Test 3 Nausea / Vomiting Flashcards
What are the different types of nausea?
- pregnancy
- motion sickness
- food induced
- medication induced
- acute infections
etiologies of N/V
- Pregnancy
- Motion sickness
- Overeating or disagreeable foods
- Food poisoning
- Medication induced
- Medical disorder induced
- Psychogenic-induced
Treatment Exclusions to Self Care (adults)
• Urine ketones and/or high blood glucose with signs of dehydration
• Severe / prolonged food poisoning >12 hours
• Severe abdominal pain (RMQ, RLQ or RUQ)
• Hematemesis (frank blood or ‘coffee ground’)
• Jaundice
• Stiff neck
• Head injury with nausea, vomiting, blurry vision
• OTC Contraindication
– Glaucoma, benign prostatic hyperplasia, chronic bronchitis, emphysema, asthma
• Pregnancy or breast feeding
• Refractory to self-care (>24-48 hours of self-care)
Treatment Exclusions to Self Care (children)
- Age less than 1 year
- Signs of dehydration
- Stiff neck
- Vomiting with each feeding
- Following head injury
- Repeated projectile vomiting and/or prolonged vomiting (> 8 hours)
- Vomitus contains red, black, or green fluid
- Diarrhea, distended abdomen, fever, severe headache
- Suspected poisoning
- Recurrent, severe, acute abdominal pain
Non-Pharmacological Treatment in Pregnancy-Induced (PINV)
- Eat 4-5 small meals per day
* Avoid greasy, spicy, or acidic foods
Non-Pharmacological Treatment in Motion Sickness
- Get air
- Sit where there is less motion
- Avoid alcohol/strong odors/tobacco smoke
Non-Pharmacological Treatment for Dyspepsia
- Avoid overeating and disagreeable foods
- Avoid precipitating substances ex. NSAIDs
- Stress reduction
- Weight loss
Non-Pharmacological Treatment for Food Poisoning
- Eliminate contaminated food
* Initiate bland diet
Non-pharmacological Treatment of Medication-Induced N/V
- Take medication with food if appropriate
* Change time of administration if appropriate
Antacids
- Magnesium hydroxide, sodium salts, aluminum hydroxide, calcium or magnesium carbonate
- mainly for food induced N/V
- Neutralize gastric acidity
- take with food
Antacids adverse effects
- Mg causes diarrhea
- Ca causes constipation
- be careful with your renal pts b/c can lead to Na, Mg, and Ca overload
Antihistamines / Anticholinergics
- Block receptors in vestibular system and on the vomiting center
- for motion sickness / vertigo, PINV, pediatrics
age limit for Dimenhydrinate (Dramamine)
≥ 2 years old
age limit for Diphenhydramine (Benadryl)
≥ 2 years old
age limit for meclizine
≥ 12 years old
age limit for Scopolamine
≥ 12 years
Antihistamines and Anticholinergics Adverse Effects
- anti-SLUDGE
- blurred vision, dry mouth, urinary retention
Under which conditions should you be cautious with when dispensing scopolamine?
- BPH
- narrow angle glaucoma
- asthma
- elderly (CNS sedating)
H2-Receptor Antagonists
- used for simple N/V related to heartburn / GERD
- Blocks one of three pathways that stimulate acid production
- do NOT use for more than 2 weeks
- if using for more than 2 weeks, at risk for colon cancer / ulcers
age limit for H2-Receptor Antagonists
not for use in age <12 years
adverse effects of H2-Receptor Antagonists
- diarrhea / constipation
- headache
- lethargy
- inhibition of cyp450
5-HT3 Antagonists
- rarely for simple n/v; more for complex
- lack extrapyramidal symptoms
- well tolerated; lack EPS
adverse effects of 5-HT3 Antagonists
- HA
- QTc prolongation
- constipation
What has a long half-life (40hr)?
Palonosetron (Aloxi)
5-HT3 Antagonist example
Ondansetron (Zofran)
Phenothiazines
- most commonly used
- simple N/V
- block dopamine
- should be last line treatment of motion sickness
adverse effects of Phenothiazines
- sedation
- hypotension
- EPS
Phenothiazines examples
- compazine: Prolonged QT interval, sedation, tardive dyskinesia
- phenergan: Drowsiness, sedation contraindicated < 2 YO
Metoclopramide (Reglan®)
- safer than the other meds in kids 2 and under
- high EPS
- inhibit dopamine and 5HT3
Bismuth Salts
- protects gut wall and prevents acid from being produced
- Pepto-Bismol®, Kaopectate®
- simple N/V
- never use in kids w/ viral infection or chicken pox
adverse effects of Bismuth Salts
- black mouth, tongue, stool
- ringing of ears, confusion, seizure
- increases bleeding with other antiplatelet / anticoag. therapies
Phosphate Solutions
- Hyperosmolar solution has direct local action on hyperactive GI tract wall
- PINV, motion sickness
adverse effects of Phosphate Solutions
large doses of fructose = adb pain and diarrhea
motion sickness
- Ach and histamine receptors activated
- most common in ages 2-12 and females
- drugs taken prophylactically
- use anticholin. and antihista
PINV
- hormones; hCG levels
- at risk for dehydration
- replace thiamine prior to dextrose; if you don’t, your brain can swell
Diclegis (doxylamine + vitamin B6)
- FDA approved for PINV
Alternative Therapy of PINV
Pyridoxine (recommended first-line)
