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High - Nervous system > Nausea + vomiting > Flashcards

Nausea + vomiting Flashcards

1
Q

What triggers the chemoreceptor trigger zone? what drugs are used?

A

Drugs: chemo, opioid, anaesthetic
Chemicals
Toxins

  • 5HT antagonist
  • Neurokinin receptor antagonist
  • Antimuscarinic
  • Antihistamine
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2
Q

What triggers the GI tract? what drugs are used?

A

Chemotherapy
Operation
Radiotherapy
Food poisoning

  • Dopamine receptor antagonist (prokinetic)
  • 5HT antagonist
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3
Q

What triggers the cortisol centre? What drugs are used?

A

Sensory input: pain, sight, smells
Emotions
Anticipatory

  • Benzodiazepine
  • Cannabiniod
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4
Q

What triggers the vestibular system? What drugs are used?

A

Motion sickness
Labyrinth disorder: vertigo

  • Antihistamine
  • Antimuscarinic
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5
Q

What is the treatment for nausea and vomiting in pregnancy?

A

First line: rest, hydration + change diet

Persistent
- Antiemetic: Metoclopramide, Prochlorperazine, Cyclizine, Promethazine (sedating), Ondansetron
- 24h symptoms: switch to diff class
- 48h: seek specialist opinion

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6
Q

What is the treatment for post-operative nausea + vomiting?

A

Before a patient has an operation, they are assessed on their risk of nausea and vomiting, If at high risk, offer prevention with a combination of two or more anti emetics from different drug classes:

  • Metoclopramide
  • Domperidone
  • Dexamethasone
  • Prochlorperazine , droperidol, haloperidol
  • Cyclizine
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7
Q

What is classed as high risk post-operative nausea and vomiting?

A
  • Female
  • Non-smoker
  • Hx motion sickness
  • Opioid
  • Anaesthetic
  • Surgery type + duration
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8
Q

Give examples of dopamine receptor antagonist used in N+V

A
  • Domperidone (choice in PD)
  • Metoclopramide
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9
Q

Give examples of 1st gen antipsychotics used in N+V

A
  • Prochloperazine (bucally: migraine)
  • Levopromazine (palliative)
  • Droperidol (post-op)
  • Haloperidol (palliative)
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10
Q

Give an example of a 5HT receptor antagonist used in N+V

A

Ondansetron

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11
Q

Give an example of an antimuscarinic used in N+V

A

Hyoscine hydrobromide (most effective. Motion sickness)

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12
Q

What is the mechanism of action of metoclopramide?

A
  • Blocks D2 receptors in chemoreceptor trigger zone
  • Acts directly on GI tract = prokinetic effect
  • It promotes gastric emptying and increases gastrointestinal motility
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13
Q

What is the indication of metoclopramide?

A
  • Nausea + vomiting
  • Prevention: post op, chemo + radiotherapy
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14
Q

What is the dose of metoclopramide?

A

10mg TDS 5 days
- 18+
- Max: 500mcg/Kg

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15
Q

What is the side effect of metoclopramide?

A

Acute dystonic reactions: oculogyric crises

  • Uncontrolled muscle spasms in the face, skeletal muscles and eyes
  • Common in young females and the elderly
  • MHRA: neurological effects - restricted use
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16
Q

What are the interactions of metoclopramide?

A
  • Antipsychotics → INC extrapyramidal symptoms
  • Dopaminergic drugs + PD → Do not give, antagonises treatment + worsens condition
17
Q

What is the mechanism of action of domperidone?

A
  • Blocks D2/D3 receptors in chemoreceptor trigger zone
  • Acts directly on GI tract = prokinetic effect
  • It promotes gastric emptying and increases gastrointestinal motility
18
Q

What is the indications of domperidone?

A

Nausea + vomiting
Choice in PD

19
Q

What is the dose for domperidone?

A

10mg TDS 1 week
- Over 35kg
- MHRA: domperidone: lack of efficacy in certain populations (Under 12 + <35kg)

20
Q

What are the side effects of domperidone?

A

QT prolongation

CI:

  • Impaired cardiac conduction
  • Cardiac disease
  • Avoid in mod-severe hepatic impairment
21
Q

What are the interactions of domperidone?

A

QT prolongation = arrhythmias
- Antipsychotics
- Antiarrhythmics
- Escitalopram + citalopram
- Macrolides

CYP3A4 inhibitor
- Amiodarone
- Azole
- Macrolides
- Rate limiting CCBs

22
Q

What is the mechanism of action of 5 HT3 receptor antagonists?

A

Blocks 5-HT3 receptors in chemoreceptor trigger zone + GI tract

23
Q

What is the indication for 5-HT3 receptor antagonists?

A

Post operative + chemotherapy induced nausea + vomiting

23
Q

What are the side effects of 5-HT3 receptor antagonists?

A

QT prolongation

24
Q

What is the policy of 5-HT3 receptor antagonists in pregnancy?

A

Teratogenic: MHRA: ondansetron: INC risk of oral clefts if used in 1st trimester

25
Q

What are the interactions of 5-HT3 receptor antagonists?

A

Drugs that cause hypOkalaemia increasing risk of torsade de pointes (Beta2 agonist, Corticosteroids, Loop + thiazide diuretics, Theophylline)

QT prolongation = arrhythmias (Antipsychotics, Antiarrhythmics, Escitalopram + citalopram
- Macrolides

Serotonergic drugs → Serotonin syndrome

High - Nervous system (12 decks)

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