Nausea and Vomiting Flashcards
Define nausea
an pleasant painless subjective feeling that one will imminently vomit
What autonomic symptoms often accompany nausea?
pallor, cold sweat, salivation, tachycardia, diarrhea
Define vomiting
a rapid, forceful evacuation of gastric contents from the stomach up to and out of the mouth
What medications commonly cause nausea and vomiting?
opioids
digoxin
antibiotics/antivirals
chemotherapy
SSRIs
NSAIDS, ASA
Anticonvulsants
Iron
Potassium supplements
What are some metabolic causes of nausea and vomiting?
Renal or liver failure
hypercalcemia
hyponatremia
diabetic ketoacidosis
hyperthyroidism
What can cause gastric stasis and subsequent nausea and vomiting?
opioids
anticholinergics
hepatomegaly
mechanical gastric outlet obstruction
tumor ascites
tumor infiltration
autonomic dysfunction (may be associated with anorexia-cachexia syndrome)
What can stretch/distort the gi tract leading to nausea/vomiting?
constipation or fecal impaction
intestinal obstruction
mesenteric metastasis
True or False
Nausea can occur without vomiting and vice versa.
True
True or False.
Nause and vomiting increase in prevalence as the disease progresses.
True.
Where is the chemoreceptor zone located?
4th ventricle
Lies outside of the BBB
Where is the chemoreceptor zone located in the brain?
CRTZ aka area postrema (AP)
located within the dorsal surface of the medulla oblongata, on the floor of the 4th ventricle
Does the chemoreceptor zone lie inside or outside of the bbb?
Outside
*
The CRTZ relays information to what area of the brain?
Vomiting center
The vomiting center is responsible for inducing the vomiting reflex
What are the main receptors present at the CRTZ?
Dopamine (D2)
Serotonin (5HT3)
Neurokinine-1
Substance P and contains cannabinoids receptors
Name 2 prokinetic agents that are antidopaminergic
domperidone
metoclopramide
What are extrapydramidal symptoms
Also called drug induced movement disorders.
What causes extrapyramidal symptoms?
Dopamine blockade or depletion in the basal ganglia.
What are examples of extrapyrimal symptoms?
akathisia
dystonia
parkinsonism
tardive dyskinesia
akathisia- feeling restless
dystonia- muscles contract involuntarily
parkinsonism- sx are similar to PD
tardive dyskinesia- facial movement happen involuntarily
What generation of antipsychotics are more likely to have EPS side effects?
What is an example?
First generation antipsychotics
Haldol
Provide examples of second generation/atypical antipsychotics
quetiapine
risperidone
olanzapine
What atypical antipsychotic has a high affinity for multiple dopamine, serotonin, H1 and cholinergic receptors?
Olanzapine
Provide an example of a 5-HT3 antagonist, effective especially in chemotherapy induced nausea and vomiting
5HT3- serotonin
ondansetron
methotrimeprazine and prochlorperazine are part of what class of medicaitons?
Phenothiazines
Provide an example of a neurokinin (NK)-1 receptor antagonist
aprepitant
Brand name- Emend
What is nabilone?
A synthetic cannabinoid
What medication is very useful in the management of nause and vomiting secondary to increased ICP?
dexamethasone
What class of medications are useful in treating anticipatory nausea and vomiting?
Benzodiazepines
Where is the vomiting Center located in the brain?
Medulla oblongata
List 4 pharmacological treatments for hiccups
- Dopamine antagonist (chlorpromazine, haloperidol, metoclopramide)
- anticonvulsant- gabapentin, phenytoin, sodium valproate, carbamazepine
- antispasmodic-baclofen (smooth muscle relaxant)
- corticosteroid- dexamethasone (anti-inflammatory)
