Nausea and Vomiting

Question 1

Define nausea

Answer 1

an pleasant painless subjective feeling that one will imminently vomit

Question 2

What autonomic symptoms often accompany nausea?

Answer 2

pallor, cold sweat, salivation, tachycardia, diarrhea

Question 3

Define vomiting

Answer 3

a rapid, forceful evacuation of gastric contents from the stomach up to and out of the mouth

Question 4

What medications commonly cause nausea and vomiting?

Answer 4

opioids
digoxin
antibiotics/antivirals
chemotherapy
SSRIs
NSAIDS, ASA
Anticonvulsants
Iron
Potassium supplements

Question 5

What are some metabolic causes of nausea and vomiting?

Answer 5

Renal or liver failure
hypercalcemia
hyponatremia
diabetic ketoacidosis
hyperthyroidism

Question 6

What can cause gastric stasis and subsequent nausea and vomiting?

Answer 6

opioids
anticholinergics
hepatomegaly
mechanical gastric outlet obstruction
tumor ascites
tumor infiltration
autonomic dysfunction (may be associated with anorexia-cachexia syndrome)

Question 7

What can stretch/distort the gi tract leading to nausea/vomiting?

Answer 7

constipation or fecal impaction
intestinal obstruction
mesenteric metastasis

Question 8

True or False

Nausea can occur without vomiting and vice versa.

Answer 8

True

Question 9

True or False.
Nause and vomiting increase in prevalence as the disease progresses.

Answer 9

True.

Question 10

Where is the chemoreceptor zone located?

Answer 10

4th ventricle
Lies outside of the BBB

Question 11

Where is the chemoreceptor zone located in the brain?

Answer 11

CRTZ aka area postrema (AP)

located within the dorsal surface of the medulla oblongata, on the floor of the 4th ventricle

Question 12

Does the chemoreceptor zone lie inside or outside of the bbb?

Answer 12

Outside

Question 13

*

The CRTZ relays information to what area of the brain?

Answer 13

Vomiting center

The vomiting center is responsible for inducing the vomiting reflex

Question 14

What are the main receptors present at the CRTZ?

Answer 14

Dopamine (D2)
Serotonin (5HT3)
Neurokinine-1
Substance P and contains cannabinoids receptors

Question 15

Name 2 prokinetic agents that are antidopaminergic

Answer 15

domperidone
metoclopramide

Question 16

What are extrapydramidal symptoms

Also called drug induced movement disorders.

Question 17

What causes extrapyramidal symptoms?

Answer 17

Dopamine blockade or depletion in the basal ganglia.

Question 18

What are examples of extrapyrimal symptoms?

Answer 18

akathisia
dystonia
parkinsonism
tardive dyskinesia

akathisia- feeling restless
dystonia- muscles contract involuntarily
parkinsonism- sx are similar to PD
tardive dyskinesia- facial movement happen involuntarily

Question 19

What generation of antipsychotics are more likely to have EPS side effects?
What is an example?

Answer 19

First generation antipsychotics

Haldol

Question 20

Provide examples of second generation/atypical antipsychotics

Answer 20

quetiapine
risperidone
olanzapine

Question 21

What atypical antipsychotic has a high affinity for multiple dopamine, serotonin, H1 and cholinergic receptors?

Answer 21

Olanzapine

Question 22

Provide an example of a 5-HT3 antagonist, effective especially in chemotherapy induced nausea and vomiting

5HT3- serotonin

Answer 22

ondansetron

Question 23

methotrimeprazine and prochlorperazine are part of what class of medicaitons?

Answer 23

Phenothiazines

Question 24

Provide an example of a neurokinin (NK)-1 receptor antagonist

Answer 24

aprepitant

Brand name- Emend

Question 25

What is nabilone?

Answer 25

A synthetic cannabinoid

Question 26

What medication is very useful in the management of nause and vomiting secondary to increased ICP?

Answer 26

dexamethasone

Question 27

What class of medications are useful in treating anticipatory nausea and vomiting?

Answer 27

Benzodiazepines

Question 28

Where is the vomiting Center located in the brain?

Answer 28

Medulla oblongata

Question 29

List 4 pharmacological treatments for hiccups

Answer 29

1. Dopamine antagonist (chlorpromazine, haloperidol, metoclopramide)
2. anticonvulsant- gabapentin, phenytoin, sodium valproate, carbamazepine
3. antispasmodic-baclofen (smooth muscle relaxant)
4. corticosteroid- dexamethasone (anti-inflammatory)