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S2 Case 1 - IBD > Nausea + Emesis > Flashcards

Nausea + Emesis Flashcards

1
Q

Can vomiting without nausea occur?

A

Yes, but it is less frequent

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2
Q

Who is more likely to experience vomiting?

A

Women over men

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3
Q

What does the brainstem “vomiting center” do?

A

Coordinates vomiting through interactions with cranial nerves 3 + 10

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4
Q

What does the vomit center contain?

A

M1 receptors
H1 receptors
NK1 receptors
5HT receptors

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5
Q

What does the nucleus tractus solitarius contain?

A

M1 receptors
H1 receptors
NK1 receptors
5HT receptors

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6
Q

What does the chemoreceptor trigger zone contain?

A

Chemoreceptors
D2 receptors
NK1 receptors

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7
Q

What are the triggers for vomiting?

A

Intracranial pressure
Motion sickness
Anxiety
Drugs
Toxins
Chemotherapy

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8
Q

What is serious morning sickness for pregnancy?

A

Hyperemesis gravidarum

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9
Q

What is the process for treating nausea + vomiting?

A
  1. treat complication regardless of cause = replaces salt, H2O
  2. identify + treat underlying cause
  3. provide temporary relief for symptoms
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10
Q

What is the problem with anti-emetics?

A

Oral = if patient is being sick, they aren’t ging to keep them down
Injection = needles aren’t accessible at home + low patient acceptability

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11
Q

What is the best way to treat CINV?

A

Preventive treatment
= stop being sick in first place
= deceases chance of being sick in future
= able to give higher dose

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12
Q

What are pharmacological treatments for nausea + vomiting?

A

D2 antagonists
5HT3 antagonists
Antihistamines
Anticholinergics
Pro-motility = metoclopramide

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13
Q

What are antihistamines used to treat?

A

Montion sickness
PONV

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14
Q

Describe antihistamines

A

H1 antagonists

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15
Q

What are some examples of antihistamines?

A

Cyclizine
Diphenhydramine
Meclizine

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16
Q

What are the problems with antihistamines?

A

Cause CNS depression + sedation
= drowsiness

17
Q

What are anticholinergics used to treat?

A

Motion sickness

18
Q

Describe anticholinergics

A

Muscarinic acetylcholine receptor antagonists

19
Q

What are the problems with anticholinergics?

A

Blockage of parasympathetic ANS
= blurred vision, dry mouth, urinary retention

20
Q

What is an example of anticholinergic?

A

Hyoscine

21
Q

What are dopamine antagonists used to treat?

A

Drug-induced vomiting + vomiting in GI disorders

22
Q

How do dopamine antagonists work?

A

Centrally block D2 receptors in CTZ
Exert prokinetic action on oesophagus, stomach + intestine

23
Q

What are some examples of dopamine antagonists?

A

Metoclopramide (low dose)
Chlorpromazine
Haloperidol

24
Q

What are the problems with dopamine antagonists?

A

Mimic Parkinson’s disease

25
Q

When is metoclopramide used at high dose?

A

Chemo
= at higher level effect serotonin

26
Q

What does 5HT3 antagonists treat?

A

PONV
CINV

27
Q

What are examples of 5HT3 antagonists?

A

Ondansetron
Granisetron

28
Q

What are the side effects of 5HT3 antagonists?

A

Constipation
Headaches

29
Q

What is an example of prokinetic agent?

A

Metoclopramide

30
Q

What do prokinetic agents do?

A

CTZ anti-dopaminergic activity

31
Q

What are problems with prokinetic agents?

A

Obstructed intestine = can cause colic
Increases pressure at lower oesophageal sphincter

32
Q

What are NK1 antagonists?

A

Aprepitant
Antagonise NK1 receptors

33
Q

When are NK1 antagonists used?

A

Delayed onset nausea associated with chemotherapy

34
Q

When are cannabinoids used?

A

For patients undergoing cytotoxic chemotherapy, that is unresponsive to other anti-emetics

35
Q

How do cannabinoids work?

A

Decrease vomiting induced by stimulating CTZ

S2 Case 1 - IBD (18 decks)

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