nausea + vomiting

Question 1

when are antiemetics prescribed

Answer 1

only prescribed when the cause of vomiting is known because otherwise, they may delay diagnosis, particularly in children

Question 2

name some antihistamines that can be for nausea + vomiting

Answer 2

cinnarizine, cyclizine, promethazine

Question 3

which drugs can be used for chemotherapy-induced and radiation-induced nausea and vomiting

Answer 3

• Prochlorperazine, chlorpromazine (the phenothiazines)

- Dexamethasone

Question 4

which antipsychotics can be used for the relief for nausea + vomiting in palliative care

Answer 4

haloperidol [unlicensed use] and levomepromazine

Question 5

how does Metoclopramide act as an antiemetic

Answer 5

it acts directly on the gastric smooth muscle stimulating gastric emptying

Question 6

what is the advantage of Domperidone as an antiemetic

Answer 6

less likely to cause central effects, such as sedation and dystonic reactions compared to metoclopramide + the phenothiazines (e.g chlorpromazine, prochlorperazine)

This is because it does not readily cross the blood-brain barrier

Question 7

when can antiemetics be used during pregnancy

Answer 7

Antiemetics should be considered for women with persistent symptoms where self-care measures have been ineffective.

self-care advice (such as rest, oral hydration and dietary changes)

Question 8

TRUE OR FALSE

ginger may be helpful for mild to moderate nausea during pregnancy

Answer 8

true

Question 9

name some antiemetics that can be used during pregnancy

Answer 9

• drug treatment options: chlorpromazine , cyclizine, metoclopramide prochlorperazine, promethazine and ondansetron.
• choice depends on patient preference. if response to a drug after 24 is inadequate, switch to a different one in a different therapeutic class

Question 10

what is Hyperemesis gravidarum

Answer 10

a more serious condition of severe nausea + vomiting which requires regular antiemetic therapy, intravenous fluid and electrolyte replacement, and sometimes nutritional support.

Question 11

why must thiamine supplement be considered during pregnancy

Answer 11

to reduce the risk of Wernicke’s encephalopathy (a neurological disease that results in confusion, the inability to coordinate voluntary movement (ataxia) and eye (ocular) abnormalities)

Question 12

what are the risk factors for postoperative nausea + vomiting

Answer 12

• female sex
• younger age
• non-smokers
• a history of postoperative nausea and vomiting or motion sickness
• use of opioids

risk of nausea + vomiting also depends on: the anaesthetic used, and the type and duration of surgery

Question 13

how are antiemetics used for Postoperative nausea and vomiting

Answer 13

A combination of two or more antiemetic drugs that have different mechanisms of action is often used in patients with risk factors for postoperative nausea and vomiting

• Drugs used include 5HT3-receptor antagonists (e.g. granisetron, ondansetron), dexamethasone, droperidol and haloperidol

Question 14

which antiemetics can be used for motion sickness

Answer 14

• Hyoscine hydrobromide
• antihistamines such as cyclizine, promethazine

note Domperidone, metoclopramide hydrochloride, 5HT3-receptor antagonists, and the phenothiazines (except promethazine—an antihistamine phenothiazine) are ineffective in motion sickness

Question 15

what is Ménière’s disease

Answer 15

Ménière’s disease is an ear condition that can cause sudden attacks of vertigo (a spinning sensation).

• Patients presenting with symptoms of Ménière’s disease should be referred to an ear, nose, and throat specialist to confirm the diagnosis.