Nausea and labriynth disorders Flashcards
MOA of phenothiazones
Dopamine anatagonists that block the chemoreceptor trigger zone
List the antihistmines used in nausea and vomiting
Cinnarizine, cyclizine, promethazine hydrochloride and teoclate
Which antihistmine resembles that of the ohenothiazones but is not classed as one?
Metoclopramide
List the phenothiazones used in nausea and vomiting
Prochlorperazine, Trifluoperazine, and chlorpromazine
Which antiemetic works on the gastric smooth muscle and can be used to assist in gastric emptying?
Metoclopramide
What is the maximum number of days Metoclopramide should be used for in N&V not associated with palliative care?
5 days
Which cause of N&V is prochlorperazine particularly useful for?
chemotherapy and radiotherapy induced N&V
Which neurological condition is metoclopramide contra-indicated in?
Epilepsy
How many days after GI surgery should metoclopramide not be used for?
3-4 post-op
What type of reactions can phenothiazines cause, particulary in children?
Dystonic reactions
Which of the antiemetics does not cross the BBB and is therefore not likely to cause dystonic reactions?
Domperidone
What drug class does ondansetron belong to?
5HT3- receptor- antagonists
Which antiemetic should be avoided in pregnancy in the first 12 weeks due to increased risk of oral clefts?
ondansetron
Whicha antiemetic is cautioned in Parkinson’s disease?
Metoclopramide
What cause of N&V are neurokinin-1-receptor antagonists used in?
N&V associated with nausea and vomiting
Describe the licensing for nabilone
Cannabinoid used as last line therapy for chemotherapy induced nausea where optimised conventional therapies haven’t worked.
When does pregnancy induced N&V usually resolve?
16-20 weeks
Describe gingers place in therapy for pregnancy inudced N&V
Can be used in mild-moderate N&V if non-pharmacological therapy preferred
Uusal 1st line options for N&V in pregnancy?
cyclizine, prochlorperazine, promethazine, xonvea
How to follow up N&V in pregnancy
If no response to treatment after 24 hours, switch antiemetic. If no response after a further 24 hours, refer to specialist
What adjunctive treatment is recommended in addition to pharmacological therapy in moderate to severe N&V in pregnancy?
Accupressure and IV fluids
What may be considered to reduce the risk of wernicke’s encelopathy in patients with hyperemesis gravidarum?
Thiamine
What are the risk factors associated with post-operative N&V?
Female, young, non-smoker, use of opioids and aneasthetic intraoperatively and postoperatively, history of motion sickness
How many antiemetics are usually required for post-operative nausea?
2+ with different mechanisms of action
Which antihistmaines used for N&V are less sedating?
cyclizine and cinnarizine
Which antihistmaines used for N&V are more sedating?
Promethazine hydrochloride and teoclate
Which antiemetics are ineffective in motion sickness?
Domperidone, metoclopramide, 5-HT3-receptor-antagonists, phenothiazines
First line for motion sickness
Hyoscine hydrobromide
What conditions are hyoscine hydrobromide contra-inidcated in?
Bladder problems, GI problems including severe UC, myasthenia gravis and angle closure glaucoma
What antiemetics are used in menieres disease for severe, acute attacks of N&V?
IM or buccal prochlorperazine, IM cyclizine
Describe the licnesing of Betahistine
Licensed in menieres disease to reduce the frequency/severity of tinnitus, hearing loss, and vertigo
