Nausea and Vertigo Flashcards
Why is it important to identify the cause of nausea and vertigo prior to treatment?
To ensure the correct treatment is given, to try and correct the cause and to prevent complications.
When in pregnancy would nausea not generally require treatment?
First trimester.
If nausea and vomiting in pregnancy is severe, what treatment can be given?
Short term therapy with an antihistamine such as promethazine. Prochlorperazine or metoclopramide are alternatives.
What is the most effective drug for the treatment of travel sickness?
Hyoscine butylbromide.
For children over the age of 10, what alternative medicinal form may be useful for the treatment of travel sickness, providing prolonged activity?
A transdermal patch.
If a sedative effect is required when treating travel sickness, what drugs can be used?
Cyclizine or cinnarizine.
What drug is licensed for the treatment of vertigo, tinnitus and hearing loss associated with Meniere’s disease?
Betahistine.
What is Meniere’s disease?
A rare condition of the inner ear causing nausea, vertigo, tinnitus and hearing loss.
What is domperidone only licensed for the treatment of?
Nausea and vomiting.
What benefit does domperidone have over metoclopramide and the phenothiazines? Why is this?
It is less likely to cause central effects such as sedation and dystonic reactions. This is because it doesn’t readily cross the BBB.
Domperidone is associated with an increased risk of what side effects?
Serious cardiac side effects.
How should domperidone be used to minimise the risk of serious cardiac side effects?
At the lowest effective dose for the shortest possible duration. Max duration should not exceed one week.
When is domperidone contraindicated?
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.
What is the recommended dose of domperidone in adults and children over 12 years and 35kg?
10mg tds.
What is the recommended dose of domperidone in children under 35kg?
250mcg/kg up to tds.
How should oral preparations of domperidone be given?
Via an appropriately designed, graduated oral syringe to ensure dose accuracy.
Metoclopramide can induce acute dystonic reactions involving facial and skeletal muscle spasms and oculogyric crisis. In which patient groups is this more common?
Young children and young women.
Which drug can be used to reverse the acute dystonic attacks seen with the use of metoclopramide?
The antimuscarinic procyclidine.
In adults over 18 years old, what should metoclopramide be used for?
Prevention of postoperative N&V, RINV, delayed CINV, symptomatic treatment of N&V.
For how long should metoclopramide be prescribed?
Short term, up to 5 days.
What is the maximum dose of metoclopramide?
10mg up to tds, max daily dose of 500mcg/kg.
There is an increased risk of which side effects when using metoclopramide?
Extrapyramidal side effects.
How should intravenous boluses of metoclopramide be administered?
Slowly, over at least 3 minutes.
How should oral liquid preparations of metoclopramide be given?
By an accurate, graduated oral syringe to ensure dose accuracy.
