Nausea/Vomiting Flashcards

1
Q

Nausea

A

inclination to vomit or a feeling in the throat or epigastric region alerting an individual that vomiting is imminent

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2
Q

Vomiting

A

forceful expulsion of gastric contents due to retroperistalsis

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3
Q

Mose Common Causes of N & V

A
  • infection (gastroenteritis)
  • pregnancy
  • medications
  • motility disorders
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4
Q

Pathophysiology of Vomiting

A
  • triggered by afferent impulses to cells in medulla from GI tract; impulses received by chemoreceptor trigger zone, cerebral cortex, vestibular apparatus
  • cause efferent signals to go to GI and other tissues resulting in vomiting
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5
Q

Chemoreceptor Trigger Zone (CTZ)

A
  • major area of chemosensory info

- stimulation of CTZ by chemicals usually results in vomiting

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6
Q

General Principles Important for Tx of N&V

A
  • identify underlying cause
  • usually self-limited
  • maintain adequate hydration
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7
Q

Drug-Induced N&V

A
  • common
  • timing and reproducibility of NV in relationship to the administration of a drug
  • discontinuing drug is the best therapy
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8
Q

Drugs that Commonly Cause N&V

A
  • chemotherapy agents
  • oral and some IV abx
  • anticonvulsants (toxic levels)
  • amphotericin (antifungal)
  • narcotic analgesices
  • theophyllien (toxic levels)
  • digoxin (toxic levels)
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9
Q

Anticipatory N/V

A
  • defined as N/V occurring before an expected event
  • generally associated with the administration of chemo
  • can result in sig. problems including delay of chemo administration
  • commonly treated w/ benzodiazepines due to their amnestic properties
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10
Q

Refractory N/V

A
  • defined as N/V despite the use of standard antiemetic therapy
  • seen in up to 30% of chemo pts
  • generally requires use of combination antiemetic regimens w/ more than one site or MOA
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11
Q

Anticholinergics MOA

A

-block muscarinic ACh receptors in vestibular system

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12
Q

Anticholinergics Generic

A

scopolamine

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13
Q

Scopolamine Trade Name

A

Transderm Scope

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14
Q

Anticholinergics Efficacy

A
  • effective for preventing and treating motion sickness

- possibly post op NV

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15
Q

Anticholinergics AEs

A
  • common: dry mouth and eyes, drowsiness, impaired eye accommodation
  • rare: disorientation, memory disturbance, dizziness, hallucinations
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16
Q

Antihistamines MOA

A

-block H1 and muscarinic ACh receptors in vestibular system

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17
Q

Antihistamines Generics

A
  • Dimenhydrinate
  • Diphenhydramine
  • Meclizine
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18
Q

Antihistamines Trade Names

  1. Dimenhydrinate
  2. Diphenhydramine
  3. Meclizine
A
  1. Dramamine
  2. Benadryl
  3. Antivert
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19
Q

Antihistamines Efficacy

A
  • moderately effective

- more effective when combined w/ other antiemetics for chemo induced NV

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20
Q

Antihistamines AEs

A
  • common: sedation, dry mouth, constipation

- less common: confusion, blurred vision, urinary retention

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21
Q

Phenothiazines MOA

A

-block dopamine stimulation of chemoreceptor trigger zone

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22
Q

Phenothiazines Generic

A

-Prochlorperazine

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23
Q

Prochlorperazine Trade Name

A

Compazine

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24
Q

Phenothiazines Efficacy

A
  • effective for severe motion sickness
  • vertigo
  • NV with pregnancy
  • chemo NV
  • post op NV
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25
Phenothiazines AEs
- sedation - orthostasis - EPS such as dystonia, tardive dyskinesia (abnormal lip/mouth movement), akathisia
26
Butyrophenones MOA
-block dopamine stimulation of chemoreceptor trigger zone
27
Butyrophenones Generics
- Droperidol | - Haloperidol
28
Butyrophenones Trade Names 1. Droperidol 2. Haloperidol
1. Inapsine | 2. Haldol
29
Butyrophenones Efficacy
- effective for preventing post op NV | - may be used for chemo NV for pts who can't tolerate usual tx
30
Butyrophenones AEs
- sedation, agitation, restlessness - droperidol may prolong QT interval - EKG before and after dosing - EPSE
31
Benzamides MOA
- block central and peripheral dopamine receptors | - increase GI motility (cholinergic effect)
32
Benzamides Generics (2)
- metoclopramide | - trimethobenzamide
33
Benzamides Trade Names 1. Metoclopramide 2. Trimethobenzamide
1. Reglan | 2. Tigan
34
Benzamides Efficacy
- used for post op NV, chemo NV, NV preg | - GERD, gastroparesis and migraine HA
35
Benzamides AEs
- common: sedation, restlessness, drowsiness, agitation, CNS depression - less common: EPSE, HoTN, neuroleptic syndrome, SVT
36
Corticosteroids MOA
- through to be due to release of serotonin - decrease BBB permeability - decrease inflammation
37
Corticosteroids Generics (2)
- dexamethasone | - methylprednisolone
38
Corticosteroids Trade Names 1. Dexamethasone 2. Methylprednisolone
1. Decadron | 2. Medrol
39
Corticosteroids Efficacy
-used alone or in combo for post op, chemo, and radiation induced NV
40
Corticosteroids AEs
- common: GI upset, anxiety, insomnia | - less common: increase blood glucose, facial flushing, euphoria
41
Cannabinoids MOA
-work centrally but exact mechanism unknown
42
Cannabinoids Generics (2)
- dronabinol | - nabilone
43
Cannabinoids Trade Names 1. Dronabinol 2. Nabilone
1. marinol | 2. cesamet
44
Cannabinoids Efficacy
-used to prevent or treat refractory chemo NV
45
Cannabinoids AEs
-common: drowsiness, euphoria, abnormal thinking, dysphoria
46
Benzodiazepines MOA
-through to block input from cerebral cortex and limbic system from reaching vomiting center
47
Benzodiazepines Generics (2)
- lorazepam | - alprazolam
48
Benzodiazepines Trade Names 1. Lorazepam 2. Alprazolam
1. ativan | 2. xanax
49
Benzodiazepines Efficacy
-used to prevent and treat chemo NV
50
Benzodiazepines AEs
- common: sedation, amnesia | - less common: respiratory depression (caution in COPD), ataxia, blurred vision, hallucinations, paradoxical reactions
51
5HT3 Antagonists MOA
-selectively block 5HT3 receptors
52
5HT3 Antagonists Generic
ondansetron
53
Ondansetron Trade Name
Zofran
54
5HT3 Antagonists Efficacy
-very effective for prevention or tx of chemo or post op NV
55
5HT3 Antagonists AEs
- generally well-tolerated - constipation, HA, somnolence, diarrhea - all except palonsetron can prolong QT interval
56
NK1 Antagonist MOA
-block neurokinin1 receptors in CTZ and GI tract
57
NK1 Antagonist Generic
aprepitant
58
Aprepitant Trade Name
Emend
59
NK1 Antagonist Efficacy
- effective for preventing acute and delayed chemo NV in combo with 5HT3 antagonists and CS - also effective for prevention of post op NV
60
NK1 Antagonist AEs
- common: fatigue, hiccups, - less common: dizziness, HA, insomnia - rare: transient increase in LFTs
61
2 Non-Pharm Options for NV Tx
- wrist bands with acupressure point 3 fingers below wrist fold - ginger ale
62
Recommended Therapy for Motion Sickness
- dimenhydrinate/dramamine 50-100 mg q4-6 hr PRN | - scopolamine 0.5 mg q72 hr PRN
63
Recommended Therapy for Preg Induced NV
- pyridoxine (B6) +/- doxylamine (unisom); 10-25/12.5-20 mg 1-4x/day - can also add promethazine, metoclopramide, trimethobenzamide, ondansetron
64
Recommended Therapy for Anticipatory NV
-lorazepam/ativan: 0.5 to 4 mg prior to chemo then q4-6 hr PRN
65
Recommended Therapy for Chemo Induced Highly Emetogenicity or Moderate AC
-5HT3 Antagonist + dexamethasone + aprepitant
66
Recommended Therapy for Chemo Induced Moderately Emetogenicity
-5HT3 Antagonist + dexamethasone
67
Recommended Therapy for Chemo Induced Low Emetogenicity
-dexamethasone 8 mg PO x1
68
Recommended Therapy for Post Op NV
- 5HT3 Antagonists (dolasetron, granisetron, ondansetron, tropisetron) - dexamethasone - droperidol
69
Recommended Therapy for Refractory NV
-add chlopromazine, prochlorperazine, promethazine, methylprednisolone, lorazepam, metoclopramide, dexamethazone if needed