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Gastrointestinal > Nausea and vomiting > Flashcards

Nausea and vomiting Flashcards

1
Q

Give some possible consequences of severe vomiting

A

Dehydration
Loss of gastric protons and chloride causing hypochloraemic metabolic alkalosis
Hypokalaemia
Oesophageal damage eg mallory weiss tear

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2
Q

Give some triggers for vomiting

A 
Pain
Repulsive smell/sight/emotions
Motion
Toxins, drugs etc
Gag reflex
GI tract signals
Pregnancy (hormones)
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3
Q

Are the oesophageal sphincters contracted or relaxed during vomiting?

A

Relaxed

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4
Q

Where is the chemoreceptor trigger zone?

A

The area postrema, in the medulla (floor of the fourth ventricle)

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5
Q

What does the chemoreceptor trigger zone do?

A

Located outside the BBB and so detects circulating emetic agents

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6
Q

Why do you get motion sickness?

A

The input from the vestibular system does not match the input of the optic nerves

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7
Q

What sends signals out to induce vomiting?

A

The vomiting centre

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8
Q

Why do drugs with dopamine agonist properties induce vomiting?

A

Dopamine receptors are very prevalent in CTZ. If you trigger these then signals will be sent to vomiting centre

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9
Q

Give an example of a 5HT3 receptor antagonist.

A

Ondansetron

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10
Q

What kind of emesis would 5 HT3 receptor antagonists be used in?

A

Chemotharapy and radiotherapy induced emesis

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11
Q

What is 5HT?

A

It is a chemical released in response to gut insult (There are receptors for this on the peripheral nerve terminals here. When activated they will cause an action potential to be released and travel to the central terminal and trigger an emetic response.

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12
Q

What letters do all 5HT3 receptor antagonists end in?

A

setron

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13
Q

Give an an example of a neurokinin 1 receptor antagonist

A

Aprepitant

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14
Q

What do neurokinin 1 receptor antagonists do?

A

Block Nk 1 recetprs in the VC and CTZ that may be stimulated by an endogenous substance. These are therefore useful in drug induced emesis.

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15
Q

Give an example of a Muscarinic acetylcholine receptor antagonists

A

Hyosine/Scopolamine

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16
Q

What are Muscarinic acetylcholine receptor antagonists used for?

A

Motion sickness

17
Q

What do Muscarinic acetylcholine receptor antagonists do?

A

Block Ach receptors at multiple sites and also directly inhibit GI tract movement

18
Q

Do Muscarinic acetylcholine receptor antagonists have any adverse effects? Why?

A 
Dry mouth
Blurred vision
Urinary retention
Sedation
Due to blockage of parasympathetic ANS
19
Q

What are Muscarinic acetylcholine receptor antagonists not used for?

A

Chemotherapy induced emesis

20
Q

Give an example of a Histamine antagonist

A

Cyclizine

21
Q

What are H1 receptor antagonists used for?

A

Motion sickness
Prophylaxis
Acute labyrinthitis (ear infection)

22
Q

What are the side effects of H1 receptor antagonists?

A

Depression

Sedation

23
Q

Give 2 examples of dopamine receptor antagonists

A

Domperidone

Metclopramide

24
Q

When are dopamine receptor antagonists used?

A

Drug induced vomiting

25
Q

When should you be careful about dopamine receptor antagonist use?

A

Children

26
Q

How do dopamine receptor antagonists work?

A

Block D2 receptors in CTZ

Prokinetic action on oesophagus, stomach and intestine

27
Q

What is the advantage of domperidone over metclopramide?

A

Domperidone does not cross BBB and so is less likely to cause unwanted effects that metclopramide, which does cross BBB, exerts.

28
Q

When are dopamine receptor antagonists not effective?

A

Motion sickness

29
Q

When are phenothiazines used? What is part of their action?

A

Severe nausea and vomiting

Dopamine D2 blockade

30
Q

Give an example of a cannabinoid

A

Nabilone

31
Q

How do cannabinoids work?

A

Decrease vomiting induced by agents stimulating the CTZ.

32
Q

When are cannabinoids used?

A

In patients who are getting chemotherapy that is unresponsive to other anti emetics

33
Q

What are some of the unwanted effects of cannabinoids?

A

Drowsiness, dizziness, dry mouth, mood changes, addictive

Gastrointestinal (7 decks)

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