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Nausea/Vomiting Flashcards

1
Q

What are the high emetic risk chemotherapy regimens?

A
  1. doxorubicin or epirubicin + cyclophosphamide
  2. carmustine
  3. cisplatin (>50 mg/m2)
  4. cyclophosphamide (≥ 1,500 mg/m2)
  5. dacarbazine
  6. ifosfamide (>10 g/m2)
  7. mechlorethamine
  8. streptozotocin
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2
Q

Does acute vomiting require treatment?

A

Not always

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3
Q

Match the symptom with the diagnosis: hematemesis

A

Upper GI tract bleed

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4
Q

Match the symptom with the diagnosis: fever

A

Gastroenteritis, appendicitis, PID, UTI, meningitis

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5
Q

Match the symptom with the diagnosis: constipation

A

Appendicitis, intestinal obstruction

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6
Q

Match the symptom with the diagnosis: diarrhea

A

Gastroenteritis

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7
Q

Match the symptom with the diagnosis: dysuria/vaginal discharge

A

UTI, PID

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8
Q

Match the symptom with the diagnosis: amenorrhea

A

Pregnancy

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9
Q

Match the symptom with the diagnosis: headache

A

Migraine, meningitis, stroke, head trauma

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10
Q

Match the symptom with the diagnosis: abdominal pain

A

Cholecystitis, PID, gastroenteritis, appendicitis, pancreatitis, intestinal obstruction

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11
Q

Match the symptom with the diagnosis: chest pain

A

myocardial infarction

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12
Q

What meal habits are beneficial in N/V patients?

A
  1. frequent small meals
  2. avoid spicy or fatty foods
  3. high protein snacks
  4. BRAT diet
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13
Q

Dose of peppermint oil in dyspepsia and motion sickness

A

weak evidence of one tablet (0.2 mL) 2-3 times per day

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14
Q

Use of ginger in motion sickness and pregnancy induced N/V

A

weak evidence of 250 mg po TID with food or 1-4 g/day in divided doses of powder/tablet/capsules

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15
Q

Describe physical treatment option for N/V

A

acupuncture/acupressure on the p6 (Neiguan) point on the inside of the wrist

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16
Q

What is hyperemesis gravidarum?

A

Severe N/V in pregnancy

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17
Q

What psychological treatment may be effective for hyperemesis gravidarum?

A

psychotherapy

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18
Q

What are the factors to consider when choosing a pharmacologic agent for N/V

A
  1. Suspected etiology
  2. Frequency, duration, severity of symptoms
  3. Route of medication tolerated
  4. What has worked in past
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19
Q

What are the major drug classes for N/V

A
  1. Phenothiazines
  2. Serotonin antagonists
  3. Antihistamines
  4. Butyrophenones
  5. NK1 antagonists
  6. Antimuscarinic agent
  7. Cannabinoids
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20
Q

What are the three phenothiazines?

A
  1. promethazine (phenergan)
  2. prochlorperazine (compazine)
  3. chlorpromazine (thorazine)
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21
Q

What is the MOA of phenothiazines?

A

block D2 dopaminergic receptors in the brain and chemotrigger zone (CTZ blockade)

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22
Q

What can phenothiazines be used for?

A

acute vomiting of central origin (motion sickness, migraine)

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23
Q

What are the major side effects of phenothiazines?

A

sedation and extrapyramidal symptoms

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24
Q

By what route of administration can you NOT give phenothiazines?

A

subQ because of injection site reactions

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25
What phenothiazine causes the most drowsiness?
promethazine (phenergan)
26
Why are prochlorperazine and chlorpromazine less drowsy?
They are predominantly antidopaminergic
27
What are the four serotonin antagonists?
1. ondansetron (Zofran) 2. granisetron (Kytril) 3. palonosetron (Aloxi) 4. dolasetron (Anzemet)
28
What is the MOA of serotonin antagonists?
block 5-HT3 serotonin receptors in the gut wall
29
What drug is contraindicated with the serotonin antagonists?
apomorphine
30
Which serotonin antagonists can cause QTC prolongation?
ondansetron, granisetron, and dolasetron
31
With which two serotonin antagonists do you have to correct hypomagnesemia and hypokalemia?
ondansetron and dolasetron
32
Which serotonin antagonists typically only require one dose?
palonosetron and dolasetron
33
What types of N/V are serotonin antagonists used for?
PONV, CINV, RINV, and refractory N/V
34
What are the Antihistamines used for N/V?
1. dimenhydrinate (dramamine) 2. meclizine (bonine) 3. doxylamine (unisom) 4. diphenhydramine (benadryl)
35
What is the MOA of antihistamines in N/V?
blocks H-1 and M-1 receptors in the vomiting center and vestibular system
36
What are the antihistamine used for?
Vertigo and motion sickness
37
What are the major side effects of antihistamines?
sedation and anticholinergic effects
38
When should antihistamines be taken?
30-60 minutes before travel or motion activity
39
What are the two butyrophenones?
haloperidol (haldol) and droperidol (inapsine)
40
What are butyrophenones used for?
PONV and palliative care
41
What is the black box warning on butyrophenones?
QTC prolongation and torsades
42
What is the major risk with butyrophenones?
EPS
43
When should ECGs be obtained with butyrophenones?
baseline and 2-3 hours post dose
44
What are the four NK1 antagonists?
1. aprepitant 2. fosaprepitant 3. netupitant/palonsetron 4. rolapitant
45
What is the MOA of NK1 antagonists?
inhibits substance P/NK-1 receptor
46
What are the NK1 antagonists used for?
CINV
47
What are the common side effects of aprepitant?
fatigue and hiccups
48
When should netupitant/palonsetron be avoided?
In pt with severe renal or hepatic disease
49
What are the drug interactions associated with aprepitant and fosaprepitant?
dose-dependent inhibitor of CYP3A4. Reduces efficacy of warfarin and oral contraceptives
50
How long is the half life of rolapitant?
7 days
51
What is the one antimuscarinic agent?
scopolamine (patch)
52
What are the indications for antimuscarinic agents?
motion sickness and PONV
53
What is the MOA of muscarinic agents?
blocks M-1 receptors in the VC and the vestibular system
54
What are the directions for scopolamine for PONV?
place patch the evening prior to surgery or 1 hour prior to C-section
55
What are the directions for scopolamine for motion sickness?
place patch 4 hours prior to activity
56
What happens if a scopolamine patch dislodges during treatment time?
remove patch and place another at a different postauricular site
57
What are the two cannabinoids?
dronabinol (marinol) and nabilone (cesamet)
58
What is the MOA of the cannabinoids?
CB1 and CB2 receptor antagonists
59
Which receptor causes the antiemetic effect of cannabinoids?
CB1
60
What are cannabinoids used for?
CINV and refractory vomiting
61
What are the major ADRs of cannabinoids?
appetite stimulation, euphoria, cognitive impairment, somnolence, and psychotropic reactions
62
What is the MOA of metoclopramide (reglan)?
D2 dopaminergic receptor blocker
63
What is metoclopramide most used for?
gastroparesis
64
What is the black box warning on metoclopramide?
tardive dyskinesia
65
What are the main ADRs associated with metoclopramide?
restlessness, anxiety, somnolence, EPS, and QTC prolongation
66
What is the MOA of emetrol?
unknown, helps reduce muscle contractions
67
What is emetrol used for?
upset stomach secondary to GI virus or food indiscretions
68
What patient population should NOT use emetrol?
diabetics due to fructose and dextrose
69
What are the instructions on emetrol?
15-30 mL q15 minutes no more than 5 doses
70
What is the MOA of erythromycin?
motilin receptor agonist
71
What is erythromycin used for?
gastroparesis
72
What are the ADRs associated with erythromycin?
GI upset, diarrhea, and N/V
73
What is methylprednisolone and dexamethasone used for?
CINV (prophylaxis) + another antiemetic
74
What are the ADRs of methylprednisolone and dexamethasone?
GI upset, anxiety, and insomnia
75
What is the MOA of lorazepam?
GABA agonist
76
What is lorazepam used for?
anxiety induced N/V
77
What are the major ADRs of lorazepam?
sedation and amnesia
78
What is the MOA of antacids/H2RAs?
reduce gastric acid to neutralize stomach
79
What are antacids/H2RAs used for
N/V associated with GERD
80
What is the MOA of doxylamine/pyridoxine (diclegis)?
H-1 receptor blocker
81
What is doxylamine/pyridoxine used for?
PINV
82
What is the treatment for hyperemesis gravidarum?
non-pharm first then pyridoxine w/wo doxylamine. IV hydration and nutrition
83
What is the gold standard for CINV?
ondansetron
84
What are the risk factors for CINV?
1. age < 50 2. female 3. nonsmoker 4. hx of PONV or motion sickness 5. anesthesia 6. nitrous oxide 7. opioids
85
How many prophylactic antiemetics should a high risk person receive?
2 or more

GI/Hepatic (4 decks)

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