Nausea and Vertigo

Question 1

Why is it important to identify the cause of nausea and vertigo prior to treatment?

Answer 1

To ensure the correct treatment is given, to try and correct the cause and to prevent complications.

Question 2

When in pregnancy would nausea not generally require treatment?

Answer 2

First trimester.

Question 3

If nausea and vomiting in pregnancy is severe, what treatment can be given?

Answer 3

Short term therapy with an antihistamine such as promethazine. Prochlorperazine or metoclopramide are alternatives.

Question 4

What is the most effective drug for the treatment of travel sickness?

Answer 4

Hyoscine butylbromide.

Question 5

For children over the age of 10, what alternative medicinal form may be useful for the treatment of travel sickness, providing prolonged activity?

Answer 5

A transdermal patch.

Question 6

If a sedative effect is required when treating travel sickness, what drugs can be used?

Answer 6

Cyclizine or cinnarizine.

Question 7

What drug is licensed for the treatment of vertigo, tinnitus and hearing loss associated with Meniere’s disease?

Answer 7

Betahistine.

Question 8

What is Meniere’s disease?

Answer 8

A rare condition of the inner ear causing nausea, vertigo, tinnitus and hearing loss.

Question 9

What is domperidone only licensed for the treatment of?

Answer 9

Nausea and vomiting.

Question 10

What benefit does domperidone have over metoclopramide and the phenothiazines? Why is this?

Answer 10

It is less likely to cause central effects such as sedation and dystonic reactions. This is because it doesn’t readily cross the BBB.

Question 11

Domperidone is associated with an increased risk of what side effects?

Answer 11

Serious cardiac side effects.

Question 12

How should domperidone be used to minimise the risk of serious cardiac side effects?

Answer 12

At the lowest effective dose for the shortest possible duration. Max duration should not exceed one week.

Question 13

When is domperidone contraindicated?

Answer 13

When the patient has conditions where cardiac conduction is, or could be, impaired, or when there is underlying cardiac disease, when administered with drugs which could prolong the QT interval, with potent CYP450 inhibitors or in severe hepatic impairment.

Question 14

What is the recommended dose of domperidone in adults and children over 12 years and 35kg?

Answer 14

10mg tds.

Question 15

What is the recommended dose of domperidone in children under 35kg?

Answer 15

250mcg/kg up to tds.

Question 16

How should oral preparations of domperidone be given?

Answer 16

Via an appropriately designed, graduated oral syringe to ensure dose accuracy.

Question 17

Metoclopramide can induce acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crisis. In which patient groups is this more common?

Answer 17

Young children and young women.

Question 18

Which drug can be used to reverse the acute dystonic attacks seen with the use of metoclopramide?

Answer 18

The antimuscarinic procyclidine.

Question 19

In adults over 18 years old, what should metoclopramide be used for?

Answer 19

Prevention of postoperative N&V, RINV, delayed CINV, symptomatic treatment of N&V.

Question 20

For how long should metoclopramide be prescribed?

Answer 20

Short term, up to 5 days.

Question 21

What is the maximum dose of metoclopramide?

Answer 21

10mg up to tds, max daily dose of 500mcg/kg.

Question 22

There is an increased risk of which side effects when using metoclopramide?

Answer 22

Extrapyramidal side effects.

Question 23

How should intravenous boluses of metoclopramide be administered?

Answer 23

Slowly, over at least 3 minutes.

Question 24

How should oral liquid preparations of metoclopramide be given?

Answer 24

By an accurate, graduated oral syringe to ensure dose accuracy.

Question 25

What is the MHRA alert for ondansetron

Answer 25

Small increased risk of oral clefs in first 12 weeks of pregnancy