Nausea And Vomitting

Question 1

Prescribe antiemetics only when cause of vomiting is known especially in children because what can antiemetics be sometimes? What can they do when the causes are what? So chose according to the what?

Answer 1

• Antiemetics are unnecessary and sometimes harmful when cause can be treated eg, diabetic ketoacidosis or digoxin overdose
  
  • Choose drug according to aetiology(cause) and vomiting

Question 2

Antihistamines(cyclizine,promethazine,cinnarizine) are effective but have many? And what else are the good for?

Answer 2

are effective for nausea and vomiting but have many underlying conditions (similar efficacies but different side effects eg , drowsiness and antimuscarinic S.Es) - Good for vertigo and motion sickness

Question 3

Phenothiazines what are examples of them? All ending in what ? They are good dopamine?? And block the what ? They are good in prophylaxis of what?

Answer 3

(eg chlorpromazine,prochlorperazine,perphenazine and trifluoperazine) are dopamine antagonists and block the chemoreceptor trigger zone. Good for prophylaxis and treatment in neoplastic disease(tumour),radiation sickness,emetics caused by opioids,cytotoxic and general anaesthesia

Question 4

Prochloroperazine(buccal tablets),trifluroperizine are less sedating than what?

Answer 4

less sedating than chlorpromazine

Question 5

Severe dystonic reactions can occur with what, especially in who?

Answer 5

can occur with phenothiazines - especially children

Question 6

Levopromazine and haloperidol are used for what in palliative care?

Answer 6

used for nausea and vomiting in terminal illness(palliative care)

Question 7

Metoclopramide acts directly on what? And so stops what?

Answer 7

acts directly on GI tract(vomiting associated with hepatic,gastroduodenal disease)

Question 8

Domperidone acts at the- what trigger zone? It can’t so what which ma’es it less sedating so what disease is it commonly used in? What kind of antagonists are ondasetron and granisetron and what are they useful in?

Answer 8

chemoreceptor trigger zone - doesn’t cross BBB so less sedating and less dystonic side effects compared to others, can be used in Parkinson’s
- 5HT 3 Antagonist(Granisetron and ondasetron) nausea and vomiting following chemo or post operative nausea

Question 9

Dexamethasone is used in

Answer 9

vomiting during chemo

Question 10

Nabilone is a synthetic what? When do we add it on? What is used in preoperative anticipatory nausea? What is used in pts with Parkinson’s? What is used in terminal illness

Answer 10

synthetic cannabinoid, add on for chemo induced nausea and vommiting as last option
-preoperative anticipatory - lorazepam
-Patients with Parkinson’s-domperidone
-terminal - haloperidol, levomepomazine

Question 11

Nausea and pregnancy what is it like during first trimester? Rare occasion we give what? Revere if symptoms persist for 24 hrs
Supplementation with what to prevent wernickes?

Answer 11

• Vomiting during pregnancy, nausea in 1st trimester usually mild and does not require drug therapy
  
  • Rare occasion its severe - promethazine,prochloroperazine,metoclopramide
  • Refer if symptoms persist after 24-48 hours
  • Supplementation with thiamine may be considered to reduce risk of wernickes encephalopathy

Question 12

Post operative nausea:
What can we give? What is cyclizine licensed for? The prevention and treatment of what? Caused by what? What is prochloroperzine

Answer 12

• 5HT3-receptor antagonists,granistron,ondasetron, droperidol,dexamethasone,some phenothiazines (eg, prochloroperazine) and antihistamines(cyclizine)
  
  • Cyclizine - licensed for prevention and treatment of postoperative nause and vomiting caused by opioids and general anaesthetics
  • Prochloroperazine - for prevention and treatment

Question 13

Motion sickness:
Can be treated using what? Which is most effective? Which is the most sedating

Answer 13

• Give antiemetics to prevent motion sickness rather than after nausea and vomiting develops
  
  • Hyoscine hydrobromide(most effective drugs)
  • Promethazine (if sedative effect required)but less sedating antihistamines such as cyclizine/cinnarizine are preferred
  • Domperidone, metoclopramide phenothiazines(except promethazine) are ineffective in motion sickness

Question 14

Other vestibular disorders (balance disturbance):
We would treat with what?

Answer 14

ANTI HISTAMINES -cinnarizine,cyclizine,promethazine and phenothiaziness eg prochloperazine - alleviate nausea, vomiting and vertigo.

Buccal prochloroperazine and intramuscular prochloroperazine or cyclizine can also relive rapid attacks

- Betahistine - licensed for vertigo,tinnitus and hearing loss associated with meunière’s disease(inner ear disorder)
- A diuretic alone or combined with salt restricted diet may provide benefits in vertigo associated with menire’s disease
- Antihistamines(cinnarizine) and phenothiazines(eg.prochloroperazine) are also used  Prochloroperazine should be reserved for acute symptoms where possible

Question 15

Domperidone does do what? Can be given for how long and how often? What the minimum age requirement? What the max days use? It’s can cause what?

Answer 15

• Doesn’t cross the blood brain barrier so suitable in Parkinson’s
  
  • 10mg x3 times a day
  • Minimum age 12
  • Max use 7 days
  • Causes QT prolongation, palpitations and syncope

Question 16

Metoclopramide

Answer 16

causes extra pyramidal side effects- DON’T USE IN PARKINSONS
- 10mg x3 times a day
- Min age 18 y/o
- Max 5 day use

Question 17

Promethazine should not be given in children less than what

Answer 17

children less than 6 shouldn’t be given OTC cough and cold medicines containing promethazine