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Nervous system 2 > Nausea and labyrinth disorders > Flashcards

Nausea and labyrinth disorders Flashcards

1
Q

What causes it ?

A 
Drugs
Labyrinthitis ( inner ear infection )
Vestibular disorders
Motion sickness
Gut irritation 
Higher stimuli
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2
Q

How does nausea and vomiting occurs ?

A

when the vomiting centre inside the brain is activated by input from the chemoreceptor trigger zone

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3
Q

What receptors does chemoreceptor trigger zone contains?

A

dopamine, serotonin, histamine, and muscarinic receptors

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4
Q

How does antiemetics work ?

A

by antagonising receptors in the chemoreceptor trigger zone

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5
Q

Name antiemetics that are dopamine antagonists ?

A
  • metoclopramide
  • domperidone
  • prochloperazine ( buccal tab in migraine, post-operative)
  • perphenazine, trifluoperazine, chlorpromazine ( post-operative)
  • haloperidol, levomepromazine ( palliative care )
  • droperidol ( post-operative)
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6
Q

Name antiemetics that are antihistamines ?

A

cinnarizine, cyclizine, promethazine teoclate ( vertigo + motion sickness)

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7
Q

Name antiemetics that are antimuscarinic?

A

hyoscine hydrobromide ( most effective in motion sickness )

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8
Q

What drug class is used in chemotherapy or post-operative nausea and vomiting ?

A

5-HT3 antagonists: granisetron, ondansetron, palonosetron

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9
Q

This drug is synthetic cannabinoid and used in chemotherapy unresponsive to other anti-emetics ?

A

nabilone

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10
Q

When is dexamethasone used as antiemetic?

A

cancer chemotherapy, post-operative

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11
Q

How should mild nausea in the first trimester be treated ?

A

no drug treatment required

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12
Q

What is the first line treatment for severe vomiting in pregnancy ?

A

short term antihistamine: promethazine

alternatives: prochloperazine or metoclopramide

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13
Q

What are the risk factors for post-operative nausea/vomtiing ?

A

anaesthetic used, type and duration of surgery, females, non-smokers, previous history, motion sickness, opioids use

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14
Q

What antiemetics are used for post-operative nausea and vomiting ?

A

5HT3 -receptor antagonists, droperidol, dexamethasone, phenothiazine antipsychotics: prochloperazine, and antihistamines: cyclizine

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15
Q

How would the patient be treated who is at high risk of post-operative nausea and vomiting ?

A

combination of two or more antiemetics from different drug classes

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16
Q

MOA of metoclopramide ?

A

antagonises ( block ) D2 receptors in chemoreceptor trigger zone. Acts directly on gut to promote gastric emptying; prokinetic effect.

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17
Q

What is metoclopramide used for ?

A

prevention of vomiting and nausea

symptomatic treatment of nausea and vomiting: acute migraine, also used to improve absorption of oral analgesics

18
Q

How long should metoclopramide be used for ?

A

five days

19
Q

For what age group should metoclopramide be prescribed ?

A

18+

20
Q

What is metoclopramide dosage ?

A

10 mg TDS

21
Q

What are the side effects of metoclopramide ?

A

ACUTE DYSTONIC REACTIONS:

  • facial and skeletal muscle spasms and oculogyric crises.
  • more common in young, especially girl and young women and in very old.
  • procyclidine: aborts dystonic attacks.
22
Q

What are the metoclopramide interactions ?

A
  • do not give with antipsychotics ( increased extrapyramidal side effects)
  • do not give in Parkinson’s disease: exacerbates condition
23
Q

How does domperidone work ?

A

same as metoclopramide blocks D2 and acts directly on the gut

24
Q

What was MHRA advise regarding domperidone ?

A

risk of cardiac side effects

25
Q

What is maximum use of domperidone ?

A

one week

26
Q

What is domperidone dose for adults 12+ and over 35 kg ?

A

10 mg TDS

27
Q

What is domperidone dose for children under 35 kg ?

A

250mcg/kg TDS

28
Q

Domperidone indications ?

A

Symtpomatic relief of nausea and vomiting

29
Q

Why domperidone is a choice of drug in Parkinson’s ?

A

domperidone does not cause extrapyramidal side effects.

30
Q

What are domperidone side effects ?

A

qt prolongation, ventricular arythmias, sudden death

31
Q

what counselling should patients be given on domperidone ?

A

report signs of arrhythmias: syncope, palpitations

32
Q

What are domperidone contraindications ?

A

impaired cardiac conduction, cardiac disease, severe liver impairment

33
Q

Which drugs interact with domperidone ?

A

potent CYP3A4 inhibitors e.g. amiodarone, ketocenazole, erythromycin
drugs causing QT prolongation: amiodarone, SSRIs, quinolone

34
Q

How does 5 HT3 receptor antagonists work ?

A

Blocks 5HT3 receptors in the chemoreceptor trigger zone and gastrointestinal tract. 5 HT is a key neurotransmitter released by the gut in response to emetogenic stimuli. ( block serotonin receptors to relieve nausea and vomiting)

35
Q

Name 5 HT3 antagonists ?

A

granisetron, ondansetron, palonosetron

36
Q

What are the indications for 5HT3 antagonists ?

A

Granisetron and ondansetron are used for symptomatic relief of post operative nausea and vomiting and chemotherapy induced nausea/vomiting

37
Q

What are the important side effects of 5HT3 antagonists?

A

qt interval prolongation

38
Q 
Explain the interaction if 5HT3 antagonists are given with the following drugs: 
loop/thiazide
corticosteroids
beta-agonist
theophylline 
stimulant laxative abuse 
amphoterecin
A

increased risk of torsade de pointes with hypokalaemia

Hypokalaemia predisposes to QT prolongation

39
Q 
Explain the interaction if 5HT3 antagonists are given with the following drugs: 
amiodarone
clarithromycin
quinine
sumatriptan
lithium
antipsychotics
A

increased risk of QT prolongation

40
Q

Explain the interaction if 5HT3 antagonists are given with the following drugs:
sumatriptan
MAOIs
SSRIs

A

serotonin syndrome

Nervous system 2 (8 decks)

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