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Pharm Y3S2 > Nausea & Vomiting > Flashcards

Nausea & Vomiting Flashcards

1
Q

Define emesis.

A

The process of vomiting

  • Nausea
  • Retching
  • Vomiting
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2
Q

Briefly describe the pathophysiology of N+V.

A

Stimulus triggers response in vestibular centre, GI tract or chemoreceptor trigger zone
Vagal afferents activates CTZ
CTZ then activates the vomiting centre
Vomiting centre triggers response in GI tract

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3
Q

Give examples of causes of N+V.

A 
Pregnancy
Abdominal conditions
Raised glucose, bilirubin, calcium
Inner ear disorder
Malignancy
Pain
Psychogenic
Drugs
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4
Q

Where is the vomiting centre found?

A

Lower medulla of the brain

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5
Q

Name the neurotransmitters involved in N+V at the vestibular centre.

A

Histamine

ACh

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6
Q

Name the neurotransmitters involved in N+V at the CTZ.

A

Serotonin
Dopamine
Substance P

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7
Q

Name the neurotransmitters involved in N+V at the vomiting centre.

A

Histamine
ACh
Substance P
Serotonin

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8
Q

Name the neurotransmitters involved in N+V at the GI tract.

A 
Histamine
ACh
Substance P
Dopamine 
Serotonin
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9
Q

Name the neurotransmitters involved in N+V at the vagus nerve.

A

ACh
Dopamine
Serotonin

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10
Q

Name the neurotransmitter involved in N+V at the higher cortical centres.

A

Histamine

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11
Q

Describe the action of antihistamines in N+V.

A

Primarily inhibit histamine in vestibular centre and GIT so do not stimulate CTZ

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12
Q

When are antihistamines useful in N+V.

A

Motion sickness

Irritants in the stomach

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13
Q

What are the cautions of cinnarizine?

A

Epilepsy
Parkinson’s
Glaucoma

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14
Q

What are the uses of cinnarizine?

A

Motion sickness

Vestibular disorders

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15
Q

What are the uses of promethazine?

A

Motion sickness
Vestibular disorders
Last line in morning sickness

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16
Q

What are the cautions of promethazine?

A

Epilepsy

Glaucoma

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17
Q

Describe the action of anticholinergics in N+V.

A

Inhibit ACh primarly present in vestibular centre and GI tract so do not stimulate CTZ

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18
Q

What are the uses of hyoscine?

A

Motion sickness

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19
Q

What are the cautions of hyoscine?

A

Cardiac conditions including MI

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20
Q

What are the contraindications of hyoscine?

A

Bowel obstruction

UC

21
Q

What are the uses of cyclizine?

A

For N+V with known cause

22
Q

What are the cautions of cyclizine?

A

Epilepsy

Glaucoma

23
Q

Describe the action of 5-HT3 antagonists in N+V.

A

Inhibit serotonin in CTZ and GI tract

24
Q

Give examples of 5-HT3 antagonists.

A

Ondansetron
Palonosetron
Granisetron

25
Q

What are the uses of 5-HT3 antagonists?

A

Chemotherapy, post-op and radiotherapy N+V

26
Q

How should ondansetron be given in patients over 65?

A

Via infusion lasting over 15 minutes

27
Q

What is the major side effect of ondansetron?

A

QT prolongation

28
Q

Describe the action of D2 antagonists in N+V.

A

Inhibit dopamine in CTZ

29
Q

Give examples of D2 antagonists.

A

Metoclopramide
Domperidone
Haloperidol

30
Q

Describe the use of metoclopramide in N+V,

A

Given orally or IV
Stimulates gut motility
Can cause EPSEs as crosses BBB

31
Q

What are the contraindications of metoclopramide?

A

Parkinson’s

32
Q

What is the MHRA alert for domperidone?

A

Cardiac toxicity risk

33
Q

When is haloperidol used in N+V?

A

Unresponsive/treatment resistant

34
Q

What is the major side effect of haloperidol?

A

QT prolongation

35
Q

Describe the action of NK1 antagonists in N+V.

A

Inhibit substance P in CTZ

36
Q

What is the main benefit of NK1 antagonists?

A

Show efficacy up to 120 hours after single dose

37
Q

Give examples of NK1 antagonists.

A

Aprepitant
Fosapreitant
Netupitant
Rolapitant

38
Q

What is nabilone?

A

Cannabinoid that acts on CTZ via opioid receptors used last line in N+V

39
Q

Describe the use of steroids in N+V. Give an example.

A

Dexamethasone

Used at supra physiological doses

40
Q

Describe the use of levomepromazine.

A

Useful in N+V due to wide action however unlicensed

Used in special cases

41
Q

Name 5 drugs that can be used for N+V in pregnancy.

A 
Metoclopramide
Prochlorperazine
Cyclizine
Promethazine
Ondansetron- hyperemesis gravidarum
42
Q

What are the 4 main risk factors for post-op N+V?

A

Female
Non-smoker
Previous history of PONV
Peri-op opioid analgesia

43
Q

What are the 5 types of chemotherapy induced N+V?

A 
Acute
Delayed
Breakthrough
Refractory
Anticipatory
44
Q

What are the risk factors for chemotherapy induced N+V?

A 
Female
Age <30
Pre-exisiting N+V
Poor control with prior treatment
History of N+V
Anxiety
45
Q

What are the protective factors for chemotherapy induced N+V?

A

History of high alcohol intake
Substance misuse
Smoking

46
Q

What is given for anticipatory CINV?

A

Lorazepam

47
Q

What is commonly given pre-chemo when there is a high risk of N+V?

A

5-HT3 antagonist
Dexomethasone
NK1 antagonist

48
Q

What two anti-emetics are used most commonly in a syringe driver?

A

Cyclizine

Levomepromazine is less irritant and more sedating

49
Q

What anti-emetics may be used in migraine?

A

Phenothiazine and antihistamine antiemetics
Buccal prochlorperazine can be bought over the counter
Metoclopramide/domperidone cautioned due to side effects

Pharm Y3S2 (29 decks)

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