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Pre-reg Exam 2021 > Nausea And Labyrinth Disorders > Flashcards

Nausea And Labyrinth Disorders Flashcards

1
Q

What are the causes of nausea?

A 
Drugs and toxic substances
Labyrinthitis
Vestibular disorders
Motion sickness
Gut irritation 
Higher stimuli
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2
Q

How does nausea and vomiting occur?

A

When the vomiting centre inside the brain is activated by input from the chemoreceptor trigger zone which contains dopamine, serotonin, histamine and muscarinic receptors

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3
Q

How do antiemetic work?

A

By antagonising the receptors in the chemoreceptor trigger zone

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4
Q

What are the dopamine antagonists that can be used for nausea?

A 
Metoclopramide
Domperidone
Prochlorperazine
Chlorpromazine
Haloperidol, levomepromazine
Droperidol
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5
Q

What are the antihistamines used for vertigo and motion sickness?

A

Cinnarizine
Cyclizine
Promethazine teoclate

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6
Q

What are the antimuscarinics used for motion sickness?

A

Hyoscine hydrobromide

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7
Q

What are the 5-HT3 antagonists used in chemotherapy or post operative nausea and vomiting?

A

Granisetron
Ondansetron
Palonosetron

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8
Q

What are the other antiemetics used in nausea?

A

Dexamethasone - chemotherapy, post operative

Nabilone - synthetic cannabinoid, used in chemo unresponsive to other anti emetics

Aprepitant - chemotherapy. + dexamethasone, 5HT3 antagonist

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9
Q

What do you use for mild nausea in the first trimester of pregnancy?

A

Nothing

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10
Q

What do you use for severe vomiting and nausea in the first trimester of pregnancy?

A

Promethazine

Prochlorperazine

Metoclopramide

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11
Q

What do you use for preventative post operative nausea and vomiting?

A

5HT3 receptor antagonists, droperidol, dexamethasone, phenothiazine, cyclizine

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12
Q

What do you use for high risk patients for post operative nausea and vomiting?

A

Combination of two or more antiemetics from different classes

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13
Q

What is the mechanism of action of metoclopramide?

A

Antagonises D2 receptors in chemoreceptor trigger zone

Also acts directly on gut to promote gastric emptying - prokinetic effect

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14
Q

What is the MHRA warning for metoclopramide?

A

Risk of neurological adverse effects - restricted dose and duration of use

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15
Q

What is the maximum dose of metoclopramide?

A

18+

5 days

10mg TDS

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16
Q

What is metoclopramide used for?

A

Prevention of nausea and vomiting

Symptomatic treatment of nausea and vomiting

17
Q

What are the side effects of metoclopramide?

A

Acute dystonic reactions

Procyclidine aborts dystonic attacks

18
Q

What are the interactions of metoclopramide?

A

Antipsychotics- increase extrapyramidal side effects

Parkinson’s disease - exacerbates condition

19
Q

What is the mechanism of action of domperidone?

A

Antagonised D2 receptors in chemoreceptor trigger zone

Also acts directly on gut to promote gastric emptying - prokinetic effect

20
Q

What is the MHRA advice for domperidone?

A

Risk of cardiac side effects - restricted indication, new contraindications, reduced dose and duration

21
Q

What is the maximum dose for domperidone?

A

1 week

10mg TDS

Adult 12+ and over 35kg

22
Q

What is domperidone used for?

A

Symptomatic relief of nausea and vomiting

Choice antiemetic in Parkinson’s disease

23
Q

What are the cardiac side effects of domperidone?

A

QT prolongation
Ventricular arrhythmias
Sudden death

24
Q

What are the counselling points for domperidone?

A

Report signs of arrhythmias

25
Q

What are the contraindications of domperidone?

A

Impaired cardiac conduction

Cardiac disease

Severe liver impairment

26
Q

What are the interactions of domperidone?

A

Potent CYP34 inhibitor - amiodarone, ketoconazole, erythromycin

Drugs causing QT prolongation - amiodarone, SSRIs, quinolones

27
Q

What is the mechanism of action of 5HT3 receptor antagonists?

A

Blocks HT3 receptors in the chemoreceptor trigger zone and GI tract

5HT is a key neurotransmitter released by the gut in response to emetogenic stimuli

28
Q

What are the 5HT3 receptor antagonists?

A

Granisetron
Ondansetron
Palonosetron - only for chemo

29
Q

What are granisetron and ondansetron used for?

A

Post operative nausea and vomiting

Chemotherapy induced nausea and vomiting

30
Q

What are the side effects of 5HT3 receptor antagonists?

A

QT interval prolongation

31
Q

What are the interactions of the 5HT3 antagonists that increase the risk of torsades de pointes with hypokalaemia?

A 
Loop/thiazide diuretics
Corticosteroids
Beta agonist - salbutamol, theophylline
Stimulant laxatives abuse
Amphotericin B
32
Q

What are the interactions of the 5HT3 antagonists that increase the risk of QT interval prolongation?

A 
Amiodarone
Clarithromycin 
Quinine
Sumatriptan 
Lithium
Antipsychotics
33
Q

What are the interactions of the 5HT3 antagonists that increase the risk of serotonin syndrome?

A

5HT1a agonists

Sumatriptan
MAOIs
SSRIs

Pre-reg Exam 2021 (79 decks)

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