Palliative Care Nausea and Vomiting Flashcards
What triggers the cerebral cortex to go to the vomiting centre?
emotions sight smell raised ICP anxiety
What receptors are in the cerebral cortex?
GABA
NK1
5HT
What drugs target the cerebral cortex?
dexamethasone
aprepitant
benzodiazepines
What triggers the chemoreceptor trigger zone to go to the vomiting centre?
metabolic (ureamia, Ca)
drugs
What receptors are in the chemoreceptor trigger zone?
D2
5HT
Ach
What drugs target the chemoreceptor trigger zone?
Haloperidol
Levomepromazine
Ondansetron
What triggers the vestibular centre to go to the vomiting centre?
motion
What receptors are at the vestiublar centre?
Ach
H1
What drugs target teh vestibular centre?
cyclizine
levomeromazine
Hyoscine
What triggers the GI tract to go to the vomiting centre?
abdo distention stasis tumour mass constipation radiotherapy
What receptors are on the GI tract?
5HT
D2
Ach
What drugs target the GI tract?
Metoclopramide
Levomeromazine
Ondansetron
Dexamethasone
What causes malignant bowel obstruction?
compression
adynamic ileus
tumour infiltration of mesentery, muscle or nerves
What are the two types of malignant bowel obstruction?
complete or partial
What is the pathophysiology of malignant bowel obstruction?
acculumation of secretions -> distention of the gut -> further secretions causing:
reduced absorption of water and sodium
inflammatory response leading to gut wall oedema
increased motor activtiy - colicky pain
increased intra luminal pressure - hypoxia, gangrene and perforation
