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Y4 Palliative Care > Nausea and Vomiting > Flashcards

Nausea and Vomiting Flashcards

1
Q

what is another name for area postrema ?

A

chemoreceptor trigger zone (CTZ)

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2
Q

what receptors are on the CTZ?

A 
D2 receptors (dopamine) 
5HT3 receptors (serotonin)
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3
Q

what does the CTZ trigger ?

A

the vomiting centre

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4
Q

is the CTZ inside or outside the BBB?

A

outside

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5
Q

can kwells (hyoscine hydrobromide) cross the BBB?

A

yes

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6
Q

what is hyoscine hydrobromide ?

A

an antiemetic

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7
Q

because hyoscine hydrobromide can cross the BBB what side effect does it have?

A

sedation

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8
Q

state two higher centres that trigger the vomiting centre?

A

cerebral cortex

limbic system

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9
Q

what receptors does the higher centres have?

A

serotonin and GABA receptors

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10
Q

what receptors does the vestibular apparatus have?

A

H1 receptors

Achm receptors

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11
Q

what systems trigger the vomiting centre?

A

Vestibular apparatus
CTZ
higher centres
GI tract

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12
Q

what nerve has Achm receptors from the GI tract?

A

vagus nerve

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13
Q

what receptors does the vomiting centres have?

A

H1
Achm
5HT2

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14
Q

is morphine water or fat soluble ?

A

water soluble

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15
Q

state some fat soluble opioids ?

A

fentanyl

alfentanyl

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16
Q

where does morphine stimulate?

A

CTZ

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17
Q

state some metabolic causes of vomiting?

A 
hypercalcaemia 
uraemia 
hyponatraemia 
ketoacidosis
infection 
addisons 
pregnancy
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18
Q

what are the signs of squashed stomach syndrome ?

A

early satiety
delayed gastric emptying
hepatomegaly
ascites

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19
Q

state some non drug management for vomiting?

A

small frequent meals
calm environment
treat constipation

20
Q

state two pro kinetic antiemetics ?

A

metoclopramide

domperidone

21
Q

what receptors do pro kinetic antiemetics act on?

A

dopamine

22
Q

what is a side effect of metoclopramide ?

A

extra pyramidal symptoms

23
Q

what is the treatment for anticipatory nausea?

A

lorazepam
diazepam
midazolam

24
Q

what is the treatment for increased ICP vomiting ?

A

dexamethasone

cyclizine

25
Q

what is the treatment for metabolic causes of vomitng ?

A

metoclopramide

haloperidol

26
Q

what is the treatment for chemo/RT causes of vomiting ?

A

ondansetron
granisetron
tropisetron

27
Q

how do the -setron drugs work for chemo vomiting?

A

bind to 5HT3 (serotonin) receptors

there is a big release of serotonin when there is apoptosis which occurs a lot with chemo

28
Q

what is a side effect of hyoscine hydrobromide ?

A

sedation

29
Q

when there is an unknown cause or multifactorial cause for vomiting what medication should be used?

A

levomepromazine

30
Q

what is levomepromazine?

A

very potent broad spectrum anti emetic

31
Q

what receptors does levomepromazine act on?

A

D2, 5HT2, H1, Achm, alpha 1 adrenergic

32
Q

what are side effects of levomepromazine?

A

postural hypotension

drowsiness

33
Q

which antiemetic should be used in opioid induced vomiting ?

A

metoclopramide (promotes bowel movements)

34
Q

what does the presentation of obstructed and metabolic vomiting look like?

A

obstructed - nausea relieved by vomiting, large volume

metabolic - nausea all the time, hypercalcaemia would cause polyuria due to the kidneys trying to excrete as much calcium as possible which would then led to dehydration and hypotension and may cause an AKI

35
Q

what are the normal ranges for Ca?

A

2.2.-2.6

36
Q

what are the common causes of hypercalcaemia ?

A

bony mets

ectopic release of PTHP

37
Q

what is the treatment for hypecalcaemia?

A

rehydrate

bisphosphonates

38
Q

what is the treatment for chemo induced vomiting ?

A

ondansetron

39
Q

what is the antiemetic for bowel obstruction?

A

metoclopramide

+ steroids

40
Q

what is the antiemetic for squashed stomach syndrome?

A

metoclopramide

- infusion over 24 hrs

41
Q

what are three types of laxatives?

A

osmotic - lactulose
stimulant - bisacodyl, senna
softens - docusate sodium

42
Q

what should also be prescribed when giving a opioid?

A

laxative

43
Q

what should also be prescribed when giving a NSAID?

A

PPI

44
Q

what three cancers commonly spread to bone?

A

breast
lung
prostate

45
Q

state some reasons for antiemetics not working ?

A 
not absorbing medication properly 
wrong established cause and wrong antiemetic 
wrong dose 
non compliance 
may need 2 antiemetics

Y4 Palliative Care (3 decks)

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