Nausea and vomiting

Question 1

State the two types of approaches to managing nausea and vomiting in a palliative setting

Answer 1

Empirical (dopamine antagonist (e.g. metoclopramide))

Mechanistic approach

Question 2

Describe the common mechanistic causes of nausea and vomiting

Answer 2

(Reduced gastric motility) May be opioid related, related to serotonin (5HT4) and dopamine (D2) receptors

(Chemically mediated) Secondary to hypercalcaemia, opioids, or chemotherapy

(Visceral/serosa) Constipation; oral candidiasis

(Raised intra-cranial pressure)

(Vestibular) Can be motion related, or due to base of skull tumours

(Cortical) anxiety, pain, fear and/or anticipatory nausea

Question 3

Describe the choice of drug in nausea and vomiting caused by reduced gastric motility

Answer 3

Pro-kinetic agents
metoclopramide and domperidone
metoclopramide should not be used when pro-kinesis may negatively affect the gastrointestinal tract