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GI > Pharmacology of Nausea and Vomiting > Flashcards

Pharmacology of Nausea and Vomiting Flashcards

1
Q

Vomiting/nausea may be caused by?

A

Anxiety
Motion sickness
Pregnancy
Side effects of drugs

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2
Q

What is nausea?

A

Unpleasant urge to vomit

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3
Q

What is vomiting and it’s medical name?

A

Emesis
Forceful expulsion of stomach contents
Defence mechanism triggered by emetic centre in brain stem

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4
Q

Retching?

A

Repetitive reverse peristalsis

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5
Q

What is regurgutation?

A

Effortless movement of food contents

Stomach acid coming back into the mouth

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6
Q

Pathway of vomiting?

A

Systemic toxins in gut lumen
>
Enterochromaffin cells in mucosa release mediators like 5HT
>
Depolarisation of sensory afferent terminals in mucosa (5HT3 receptors)
>
AP discharge in vagal afferents to brainstem
>
Coordination of vomiting by vomiting centre

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7
Q

What is the vomiting centre?

A

Group of interconnected neurones within medulla

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8
Q

What are the events of vomiting?

A
  • Sphincters are relaxed
  • Retrograde contractions from ileum to stomach take place
  • Preceeded by salivation, sweating, elevated HR and aspiration
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9
Q

Where is the CTZ and what is it?

A

Chemoreceptor trigger zone

located next to vomiting centre (medulla) - opposite side of brain barrier from VC

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10
Q

What is the chemoreceptor trigger zone triggered by?

A

Cancer chemotherapy opiods+ chemo & radiotherapy gastroenteritis

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11
Q

What acts on the CTZ?

A

DA antagonists

5HT3 antagonist

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12
Q

What is the VC?

A

Vomiting centre

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13
Q

What is the VN?

A

Vestibular nuclei

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14
Q

What does VN do?

A

Acts on VC in motion sickness

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15
Q

What drugs act on the VN?

A

H1 antagonist

Anti-muscarinic drugs

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16
Q

Examples of anti-emetics?

A 
Antihistamines 
5HT3 receptor antagonists
Dopamine Receptor Antagonists 
Neurokinin- 1 Receptor Antagonists 
Metoclopramide
17
Q

Examples of anti-histamines?

A

Antagonists at histamine H1 receptors in brain (blocks H1 receptors in VN)

18
Q

What are antihistamiines useful for?

A

Motion sickness

19
Q

Side effects of antihistamines?

20
Q

What do antimuscarinics do?

A

Act as antagonists at muscarinic ACh M1 receptors in brain ( block muscarinic receptors in VN and VC)

21
Q

What are antimuscarinics used for?

A

Motion sickness

22
Q

Examples of anti-muscarinic drugs?

A

Scopolamine (hyoscine)

23
Q

Side effects of anti-muscarinic drugs?

A

Dry mouth
Tachycardia
Constipation

24
Q

Examples of 5HT3 receptor antagonists?

A

Granisetron
Ondansetron
Palonosetron

25
Q

What do 5HT3 receptor antagonists do?

A

Block 5HT3 receptors in the GIT and CNS

26
Q

What are 5HT3 receptor antagonists used for?

A

Good for chemo induced nausea & vomiting
Radiation induced emesis
Post-operative nausea/vomiting

27
Q

Side effects of 5HT3 receptor antagonists?

A

Constipation
Diarrhoea
Headache

28
Q

Examples of dopamine Receptor antagonists? (DA)

A 
Prochloroperazine 
Droperidol 
Haloperidol 
Trifluoperazine 
Chloropromazine 
Metoclopramide
29
Q

What do Dopamine receptor antagonists do?

A

Block D2 receptors in the CTN of he medulla and D2 receptors in the GIT

30
Q

What are Dopamine receptor antagonists used for?

A

Nausea & vomiting associated with neoplastic disease
Radiation sickness
Drug-induced emesis

31
Q

Side effects of Dopamine receptor antagonists?

A

Diarrhoea

Extrapyramidal side effects

32
Q

Examples of Neurokinin 1 receptor Antagonists?

A

Fosaprepitant

Aprepitant

33
Q

How do Neurokinin 1 receptor antagonists work?

A

Block NK1 receptors in GI tract and the CTZ of medulla in hindbrain- blocking side effects of substance P (which evokes vomiting)

34
Q

Side effects of Neurokinin receptor antagonists?

A

Constipation

Headache

35
Q

Examples of anti-diarrhoeal drugs?

A

Loperamide

Diphenoxylate

36
Q

What are anti-diarrhoeal drugs?

A

Electrolyte replacements

37
Q

Side effects of anti-diarrhoeal drugs?

A

Constipation
Sedation
Respiratory depression

GI (15 decks)

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