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RB Y1 GI > pharmacology of nausea and vomiting > Flashcards

pharmacology of nausea and vomiting Flashcards

1
Q

how is vomiting induced

A

toxic materials and toxins stimulate enterochromaffin cells in the mucosa which release mediators eg serotonin.
there is depolarisation of sensory afferent terminals in the mucosa and AP discharge in vagal afferents to brainstem

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2
Q

what are the sphincters like during vomiting

A

relaxed

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3
Q

name 3 prodromal signs

A

skin - pallor and cold sweat
heart - inc rate and force
salivary glands - inc secretion

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4
Q

what effect does vomiting have on K

A

hypokalaemia

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5
Q

how do dopamine antagonists work

A

block the CTZ

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6
Q

what are dopamine antagonists used for

A

associated radiation sickness, drug induced emesis and neoplastic disease

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7
Q

how are dopamine antagonists available

A

rectal suppositories and buccal

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8
Q

name 2 prokinetic drugs

A

metoclopramide and domperidone

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9
Q

what is metoclopramide also used in

A

migraine - inc the absorption of other drugs

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10
Q

what does domperidone not cross

A

the BBB

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11
Q

what are 5HT3 antagonists used in

A

CINV, radiation induced and PONV

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12
Q

what is a side effect of 5HT3 antagonists

A

headache

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13
Q

what are H1 antihistamines used in

A

motion sickness, morning sickness and PONV

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14
Q

what is cinnarzine also used for

A

additional antivertigo action inhibiting calcium influx & suppressing labyrinthine reflexes, thus helping in tinnitus and Ménière’s disease.

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15
Q

anticholingerics

A

hyoscine and dicyclomine

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16
Q

how can anticholingerics be used

A

transdermal patch, oral, IM

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17
Q

what are the side effects of anticholingerics

A

blurred vision, urinary retention, dry mouth and sedation

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18
Q

what are anticholingerics used in

A

motion sickness

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19
Q

what is the triple drug regime used in CINV

A

5HT3 receptor antagonist and dexamethasone and aprepitant

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20
Q

what is dexamethasone

A

corticosteroid

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21
Q

acute CINV

A

pretreatment with dexamethasone, lorazepam and triple regime

22
Q

delayed CINV

A

triple regime and metoclopramide

23
Q

anticipatory CINV

A

lorazepam

24
Q

what are some non pharmacological treatment s for pregnancy associated nausea and vomiting

A 
changes in diet 
ginger or pyridoxine 
wrist acupressure (P6)
25
Q

what is Hyperemesis gravidarum

A

fluid and electrolyte disturbances or nutritional deficiency that develops from intractable vomiting in pregnancy.

26
Q

first line for Hyperemesis gravidarum

A

antihistamine - promethazine or cyclizine

27
Q

second line for Hyperemesis gravidarum

A

prochlorperazine and metoclopramide.

28
Q

what is the gastroileal reflex stimulated by

A

gastric distension

29
Q

what does the gastroileal reflex involve

A

opening of the ileocaecal valve

30
Q

what does teh large intestine secrete

A

K, HCO3 and mucus

31
Q

what is haustration

A

Non propulsive segementation caused by contraction of the circular muscle

32
Q

what does haustration allo

A

time for fluid and electrolyte reabsorption

33
Q

what is the role of the colonic flora

A

promote motility and help maintain mucosal integrity
synthesise vitamin K2 and free fatty acids (from carbohydrate) that are absorbed
activate some drugs

34
Q

what is Sulfasalazine

A

5-ASA linked to sulfapyridine by an azo bond

35
Q

how does Sulfasalazine work

A

reduces inflammation by inhibiting COX and LOX

36
Q

Sulfasalazine AE

A

include rashes, arthralgias, blood dyscrasias

37
Q

what are Sulfasalazine AE due to

A

absorbed sulfapyridine

38
Q

what is advised durin the use of Sulfasalazine

A

folic acid

39
Q

what is better tolerated than Sulfasalazine

A

mesalazine

40
Q

what is balsalazide

A

a prodrug

41
Q

how do IS work

A

inhibit T lymphocyte function

42
Q

what is the AE of ciclosprin

A

renal toxicity

43
Q

what is 6-Mercaptopurine

A

a metabolite of azathioprine

44
Q

what is 6-Mercaptopurine

used for

A

maintenance of remission of IBD

45
Q

what is given in IBS

A

antispasmodic
laxative
antimotility
antidepressant

46
Q

what is the first line antimotility in IBS

A

loperamide

47
Q

what laxative would you not give in IBS

A

lactulose

48
Q

what is the value of antispasmodics in IBS

A

relieve cramps

49
Q

what are some direct SM relaxants

A

Alverine, mebeverine, peppermint oil

50
Q

what is the effect of antidepressants in IBS

A

prevent afferents from GIT/reduce pain perceptions

51
Q

name some selective serotonin uptake inhibitors

A

Citalopram, Fluoxetine, Paroxetine

52
Q

what is diarrhoea defined as

A

loss of fluid and solutes from the GI tract > 500ml per day

RB Y1 GI (54 decks)

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