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Palliative care > Nausea And Vomiting > Flashcards

Nausea And Vomiting Flashcards

1
Q

Nausea define

A

An unpleasant feeling of the need to vomit associated with autonomic symptoms (pallor, sweating, tachycardia, salivation)

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2
Q

Retching define

A

Rhythmic laboured spasmodic movements of the diaphragm and abdominal muscles (often occurs with nausea and results in vomiting)

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3
Q

Vomiting define

A

The forceful propulsion of gastric contents through the mouth

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4
Q

Why is treating n and v important

A

Common
Distressing
Affects up to 70%of people with cancer
QualoL

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5
Q

What areas contribute to the mechanism of causing n and v

A 
Chemoreceptor trigger zone 
Gut 
Cerebral cortex 
Vestibular cortex 
These lead to the vomiting centre 
This causes vomiting.
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6
Q

Drugs which cause n and v

A 
Analgesia - codeine, morphine
Antibiotics 
Iron e.g. ferrous sulfate
Digoxin
Antidepressants
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7
Q

Gastrointestinal problems which cause n and v

A 
Gastric irritation - tumour, gastritis
Gastric distension - tumour, diabetic autonomic neuropathy 
Bowel obstruction 
Oedematous gut 
Constipation
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8
Q

Metabolic causes of n and v

A

Hypercalcaemia
Renal failure
Hyponatraemia

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9
Q

Psychological causes of n and v

A

Anxiety

Fear

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10
Q

Toxic causes of n and v

A

Radiotherapy
Chemotherapy
Infection

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11
Q

Other causes of n and v (brain related)

A

Raised ICP

vestibular disturbance

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12
Q

Which substances/condition act as a stimulus for the CTZ

A 
Opioids 
Uraemia
Hypercalcaemia
Chemo
Toxins
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13
Q

Which neurotransmitters act on the CTZ

A

5HT

D2

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14
Q

Which substances/conditions act as a stimulus for the cerebral cortex

A

Anxiety
Raised ICP
hyponatraemia
Sights and smells

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15
Q

Which neurotransmitters act in the cerebral cortex

A

Histamine

Serotonin

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16
Q

Which substances/conditions act as a stimulus for the vestibular cortex

A

Movement

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17
Q

Which neurotransmitters act in the vestibular cortex

A

Muscarinic

Histamine

18
Q

Which substances/conditions act as a stimulus for the gut

A 
Radiotherapy 
Cytotoxics
Drugs
Toxins
Irritants
Intestinal
Distension
19
Q

Which neurotransmitters act in the gut

A

Serotonin

Dopamine

20
Q

Which neurotransmitters act in the vomiting centre

A

Muscarinic
Histamine
Serotonin

21
Q

Commonly used medication

A 
Metocloperamide 
Cyclizine
Haloperidol
Ondansetron
Levomepromazine 
Domperidone
22
Q

Metocloperamide act on which neurotransmitters receptor

A

Dopamine 2 D2 receptor antagonist and a 5HT agonist
Acts peripherally does cross BBB
So acts on the gut and CTZ

23
Q 
Metocloperamide 
What is it 
What does is to 
Dose
SE
A

Dopamine 2 D2 receptor antagonist and 5 HT4
Peripherally acting but does cross BBB
Acts as a prokinetic, useful in delayed gastric emptying
Usual dose 10mg TDS PO
SE risk of extrapyramidal SE as it crosses BBB, abdo cramps caution in complete bowel obstruction - perf
Caution in young people <20 years at risk of oculogyric crisis

24
Q

Ondansetron
What is it what does it do
SE

A 
5HT4 receptor antagonist 
Commonly used post surgery, chemotherapy and radiotherapy-where gut disturbance causing 5HT3 release 
Expensive 
SE constipation 
QTc prolongation
25
Q

Cyclizine
What does it do where does it act
Dose
SE

A

acts centrally
Anti muscarinic and anti histamine activity
Useful for motion sickness and vomiting secondary to raised ICP
Good 1st line anti emetic in hospital
50mg TDS IV/PO/SC
SE due to anti muscarinic activity - dry mouth, constipation sedation

26
Q

Which 2 antiemetics should not be prescribed together

A

Cyclizine and metocloperamide
Metocloperamide acts as a prokinetic through dopamine antagonism
Cyclizine slows gastric transit due to anti muscarinic effects therefore blocking the effect of metocloperamide

27
Q

What condition should cyclizine not be used in

A

Heart failure

28
Q

How can antiemetics be given

A

PO
IV
SC
CSCI

29
Q

What treatment should be given in gastric stasis and why

A

Con
Reduce volume or oral intake little and often
Reduce gastric secretions H2 antagonist e.g. ranitidine
Medication
Pro kinetic agents dopamine D2 antagonist
Metocloperamide
Domperidone

30
Q

What causes gastric stasis

A 
Drug se
Anticholinergics
Opioids 
Compression of gastric outflow
Tumour, hepatomegaly, ascites
Stomach emptying problems 
Autonomic, diabetes, gastritis, peptic ulcer
31
Q

What treatment should be given in gastric stasis

A 
Address the underlying cause such as constipation 
Then treat with a 5HT3 antagonist 
Ondansetron
Used in first line chemo related nausea
Anticholinergic - cyclizine
32
Q

Causes of GI or visceral irritation

A

Stimulation of the vagus /gut 5HT3 receptors
Contributing factors- GI or visceral irritation
- pharyngeal irritation x tumour, sputum, Candida
-stretch receptors of GI or GU tract- constipation, bowel ureteric obstruction, chemo/radio
- visceral capsules - hepatomegaly

33
Q

What causes chemical or metabolic NV

A

Chemical drugs - opioids, antibiotics, digoxin, NSAIDS, SSRIs, chemotherapy
Metabolic- renal/liver failure, hyperclacawmia I’d malignancy, hyponatraemia, sepsis

34
Q

How to treat chemical/metabolic NV

A 
Dopamine D2 antagonist 
-haloperidol
-levomepromazine
Or serotonin 
Ondansetron
35
Q

What is haloperidol
What does it do
SE

A 
D2 receptor antagonist 
Works on the CTZ
Commonly used in palliative care
Haloperidol 1.5mg-3mg SC/PO
SE 
Extrapyramidal SE 
QTc prolonging 
Sedation (uncommon at low doses)
36
Q

What is levomepromazine
What does it do
SE

A

Broad spectrum antiemetic targets multiple record sites
Used as an antipsychotic but effective for nausea at low doses
Used commonly in palliative care, bowel obstruction or antiemetic and sedation needed
SE
Sedation
Postural hypotension

37
Q

What causes raised ICP and what causes the NV

A 
Stimulation of the vomiting centre 
H1 and AChm receptors
Any cause
SOL
Skull mets
Intracranial haemorrhage
Meningeal Infiltration
38
Q

What doe you treat with

A

Anti histamine or anti cholinergic

Also depends on cause
For a SOL
steroids to reduce oedema
Or radiotherapy

39
Q

What causes you to feel sick on motion sickness

A

Stimulation of the vestibular system H1 and AChm receptors
Contributing factors
-stimulation of vestibular system
- opioids can increase vestibular sensitivity
- ? Intracerebral cause

40
Q

How to treat motion sickness

A

Cyclizine

41
Q

Which drug combinations should you avoid

A

Metocloperamide/domperidone and cyclizine cos they clock each other’s effects
IV metocloperamide and IV ondansetron
- risk serious cardiac arrhythmia
Avoid prolonged used of moetcloperamide /domperidone due to inc extra pyramidal SE

Palliative care (3 decks)

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