Nausea/Vomiting Flashcards
Red Flag symptoms
significant dehydration (dizzy, sunken eyes, reduced skin turgor)
blood in vomit
coffee ground emesis
altered mental status
thunderclap headache (severe)
fever/stiff neck (=meningitis?)
Signs of dehydration in adults
-dry mouth and tongue
-more thirst than usual
-weak/lethargic
-reduced need to urinate
-sunken eyes
Signs of dehydration in children?
-lack of tears
-<4 wet diapers in 24h
-irritable, lethargic
-reduced skin turgor
-sunken eyes
-sunken fontanel
-change in skin color
-dry mouth/skin
Non-Pharms
-hydration - 2.5L fluid per day, ORS for mod-severe cases
-small, bland, frequent meals
-avoid triggers (fatty, spicy, strong odors)
Which drugs can treat vestibular causes of N/V?
antihistamines or anticholinergics
(diphenhydramine, dimenhydrinate, scopolamine)
What drug classes treat problems with GI motility which cause n/v?
metoclopramide
domperidone
Which class of drugs can help with CTZ stimulation?
DA antagonists
5-HT antagonists
Types of n/v?
motion sickness
post-op
pregnancy
chemo-induced
What causes motion sickness?
an abrupt change in motion, involving the inner ear and vestibular system
What are the most responsible neurotransmitters involved in motion sickness?
Acetylcholine and histamine
How to prevent motion sickness?
adequate hydration
avoid smell/food that induce nausea,
eat frequent small meals
relaxation therapy
pain therapy
Treatment for motion sickness
Take meds 30-60 min prior to motion exposure.
-Tx: Gravol or Benadryl (onset 15-20 min, lasts 4-6 hrs)
AEs: sedation, anticholinergic effects
What are the risk factors of post-op N/V?
Female
non-smoker
history of motion sickness/PONV
opioid use
Drug options to treat post-op N/V?
ondansetron
haloperidol
dexamethasone
metoclopramide
dimenhydrinate
What is hyperemesis gravidaum?
severe, persistent nausea and vomiting during pregnancy, leads to weight loss, electrolyte imbalance, dehydration, nutritional deficiency
1st line for mild NVP (pregnancy)?
Diclectin (pyridoxine/doxylamine), or pyridoxine or ginger1
1st line for mod-severe NVP?
dimenhydrinate or
promethazine
which drugs are effective in all types of N/V except for chemo-induced?
gravol and benadryl
Side effects of Diclectin?
-combo of antihistamine and vit B6
-lots of sedation
diarhea, disorientation, headache
epigastric pain, palpitations, urinary retention
which antimotility agent should be avoided in pregnancy?
domperidone
Examples of dopamine antagonists and indications?
Domperidone - functional dyspepsia, gastroparesis
Metoclopramide - drug-induced nausea, migraine-induced nausea, gastroparesis, NVP (persistent), CINV
Concerning Side effects of domperidone
QT prolongation, ventricular arrhythmias, hyperprolactinemia
Concerning side effects of metoclopramide
EPS, tardive dyskinesia
