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PRE-REG-Thuri > NERVOUS SYSTEM- NAUSEA + VOMITING > Flashcards

NERVOUS SYSTEM- NAUSEA + VOMITING Flashcards

1
Q

What is nausea?

A

Sensation before vomiting.

Vomiting is ejecting stomach contents

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2
Q

What 5 drugs classes target the chemoreceptor trigger zone to prevent vomiting?

A

Dopamine receptor antagonists e.g. antipsychotics

5HT3 antagonists

Neurokinin-receptors antagonists

Antimuscarinic

Antihistamine

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3
Q

What 2 drug classes target the GI tract to help with nausea/vomiting ?

A

Dopamine receptor antagonist - Prokinetic (e.g. Metoclopromide, domperidone).

5HT3 antagonist

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4
Q

List 2 Dopamine receptor antagonist - pro-kinetic drugs?

A

Metoclopromide

Domperidone

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5
Q

What 2 disorders affect the vestibular system?

A

Motion sickness

Labyrinth Disorder- vertigo

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6
Q

What 2 drug classes are used to target conditions affecting the vestibular system?

A

Antihistamines + antimuscarinics

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7
Q

What 2 drug classes are used to target conditions affecting the higher cortical centre?

A

Benzos + cannabinoid

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8
Q

What are the 5 drug classes of antiemetics?

A
  1. Dopamine receptor antagonists
    2- 1st generation antipsychotics
    3- Antihistamines
    4- Antimuscarinic
    5 5HT3 antagonists
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9
Q

List 2 common dopamine receptor antagonists which are used as anti-emetics?

A

Domperidone

Metoclopramine

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10
Q

What is another indication of domperidone?

A

PD treatment

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11
Q

List 3 antihistamines which are used as antiemetics?

A

Cinnarizine
Cyclizine
promethazine - sedating

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12
Q

What 2 conditions are antihistamines used for as anti-emetics?

A

Vertigo

Motion sickness

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13
Q

List 1 sedating antihistamine?

A

Promethazine

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14
Q

List 7 1st generation antipsychotics which are used as antiemetics?

A

Chlorpromazine

Perhenazine

Trifluoperazine

Prochlorperazine

Levomepromazine

Droperidol

Haloperidol

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15
Q

What 2 1st generation antipsychotics are used in palliative care in anti-emesis?

A

Haloperidol

Levomepromazine

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16
Q

What 1st generation antipsychotics is given buccally for migraine?

A

Prochlorperazine

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17
Q

List 1 ANTIMUSCARINIC drug which are used as antiemetic for motion sickness?

A

Hyoscine hydrobromide (most effective - in motion sickness)

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18
Q

List 3 5ht3 receptor antagonists?

A

Palonosetron

Ondansetron

Granistetron

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19
Q

What corticosteroid drug is used for Nausea + vomiting?

A

Dexamethasone

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20
Q

What cannabinoid drug is used for Nausea + vomiting?

A

Nabilone

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21
Q

What 3 neurokinin- receptor antagonist is used for N + V?

A

Aprepitant, Fosaprepitant, rolapitant

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22
Q

What 6 drugs can be used for vomiting during pregnancy?

A

Prochlorperazine, chlorpromazine , Metoclopramide, cyclizine, promethazine (if needed), ondansetron

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23
Q

What to do if vomiting in pregnancy lasts MORE than 24 hrs after drug tx?

A

Switch to different class

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24
Q

What to do if vomiting in pregnancy lasts MORE than 48 hrs?

A

Specialist opinion

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25
Who are high risk patients with post-operative N + V? (6)
Female Non smoker History of vomiting Motion sickness Surgery type + duration Opioids , anaesthetic
26
What is 1st line treatment for Post operative N+ V?
Antiemetic combo therapy e.g. ondansetron, dexamethasone, haloperidol.
27
What antiemetic is given for pre-op anticipatory vomiting?
Lorazepam
28
List 5 examples of Antiemetic combo therapy for Post operative N+ V?
Dexamethasone 5HT3 antagonists Domperidone Cyclizine Droperidol, haloperidol
29
What is MOA of metoclopramide?
Blocks D2 receptors in chemoreceptor trigger zone Acts directly on GI tract- prokinetic
30
What is indication of metoclopramide?
Nausea + Vomiting Prevention in Post op, chemo, radiography.
31
What is metoclopramide dose for N + V?
10 mg TDS for 5 days (max 500mcg per kg)
32
what is maximum metoclopramide dose for nausea + vomiting?
500mcg per kg
33
What is minimum age in metoclopramide?
only 18+ used 2nd line in children if NEED to
34
What is max days you can use metoclopramide?
5 days
35
What is SE of metoclopramide?
Acute dystonic reactions e.g. oculogyric crisis
36
In what condition if metoclopramide restricted in? (MHRA warning)
risk of neurological adverse effects e.g. EPS
37
What drugs do metoclopramide interact with to increase EPS?
antipsychotics
38
What drug classes can metoclopramide interact with to cause PD?
Dopaminergic drugs
39
What is MOA of domperidone?
Blocks D2/D3 receptors in chemoreceptor trigger zone Acts directly on GI tract
40
What is indication of domperidone?
N + V relief Also used in PD
41
Why is domperidone good in PD + N+V?
does not cross BBB
42
What is dose for domperidone in N +V?
10mg TDS for 1 week
43
What is minimum age use of domperidone?
12 plus - if weight over 35kg
44
What is max duration of usage of domperidone?
7 days
45
What is weight limit to allow use of domperidone?
>35kg
46
What is MHRA warning regarding domperidone efficact?
Lack of efficacy in certain populations e.g. children under 12 years or anyone under 35kg
47
What is SE of domperidone?
Increase QT prolongation
48
What are CI of using domperidone?
Impaired cardiac function, CD, avoid in hepatic impairment
49
What is counselling point for Domperidone use if cardiac related SEs?
Report arrhythmia signs
50
What drugs can interact with Domperidone to cause QT prolongation?
antipsychotics, TCAs, SSRIs, Macrolides, Lithium , methadone, 5HT3 antagonists Amiodarone, Azole antifungal, Rate limiting CCBs
51
MOA of 5HT3 ANTAGONISTS?
Blocks 5ht3 receptors in chemoreceptor trigger zone + GI tract
52
What is indication of 5HT3 ANTAGONISTS?
For post op chemo induced N + V
53
What is SE of 5HT3 ANTAGONISTS?
QT prolongation
54
Can 5HT3 ANTAGONISTS be used in pregnancy?
NO- teratogenic
55
What is the risk of using Ondansetron in pregnanacy?
Oral clefts - if use in 1st trimester
56
What drugs interact with 5ht3 antagonists to cause QT prolongation?
Antipsychotics, anti-arrythmias, TCAs, SSRIs, macrolides, domperidone, lithium, methadone. quinolone, ondansetron
57
What drugs interact with 5ht3 antagonists to increase serotonin syndrome?
Anti-depressants, Amfetamine, Lithium, MAO-B inhibitor, methdone, st John's wort, tramadol, sumatriptan
58
What is a contraindication of metoclopramide?
Not to be used in parkinsons
59
What is a recent MHRA warning for hyoscine hydrobromide patches?
risk of anticholinergic side effects more so in unlicensed use.
60
What are the life threatening anticholinergic side effects of using hyoscine patches?
hyperthermia, urinary retention, delirium, hallucinations, seizures, respiratory paralysis, and coma
61
How is hyperemesis gravidarum treated?
regular antiemetic therapy, intravenous fluid +electrolyte replacement.
62
What supplement must be given in hyperemesis gravidarum to reduce risk of Wernicke's encephalopathy?
Thiamine
63
What is licensed for prevention + treatment of post-op N+V caused by opioids?
Cyclizine
64
What 4 anti emetics are NOT effective in motion sickness?
Domperidone, metoclopramide hydrochloride, 5HT3-receptor antagonists, and the phenothiazines
65
Which antihistamine phenothiazine works for motion sickness?
Promethazine

PRE-REG-Thuri (44 decks)

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