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MET2 > Nausea And Vomiting > Flashcards

Nausea And Vomiting Flashcards

1
Q

Vomiting

A

Forceful expulsion of gastric contents from the mouth

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2
Q

What physical actions create vomiting

A

Powerful sustained contraction of abdo muscles
Diapragm descent
Opening of LOS
Gastric Retropulsion

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3
Q

Which muscles contract during vomiting

A

Abdominal muscles
Diapragm

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4
Q

Nausea

A

Unpleasant sensation and awareness of urge to vomit

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5
Q

What are effects of prolonged nausea

A

Dehydration
Anorexia
Broken ribs - repetitive vomiting
Refusal of medications

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6
Q

Cyclic vomiting syndrome

A

Rapid fire Projectile vomiting lasting a few hrs to several days abt 10 times a yr followed by asymptomatic periods

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7
Q

Gastroparesis symptoms

A

Early satiety after eating
Postprandial fullness
Nausea
Vomiting
Belching
Bloating

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8
Q

What can cause nausea and vomiting

A

Chemo
Radiotherapy
GI disease
Infections
Severe pain
Intra cranial disease
Labyrinthine/vestibular disorder
Pregnancy
Psychological
Migraine
Circulatory syncope
Exogenous emetic substances

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9
Q

Which nucleus receives sensory inputs and coordinates motor outputs for vomiting

A

Nucleus tractus solitarius

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10
Q

What nuclei cause vomiting

A

Nucleus ambiguus
Ventral resp group of neurones
Dorsal motor vagal nucleus

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11
Q

Which type of drugs are commonly used for motion sickness

A

Muscarinic receptor agonists

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12
Q

How does diphenhydramine work

A

H1 receptor antagonist
M2 receptor antagonist

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13
Q

What molecule is diphenhydramine usually combined with and why

A

8-chlorotheophylline -> dramamine
Counteract drowsiness

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14
Q

What is a side effect of diphenhydramine

A

Drowsiness

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15
Q

What type of drug is cyclizine

A

H1 receptor antagonist

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16
Q

What can cyclizine be used to treat

A

Vertigo
Motion sickness
Labyrinthine disorders

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17
Q

What type of drugs are phenothiazines, metoclopramide, and domperidone

A

Dopamine d2 receptor antagonists

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18
Q

Side effects of D2 receptor antagonists

A

Pseudoparkinsonism
Acute distonia
Akathisia
Tardive dyskinesia

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19
Q

What is the only drug to treat gastroparesis

A

Metoclopramide

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20
Q

What is metoclopramide used to treat

A

Post operative care
Gastritis
Migraine
Dysmenorrhea
Drug/treatment induced emesis inc anaesthesia radio and chemo
GE reflux
Gastroparesis
Functional dyspepsia

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21
Q

Can domperidone cross the BBB

A

no

22
Q

Can diphenhydramine cross the BBB

A

Yes

23
Q

Why can domperidone not be used when cardiac function is impaired or pt has underlying cardiac disease

A

Can cause ventricular arrhythmia

24
Q

What drug types reduce vestibular system signalling to the NTS to prevent nausea and vomiting

A

M3/5 receptor antagonists
H1 receptor antagonists

25
Q

Are anti emetic drugs disease specific

A

No except for motion sickness

26
Q

What are effects of the severe nausea and vomiting experienced by chemotherapy patients without anti emetic treatments

A

Treatment refusal
Tears in oesophag-gastric mucosa
Vertebral collapse
Metabolic alkalosis
Hypokalaemia
Hypocholoraemia
Extracellular fluid depletion
Dehydration - exacerbates nephrotoxicity
Malabsorption
Anorexia
Stress
Incapacitation

27
Q

What are the 3 types of vomiting

A

Acute
Delayed
Anticipatory

28
Q

Cannabinoid hyperemesis syndrome

A

Some chronic cannabis users develop severe cyclic vomiting and abdo pain starting in 3rd decade

29
Q

Can THC be used to treat mild moderate or severe emesis

A

Mild or moderate

30
Q

What are 5-HT3 receptor antagonists used to treat

A

Acute chemotherapy and radiation induced emesis

31
Q

How does chemo cause vomiting

A

Chemo causes 5HT to be released from upper GI enterochromaffin cells which activates and sensitises the vagus nerve, cell breakdown releases inflammatory mediators

32
Q

Are 5-HT3 receptor agonists effective against acute or delayed emesis

A

Acute

33
Q

What causes acute emesis after chemo

A

5HT released from enterochromaffin cells activates 5HT3 receptors on vagus

34
Q

What causes delayed emesis after chemo

A

Cell breakdown produces inflammatory mediators

35
Q

What is given with 5HT receptor agonists for moderately severe emesis

A

Dexamethasone

36
Q

What are NK1 receptor antagonists used for

A

Further control when given with other antiemetics

37
Q

What part of the brain do dopamine receptor antagonists act on

A

Area postrema

38
Q

Are NK1 receptor agonists better for acute or delayed emesis

A

Delayed

39
Q

How do NK1 receptor antagonists work

A

Block actions of substance P - a NT used by vagus and some brainstem nerves

40
Q

What combination of drugs is given for severe emesis

A

5HT3 receptor antagonist + NK1 receptor antagonist + Dexamethasone

41
Q

What can cause vomiting in palliative patients

A

Opiate medications
Reflux
Gastric stasis
Intestinal obstruction

42
Q

How is partial bowel obstruction treated

A

Stim GI propulsion - metoclopramide prucalopride

43
Q

How is total bowel obstruction treated

A

Reduce inflammation - dexamethasone
Reduce fluid build up in bowel - octreatide, nasogastric tube, venting, gastronomy tube

44
Q

Types of anti emetics

A

5HT3 antagonists
NK1 antagonists
D2 antagonists
H1 antagonists
Anticholinergic
Corticosteroid
Naturals
Adjuncts

45
Q

What type of drug is olanzapine

A

Atypical antipsychotic
Antagonises loads of receptors

46
Q

What can olazapine be used for

A

Nausea (given w 5HT3 NK1 and Dexamethasone)
Breakthrough vomiting

47
Q

Interoception

A

Sensations of all tissues of the body, of physiological conditions or internal states, and of self awareness

48
Q

Which brain areas have sustained activation during nausea

A

Interoceptive
Limbic
Somatosensory
Cognitive

49
Q

What conditions cause gastric dysrhythmia

A

Gastroparesis
Functional dyspepsia
GERD
Motion sickness
Cycling vomiting syndrome
Nausea of pregnancy
Abdominal malignancy
Chronic renal failure
Anorexia
Chronic intestinal pseudo obstruction
Ischemic gastropathy

50
Q

What is the only anti emetic used for gastroparesis

A

Metoclopramide

51
Q

Tachygastria

A

Electrical activity in stomach in random uncontrolled pattern

MET2 (25 decks)

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