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AI Exam 2 > Nausea and vomiting > Flashcards

Nausea and vomiting Flashcards

1
Q

Can stimulating the back of the throat initiate the vomit reflex?

A

YES - Gag reflex activated

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2
Q

Can Noxious chemicals initiate the vomit reflex?

A

YES - Chemoreceptor Trigger Zone and Area Postrema Activated!

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3
Q

Can distension or irritation of the stomach or duodenum cause vomiting?

A

YES via mechanoreceptors / chemoreceptors (Noxious chemicals!)

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4
Q

Can rotation or acceleration of the head cause the vomit reflex to be triggered?

A

Yes!
-Dizziness
-Motion sickness
-Vestibular apparatus in inner ear feeding

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5
Q

What is a serious issue which can cause Nausea and Vomiting?

A

Elevated intracranial pressure - haemorrhage

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6
Q

Where is the area postrema located?

A

Adjacent to the 4th ventricle

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7
Q

What are the capillaries like in the area postrema?

A

Fenestrated - they have gaps that things can pass through to allow function NO BBB

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8
Q

What is the function of the area postrema?

A

Samples blood to detect noxious chemicals, such as bacterial toxins, poison and drugs!

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9
Q

What coordinates the motor side of the vomiting reflex?

A

The NTS

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10
Q

How do dopamine agonists have a pro-emetic effect?

A

By stimulating D2 receptors in the CTZ/AP
(Apomorphine!)

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11
Q

What is the input from the GI tract in vomiting?

A

1) detection and stretch
2) 5-HT out
3) vagal afferent arteriole info to NTS
4)5-HT released systemically

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12
Q

What transports the signal from the periphery to the CNS?

A

Vagal afferents

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13
Q

What are the autonomic responses in vomiting?

A

-Increased salvation
-Sweating
-Cutaneous vasoconstriction = pale skin
- Increased HR
- Retrograde contraction of small intestine
- Relaxation of the stomach, oesophagus and oesophageal sphincters

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14
Q

What are the somatomotor responses in vomiting?

A

1) Contraction of the diaphragm
2) closure of the glottis
3) Closure of nasal cavities
4) Strong contraction of the diaphragm and abdo muscles
5) Pressure forces stomach contents to move upwards and ejected via the mouth

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15
Q

The vestibular system - muscarinic - anti-muscarinic. what neurotransmitter stimulates this in vomiting?

A

Acetylcholine

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16
Q

What neurotransmitter plays a role in motion sickness and n&v?

A

Histamine

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17
Q

What neurotransmitter is released by chromaffin cells and sends info to the NTS then the drugs acting here in the peripheral and central nervous system?

A

5-HT

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18
Q

What neurotransmitter has a direct emetic effect and is also found in the gut?

A

Dopamine

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19
Q

What neurotransmitter is a neurokinin receptor?

A

Substance P

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20
Q

What neurotransmitter stimulates opioid receptors giving an anti-emetic effect?

A

Enkephalins

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21
Q

Hyoscine helps with motion sickness and has anti-muscarinic side effects includng drowsiness as it blocks the PNS, what type of drug is this?

A

Muscarinic antagonist - works on vestibular pathways

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22
Q

Cinnarizine, Cyclizine, Promethazine all help with motion sickness but can make a patient drowsy, and assert anti-muscarinic side effects what class of drug are they?

A

H1 Antagonists

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23
Q

Ondanestron, Granisetron and Palonosetron are used for N&V associated with chemotherapy, radiotherapy and anaesthesia and can prolong QT interval, what class of drug is this?

A

5-HT3 antagonists

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24
Q

Phenothiazines such as prochloperazine and chlorpromazine, what is there MOA?

A

Dopamine antagonists: block multiple receptors (H1 and mAChRs) as well as D2 receptors

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25
Q

Metoclopramide and domperidone are potent anti-emetics what class of drug is this?

A

D2 antagonist

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26
Q

Does domperidone cross the BBB?

A

No - it works at the CTZ and blocks D2 receptors, doesn’t enter brain

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27
Q

What can D2 antagonists cause if they cross the BBB?

A

Hyperprolactinaemia! - as they inhibit the dopamine receptors in the brain which make prolactin.

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28
Q

What type of drug is Substance P (Aprepitant and Fosaprepitant)

A

NK1 Antagonist
*Given as an adjunct

29
Q

What class of drug is blocked by naloxone so the mechanism of action involves opioid receptors, given for N&V from chemo, and can cause patients to be drowsy?

A

CB1 agonists - Nabilone

30
Q

What anti-emetic can cause Psychotic side effects?

A

Nabilone

31
Q

What type of steroid can be given for nausea and vomiting in chemotherapy?

A

Dexamethasone

32
Q

What are the common GI causes of vomiting?

A

-Gastro-enteritis’s
-Peptic ulceration
-Appendicitis
-Gastric carcinoma
-Infection (V.common)

33
Q

What are the common Organic diseases that cause vomiting?

A

-Renal failure (uraemia),
-Diabetic ketoacidosis, -Myocardial infaraction!

34
Q

What CNS affects can cause vomiting?

A

-Migraines
-Meningitis
-Vestibular disease (Menieres)

35
Q

Does motion sickness happen in children less than 1?

A

Rarely happens as the labyrinth isn’t functional

36
Q

What age group are most vulnerable to motion sickness?

A

3-12

37
Q

How do Opiates and levodopa cause N&V?

A

Mimic the action of neurotransmitters,

38
Q

How do 5-HT3 re-uptake inhibitors cause N&V?

A

Cause a change in levels of a transmitter

39
Q

What does activation of the abdominal afferent system (Peripheral), do?

A

Delay gastric emptying, or direct activation of mucosal afferent system

40
Q

What is Meniere’s disease?

A

Disorder of the inner ear, includes having excess fluid in the labyrinth canals (hydrops)

41
Q

What can the incapicitating attacks of Meniere’s disease cause?

A

-Giddiness, vertigo, N&V,
-Hearing loss
-Tinnitus

42
Q

If a patient with vertigo has N&V, what should be do?

A

Refer

43
Q

What is it when a patient has the sensation of rotation or spinning?

A

Vertigo

44
Q

What is the condition where Ca2+ crystals move and displace therefore causing loss of balance?

A

Benign Paroxysmal Positional Vertigo (BPPV)

45
Q

What drugs are vestibular toxic?

A

Aminoglycosides (Gent), Anticonvulsants, Furosemide, NSAIDs, Quinine

46
Q

When is the peak time for morning sickness?

A

10-14 weeks

47
Q

what causes morning sickness?

A

High levels of hCG

48
Q

What is Hyperemesis Gravidarum?

A

-Severe, persistent N&V during pregnancy
-Weight loss, dehydration, acidosis, ketosis
*if untreated can be fatal!

49
Q

Why do we treat N&V?

A

-V unpleasant
-Dehydration
-Renal impairment
-Electrolyte abnormalities
-Weight loss

50
Q

If a patient has projectile vomiting, sour smelling vomit or blood in vomit what should we do?

A

*Pyloric stenosis possible = REFER

51
Q

If we are worried about dehydration what should we do?

A

REFER

52
Q

If a patient has severe diarrhoea lasting a long time what should we do?

A

REFER

53
Q

If a patient has lost weight, what should we do?

A

REFER

54
Q

If a patient has abdo pain, what should we do?

A

REFER = possible, appendicitis, biliary colic, renal colic, hernias

55
Q

If a patient is experiencing dizziness alongside N&V, what should we do?

A

REFER = Meningitis, head injury, Meniere’s disease!

56
Q

How long does it take for H1 receptor antagonists to work?

A

Act within 2 hours

57
Q

What ‘salt’ is longer acting regarding to H1 antagonists?

A

Theoclate salts are longer acting than hydrochloride

58
Q

What anti-emetic is contraindicated in glaucoma and urinary retention?

A

Hyoscine

59
Q

Prochlorperazine is rapidly absorbed, what class is this?

A

D2 receptor antagonist

60
Q

What extra pyramidal side effects can Prochlorperazine cause?

A

Parkinson’s like!

61
Q

What anti-emetic has pro-kinetic properties, therefore stimualtes gastric emptying and is more effective in GI and biliary disease?

A

Metoclopramide

62
Q

What does Metoclopramide do?

A

Block D2 receptors and some 5HT3 acts centrally and peripherally

63
Q

How long does it take for metoclopramide to peak?

A

after 2 hours

64
Q

What is the MHRA warning regarding metoclopramide?

A

MAX DOSE = 30mg for max of 5 days!

65
Q

What D2 receptor antagonist doesn’t cross the BBB?

A

Domperidone

66
Q

Where is 5HT3 receptors located?

A

Peripherally on vagal nerve endings and vomiting centre

67
Q

What class of anti-emetics have less cardio / CNS side effects?

A

5HT3 receptor antagonists

68
Q

What type of Anti-emetic is used for chemo induced N&V?

A

NK1 receptor antagonists - as they block Neurokinin-1 receptors

AI Exam 2 (16 decks)

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