N&V clinical Flashcards
what are the GI causes of N&V
gastroenteritis
peptic ulceration
appendicitis
gastric carcinoma
infection
what diseases can cause N&V
renal failure - high urea
DKA
MI (pain/position)
what is motion sickness
conflicting information between eyes and body most common in kids 3-12 y/o
what are the CNS causes of N&V
migraine
meningitis
vestiular disease
which antibiotics can cause N&V
opiates
antibiotics - doxycycline
levodopa
theophylline/aminophylline
digoxin
chemotherapy
what are the three mechanisms that drugs can induce N&V
- mimics the action of neurotransmitters (opiates/levodopa)
- causing a change in neurotransmitter levels (5HT3 re-uptake inhibitors)
- activation of peripheral abdominal afferent system
- delaying gastric emptying
- direct activation of mucosal afferent system
what are the symptoms of meniere’s disease
incapacitating, sudden onset attacks of
- giddiness
- vertigo
- N&V
- hearing loss
- tinnitus
what is meniere’s disease
inner ear disorder causing excess fluid in labyrinth canals
what is vertigo
sensation of rotating or spinning
pt spinning - objective
surroundings spinning - subjective
what are the potential causes of vertigo
labyrinthitis - young people
benign paroxysmal positional vertigo - in the elderly
head injury
concussion
excess alcohol
MS
vestibular toxic drugs
which drugs are vestibular toxic
aminoglycosides
anticonvulsants
furosemide
NSAIDs high dose long term
quinine
what is morning sickness
sickness caused by high HGC levels between 10-14 weeks of pregnancy
what is hyperemesis gravidarum
- Severe, persistent N&V during pregnancy
- Cannot keep any food or fluid down at all
- Weight loss, dehydration, acidosis and ketosis can happen if not treated
what are the referral points for N&V
- severity
- duration
- severe diarrhoea or duration
- weight loss
- abdominal pain
- dizziness
what are the treatment options or N&V
H1 receptor antagonists
muscarinic antagonists
D2 receptor antagonists
5HT3 receptor antagonists
NK1 receptor antagonists
what are H1 receptor antagonists
cinnarizine, promethazine, cyclizine
act within 2 hours
s/e of H1 receptor antagonists
drowsiness
dizziness
tinnitus
what are muscarinic antagonists
hyoscine
act on central M1 receptors and antispasmodic
gut action
muscarinic antagonists s/e
drowsiness
dry mouth
decreased gut motility
increased HR
increased intraocular pressure
what are the C/I for muscarinic antagonists
glaucoma and urinary retention
what are D2 receptor antagonists
prochlorperazine
metoclopramide
domperidone
haloperidol
levopromazine
how does prochlorperazine work
inhibits D2 and some M1 receptors
acts centrally but causes parkinson like epses and anticholinergic s/e
how does metoclopramide work
- Blocks D2 receptors and some 5HT3
- Central and peripheral
- Antiemetic and pro-kinetic stimulates gastric emptying
- 30mg/day for 5 days
what are the s/e of metoclopramide
drowsiness
dizziness
anxiety
dystonia
tardive dyskinesia
oculogyric crises
how does domperidone work
- Blocks D2 receptors
- Does not cross BBB - no central effects
- Use in Parkinson’s and under 30s
- MHRA warning on CV risk
what are 5HT3 receptor antagonists
ondansetron
selective - central or peripheral
generally well tolerated
what are NK1 receptor antagonists
aprepitant
block neurokinin1 receptors
used for chemo induced nausea
what other treatments can be used for chemo induced nausea
dexamethasone
cannabinoids - nabilone (if resistant to others)
