correct dehydration & electrolyte disturbances (ORS)
- anti-emetics
4
Q
What anti-emetics should be used for the following situations:
- general medical use
- chemotherapy
- post-op
- motion sickness
- pregnancy
- gastroparesis
A
- general medical use: phenothiazines, 5HT3 antagonist
- chemotherapy: 5HT3 antagonist, NK1 antagonists, corticosteroids (dexamethasone), olanzapine
- post-op: 5HT3 antagonist, scopolamine, corticosteroids
- motion sickness: antihistamines, scopolamine
- pregnancy: pyridoxine, antihistamines, ginger
- gastroparesis: metoclopramide, domperidone
5
Q
Examples of phenothiazines?
A
Promethazine, prochlorperazine
6
Q
Examples of 5HT3 antagonists?
A
ondansetron, granisetron, palonestron
7
Q
Examples of antihistamines for N/V?
A
1st gen: dimenhydrinate, diphenhydramine, cinnarizine, doxylamine
8
Q
Examples of NK1 antagonists?
A
aprepitant, fosaprepitant, akynzeo (netupitant / palonestron), rolapitant
9
Q
Non-drug therapy for N/V?
A
- acupressure wrist band
- ginger
- homeopathic therapy
10
Q
Nonpharm for N/V?
A
- BRAT diet (banana, rice, applesauce, toast)
- Take small frequent meals → avoid heavy meals
- Avoid greasy, spicy, very sweet or salty food & food with strong flavours or smells
- Sip small amt of fluid often instead of trying to drink a full glass at one time
- Avoid caffeinated beverages
- Avoid lying flat for 2h after eating
11
Q
Adjunctive therapy for N/V (depends on situation)
A
- haloperidol (refractory CINV)
- benzodiazepines (anticipatory CINV)
- hyoscine butylbromide
