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GI/Hepatic > Nausea/Vomiting > Flashcards

Nausea/Vomiting Flashcards

1
Q

What are the types of non-pharmacologic therapy

A

Dietary
Physical
Psychological changes

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2
Q

What are dietary therapies for N/V?

A

Frequent small meals, avoid spicy or fatty foods, eat high-protein snacks

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3
Q

What are dietary therapies for NVP?

A

Normal dietary therapies plus:
Eat bland/dry foods first thing in the morning
Some evidence that taking a multivitamin at the time of conception may result in less likelihood of seeking medical treatment

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4
Q

What is a natural dietary therapy for motion sickness and dyspepsia?

A

Peppermint oil

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5
Q

What is a natural dietary therapy for motion sickness and NVP?

A

Ginger

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6
Q

What are physical therapies for N/V?

A

Acupuncture

Sea-Band

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7
Q

How do physical therapies work for N/V?

A

P6 (neiguan) point on the inside of the wrist
Results conflicting
Acupuncture wrist bands may be effective in preventing PONV or motion sickness

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8
Q

What are psychological therapies for N/V?

A

Hypnosis - may be effective for severe NVP

Psychotherapy - may be effective for hyperemesis gravidum

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9
Q

What are the types of phenothiazines?

A

Promethazine

Prochlorperazine

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10
Q

What is the MOA of promethazine?

A

D2 dopaminergic receptor blocker
Muscarinic-1 receptor blocker
Histamine-1 receptor blocker

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11
Q

What are the typical uses of promethazine?

A

General use

Acute vomiting of central origin (notion sickness, migraine)

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12
Q

What are ADRs of promethazine?

A

Sedation is common
May cause EPS
Injection site irritation (don’t use SQ)
-IV formulation should be diluted b/c of risk of tissue necrosis

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13
Q

What is the MOA of Compazine?

A

Mainly D2 dopaminergic receptor blocker

Some Muscarinic-1 and H-1 blockade

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14
Q

What are the typical uses of Compazine?

A

General use

Acute vomiting of central origin (motion sickness, migraine)

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15
Q

What are the ADRs of Compazine?

A

May cause EPS

Injection site irritation (don’t use SQ)

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16
Q

What are the serotonin antagonists?

A

Zofran
Granisetron (Kytril)
Palonosetron (Aloxi)
Dolasetron (Anzemet)

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17
Q

What is the MOA of serotonin antagonists?

A

5-HT3 receptor antagonist

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18
Q

What are the typical uses for serotonin antagonists?

A

General use

PONV, CINV, RINV, refractory nausea

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19
Q

What are the ADRs of Zofran and Dolasetron?

A

Contraindicated with apomorphine

Associated with QT prolongation; correct hypoMG and hypoK

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20
Q

What are the ADRs of granisetron?

A

Associated with QT prolongation

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21
Q

What are the ADRs of antihistamines

A

Risk of sedation and anticholinergic effects

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22
Q

What are the butyrophenones?

A

Haloperidol

Droperidol

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23
Q

What is the MOA of butyrophenones?

A

D2 dopaminergic receptor blocker

M1 receptor blocker

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24
Q

What is the typical use for butyrophenones?

A

PONV

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25
Q

What is the typical use for antihistamines?

A

Motion sickness

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26
Q

What are the ADRs of butyrophenones?

A

Risk of EPS
BBW for risk of QT prolongation and Torsades
Requirement for baseline ECG and 2-3 hr postdose cardiac monitoring

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27
Q

What are the NK1 antagonists?

A

Aprepitant (oral) & Fosaprepitant (Injection) (Emend)
Netupitant/palonsetron (Akynzeo)
Rolapitant (Varubi)

28
Q

What is the typical use of NK1 antagonists?

A

CINV

29
Q

What are the ADRs Emend?

A

Fatigue, hiccups
Reduces efficacy of warfarin and oral contraceptives
Dose-dependent inhibitor of CYP 3A4

30
Q

What are the ADRs of Akynzeo?

A

Avoid in severe renal or hepatic disease

31
Q

What is the antimuscarinic agent?

A

Scopolamine

32
Q

What are the typical uses of scopolamine?

A

Motion sickness

PONV

33
Q

What are cannabinoids?

A

Dronabinol (Marinol)

Nabilone (Cesamet)

34
Q

What are the cannabinoids MOA?

A

CB1 and CB2 receptor agonists (Antiemetic effect d/t CB1 agonist activity)

35
Q

What are the typical uses of cannabinoids?

A

CINV

Refractory vomiting

36
Q

What are the ADRs of cannabinoids?

A

May cause appetite stimulation, euphoria, cognitive impairment, hypotension, psychotropic reactions

37
Q

What is Metoclopramide’s MOA?

A

D2 receptor blocker

38
Q

What are the typical uses of metoclopramide?

A

Prokinetic agent used most often for gastroparesis

Also used for PONV, CINV, RINV

39
Q

What are the ADRs of Metoclopramide?

A

BBW for tardive dyskinesia (if used for more than one month)

Restlessness, anxiety, somnolence, EPS, QT prolongation

40
Q

What are the typical uses of phosphorylated carbohydrate solution?

A

Upset stomach that occurs with GI virus or food indiscretions

41
Q

What are the clinical pearls associated with phosphorylated carbohydrate solutions?

A

Avoid in diabetes and fructose intolerance

Safe in pregnancy

42
Q

What is MOA of erythromycin?

A

Motilin receptor agonist

43
Q

What are the typical uses of erythromycin?

A

Gastroparesis

44
Q

What are the ADRs of erythromycin?

A

GI upset
Diarrhea
N/V

45
Q

What are the typical uses of medrol and dexamethasone?

A

CINV
RINV
PONV

46
Q

What are the ADRs of medrol and dexamethasone?

A

GI upset
Anxiety
Insomnia

47
Q

What is the MOA of lorazepam?

A

GABA agonist

48
Q

What are the typical uses of lorazepam?

A

Anticipatory

N/V

49
Q

What are the ADR of lorazepam?

A

Sedation

Amnesia

50
Q

What are the typical uses of antacids/H2RAs?

A

Nausea associated with gastric acid

51
Q

What is the MOA of doxylamine/pyridoxine (Diclegis)

A

H1 receptor blocker

52
Q

What is the MOA of Sea-Bands?

A

Stimulates the pericardium (P6) point

53
Q

What are the typical uses of Sea-Bands?

A

All types of nausea

54
Q

What are the common diseases associated with gastroparesis?

A

Diabetes

Hypothyroidism

55
Q

What is the 1st step in treatment of gastroparesis?

A

Diagnosis: 4H gastric emptyping by scintigraphy

56
Q

What is the 2nd step in treatment of gastroparesis?

A

Exclude iatrogenic disease:
Dietary: low fat, low fiber diet
Glycemic control among diabetics

57
Q

What is the 3rd step in treatment of gastroparesis?

A

Pharmacological Rx:
Prokinetics: metoclopramide, erythromycin, demperidone
Antiemetics: antihistamines, 5-HT3 receptor antagnoists

58
Q

What is the 4th step in treatment of gastroparesis?

A

Nutritional support: Enteral formula

59
Q

What is the 5th step of treatment of gastroparesis?

A 
Non-pharmacological rx:
Pyloric injection of botulinum toxin
Venting gastrostomy, feeding jejunostomy
Parenteral nutrion
Gastric eletrical stimulation
Pyloroplasty
Partial gastrectomy
60
Q

What will decrease the occurence of NVP if taken at the time of conception?

A

vitamins

61
Q

What are the non-pharmacologic therapies for NVP?

A

Rest
Avoidance of provoking stimuli
Frequent and small meals, avoiding spicy or fatty foods
Powdered ginger capsules 250mh qid

62
Q

What are the pharmacologic therapies for NVP?

A 
Multivitamins at time of conception
Diclegis
Phenothiazines (in refractory cases)
Corticosteroids (last resort therapy in hyperemesis gravidum)
IV hydration
Enteral nutrion/TPN
Zofran (preg cat B)
63
Q

Who receives prophylaxis for PONV?

A

Only necessary with patients at moderate to high risk for PONV

64
Q

What are risk factors for PONV?

A 
Female
Non-smoker
h/o motion sickness
h/o PONV
Volatile anesthetics
NO
Opioids
65
Q

What is the treatment for PONV if no prophylaxis was given?

A

any agent is useful

66
Q

What is the treatment for PONV if prophylaxis was given?

A 
If < 6 hours post-op: select therapy from a different drug class
If > 6 hours post-op: any agent is acceptable except dexamethasone or scopolamine

GI/Hepatic (7 decks)

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