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Pre-reg > Nausea and Vomiting > Flashcards

Nausea and Vomiting Flashcards

1
Q

How are antiemetics chosen?

A

History, examination and investigations to determine the cause

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2
Q

Non pharmacological treatments for N&V

A
  • avoid triggers
  • Make sure that meals are small and palatable
  • cold fizzy drinks
  • Ginger (esp in pregnancy)
  • eating little and often
  • Bland foods (carbs- biscuits, toast)
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3
Q

How to treat toxicity-related nausea and vomiting from drug-induced or metabolic upset

A
  • Haloperidol- 1.5mg at night or BD
    oral or subcut
  • Metoclopramide- 10mg QDS
    subcut or oral
  • Levomepromazine
    Subcut
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4
Q

How to treat movement-related nausea and vomiting?

A
  • Cyclizine- 25-50mg every 8 hours.
    oral or subcut
  • Hyoscine hydrobromide: 150–300 micrograms orally,
    oral, subcutaneously, transdermal patch (1mg/72 hours)
  • Cinnarizine: 30 mg orally initially then 15 mg three times a day.
  • Levomepromazine: 3–6 mg twice daily (PO)
    oral, subcutaneous injection or infusion
  • Prochlorperazine: 3 mg buccal or 5–15 mg oral.
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5
Q

Examples of antihistamines used in N&V

A

cyclizine, promethazine (hydrobromide and teoclate), cinnarazine

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6
Q

How to phenothiazines treat N&V

A

Dopamine antagonists and block the chemoreceptor trigger zone.

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7
Q

What is the least sedative phenothiazine

A

prochlorperazine

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8
Q

Which antiemetic directly acts on the GI tract

A

Metoclopromide

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9
Q

Examples of 5HT3 antiemetics?

A

Ondansetron and Granisetron

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10
Q

MoA of Domperidone

A

dopamine antagonist and blocks the chemoreceptor trigger zone.

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11
Q

When are 5HT3 antagonists used in N&V

A

following cytotoxics

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12
Q

What’s 1st and 2nd for N&V in pregnancy?

A

1st- Self care advice- rest, oral rehydration & dietary changes
2nd- Non-pharmacological treatment Ginger

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13
Q

What antiemetics are safe in pregnancy?

A

C2OMP3
C- cyclizine and chlorpromazine
O- ondansetron
M- metoclopramide
P- prochlorperazine, promethazine hydro and teoclate (caution in 3rd tri)

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14
Q

What are the first line treatment options for N&V in pregnancy?

A
  • oral cyclizine or promethazine (antihistamines),
  • prochlorperazine or chlorpromazine (phenothiazines),
  • combination drug doxylamine/pyridoxine (Xonvea®) first-line
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15
Q

What are the second line treatment options for N&V in pregnancy?

A

oral metoclopramide or domperidone or ondansetron

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16
Q

What antiemetics are given for motion sickness

A
  • give preventatives hyoscine hydrobromide or
  • promethazine (sedation required) or cyclizine/cinarizine (less sedating required)
17
Q

What antiemetics should be ineffective for the treatment of motion sickness

A

domperidone, 5HT3 antagonist, metoclopramide, phenothiazines.

18
Q

What phenothiazine can be given for motion sickness

A

prochlorperazine

19
Q

How to treat post operative N&V

A

combo of 2 or more antiemetics:
- 5HT3 (ondansetron)
- Dexamethasone
- Doperidol and haloperidol
- Prochlorperazine
- Cyclizine

20
Q

Licensing for prochlorperazine for post-op N&V

A

prevention and treatment

21
Q

Licensing for cyclizine for post-op N&V

A

prevention and treatment N&V caused by opioids or general anaesthesia

22
Q

What is Menieres disease?

A

Condition of the inner ear that causes sudden attacks of vertigo and tinnitus.

23
Q

Medications used in Menieres disease

A

Betahistine- Vertigo and tinnitus associated
antihistamines- cinnarzine
phenothiazine- prochlorperazine –> should only be used for acute symptoms

24
Q

Domperidone safety advice

A

Risk of cardiac side effects. Report symptoms of arrhythmia (palps or syncope)

25
Q

What’s the maximum treatment duration for domperidone

A

7 days

26
Q

Metoclopramide safety advice

A

risk of neurological adverse effects

27
Q

what’s the recommended treatment duration for metoclopramide

A

up to 5 days

28
Q

Promethazine MHRA advice

A

Not to be sold OTC for children under 6.

29
Q

At what age is promethazine contraindicated?

A

2 years
potential for fatal respiratory depression

Pre-reg (13 decks)

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