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PHM 604- GI Therapeutics > Nausea/Vomiting > Flashcards

Nausea/Vomiting Flashcards

1
Q

General N/V can be caused by what two conditions?

A

Gastroenteritis and pancreatitis

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2
Q

Disorders of balance can be caused by what three conditions?

A

Motion sickness, dizziness, vertigo

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3
Q

Post-operative N/V can be caused by what?

A

Opioids and anesthetics

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4
Q

Arfal’s Risk Score is used for what?

A

Determining treatment for post-op N/V

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5
Q

Four factors that go into in Arfal’s Risk Score

A

Female
Smoker
History of motion sickness or previous post-op N/V
Expected use of post-op opioids

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6
Q

Rx therapies for general N/V (the drug classes)

A

Metoclopramide (prokinetic), phenothiazine, 5-HT antagonists

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7
Q

Therapy for disorders of balance (the drug class)

A

Antihistamines

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8
Q

Therapies for N/V with pregnancy (OTC, Rx, CAM)

A

Doxylamine, B6, acupressure bands, ginger, Emetrol, sea bands, 5HT-3 antagonists (ondansetron), metoclopramide, prochlorperazine

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9
Q

Therapy for post-op N/V with an Arfal Risk Score of 4

A

Scopolamine patch 2h before anesthesia
IV dexamethasone after anesthesia induction
5HT-3 antagonist after surgery

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10
Q

Therapy for post-op N/V with an Arfal Risk Score of 2-3

A

5HT-3 antagonist after surgery

Other antiemetics PRN

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11
Q

Therapy for post-op N/V with an Arfal Risk Score ≤1

A

No therapy needed

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12
Q

Complications of N/V

A

DEHYDRATION, electrolyte imbalances, esophageal tears, aspiration, malnutrition

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13
Q

Where are H1 antagonists used in N/V treatment?

A

N/V in pregnancy, disorders of balance, rescue therapy for post-op N/V when alternate treatment is needed

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14
Q

H1 antagonist drugs

A

Dimenhydrinate (Dramamine), diphenhydramine (Benadryl), meclizine, doxylamine, scopolamine, hydroxyzine

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15
Q

H1 antagonists that are available OTC

A

Dimenhydrinate, diphenhydramine, meclizine, doxylamine

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16
Q

H1 antagonists available Rx

A

Doxylamine (when in combination with B6 in one tablet), scopolamine, hydroxyzine

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17
Q

Which brands of doxylamine are available OTC?

A

Unisom, Diclegis (delayed-release with B6)

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18
Q

Which brand of doxylamine is available Rx?

A

Bonjesta (ER with B6)

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19
Q

Route of administration for scopolamine

A

Transdermal (place patch behind the ear)

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20
Q

How often is scopolamine dosed?

A

Every 72 hours

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21
Q

Side effects of H1 antagonists

A

SEDATION, dry mouth, constipation with frequent use, paradoxical effect in kids

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22
Q

H2 antagonists

A

Ranitidine, cimetidine

23
Q

Where are H2 antagonists used?

A

Overeating

24
Q

Where are phenothiazines used?

A

General N/V, post-op N/V as rescue therapy, lower-line in N/V with pregnancy

25
Q

Phenothiazine drugs

A

Promethazine, prochlorperazine, chlorpromazine

26
Q

Formulations of the phenothiazine drugs

A

PO, IM, IV

27
Q

Which formulation of phenothiazine drugs is preferred?

28
Q

Side effects of phenothiazines and when they happen

A

Tissue damage, hypotension, QT prolongation, dystonia, EPS symptoms

ALL OCCUR WITH CHRONIC USE

29
Q

Where are 5HT-3 antagonists used?

A

General N/V, post-op N/V, N/V in pregnancy as a lower line option

30
Q

5HT-3 antagonist drug

A

Ondansetron (Zofran)

31
Q

Side effects of 5HT-3 antagonist drug

A

Well tolerated overall, but may have constipation, headache, and QT prolongation

32
Q

Where are corticosteroids used in N/V?

A

Post-op N/V

33
Q

Corticosteroid used in N/V

A

Dexamethasone

34
Q

Side effects of corticosteroids

A

agitation, insomnia, increased appetite, hyperglycemia, Cushing’s, adrenal suppression

35
Q

Where are prokinetics used?

A

General N/V (gastroparesis in diabetic patients), lower line in pregnancy N/V (after OTC, Rx doxylamine and B6, ondansetron)

36
Q

Prokinetics drugs

A

Metoclopramide, erythromycin

37
Q

Side effects of metoclopramide

A

EPS, dystonia (IV > PO), QT prolongation, diarrhea

38
Q

Side effects of erythromycin

A

N/V/D, QT prolongation

39
Q

Self-care therapies for general N/V

A

Oral rehydration solution (Pedialyte)
Pepto Bismol
Phosphorated carbohydrate solution (Emetrol)

40
Q

Age minimum for Pepto Bismol

A

> 12 years old

41
Q

Age minimum for Emetrol

A

> 2 years old

42
Q

ADEs of Pepto Bismol

A

Tongue discoloration, fecal discoloration, chelation with quinolones

43
Q

ADEs of Emetrol

A

Stomach pain and diarrhea

44
Q

Nonpharm care for overeating

A

Eat 4-5 small meals/day, don’t drink fluids or eat soups at mealtime, avoid greasy/fatty foods, eat chilled food

45
Q

Self-care therapies for overeating (pharmacologic treatment)

A

Pepto Bismol, ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet)

46
Q

H2 receptor antagonists ADEs

A

Headache, dizziness, diarrhea, constipation, abdominal discomfort

47
Q

Non-pharm care for motion sickness

A

Avoid reading during travel, focus on line of vision straight ahead, avoid excess food or alcohol before and during extended travel, stay where motion is least experienced (wings of plane or front of car), avoid strong odors, drive if possible

48
Q

Self-care for motion sickness

A

Meclizine (Bonine), dimenhydrinate (Dramamine), Sea Band, BioBand, ReliefBand

49
Q

ADEs of meclizine and dimenhydrinate

A

Dry mouth, confusion (in elderly), constipation, dizziness

50
Q

Age minimum to use Dramamine

A

> 2 years old

51
Q

Non-pharm care for pregnancy

A

Get fresh air, eat crackers and lay in bed for 10-15 minutes before getting up, get up out of bed slowly, eat 4-5 small meals/day, don’t drink fluids or eat soup at meals, avoid greasy/fatty foods

52
Q

Self-care for pregnancy

A

Pyridoxine (B6) and doxylamine taken SEPARATELY, Emetrol, ginger, acupressure bands

53
Q

What does Vitamin B6 not have an effect on in N/V during pregnancy?

A

The vomiting

54
Q

ADEs of doxylamine

A

Dry mouth, constipation, dizziness

PHM 604- GI Therapeutics (10 decks)

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