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OU PharmCare Fall 2017 > Test 3 Nausea / Vomiting > Flashcards

Test 3 Nausea / Vomiting Flashcards

1
Q

What are the different types of nausea?

A
  • pregnancy
  • motion sickness
  • food induced
  • medication induced
  • acute infections
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2
Q

etiologies of N/V

A
  • Pregnancy
  • Motion sickness
  • Overeating or disagreeable foods
  • Food poisoning
  • Medication induced
  • Medical disorder induced
  • Psychogenic-induced
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3
Q

Treatment Exclusions to Self Care (adults)

A

• 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)

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4
Q

Treatment Exclusions to Self Care (children)

A
  • 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
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5
Q

Non-Pharmacological Treatment in Pregnancy-Induced (PINV)

A
  • Eat 4-5 small meals per day

* Avoid greasy, spicy, or acidic foods

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6
Q

Non-Pharmacological Treatment in Motion Sickness

A
  • Get air
  • Sit where there is less motion
  • Avoid alcohol/strong odors/tobacco smoke
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7
Q

Non-Pharmacological Treatment for Dyspepsia

A
  • Avoid overeating and disagreeable foods
  • Avoid precipitating substances ex. NSAIDs
  • Stress reduction
  • Weight loss
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8
Q

Non-Pharmacological Treatment for Food Poisoning

A
  • Eliminate contaminated food

* Initiate bland diet

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9
Q

Non-pharmacological Treatment of Medication-Induced N/V

A
  • Take medication with food if appropriate

* Change time of administration if appropriate

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10
Q

Antacids

A
  • Magnesium hydroxide, sodium salts, aluminum hydroxide, calcium or magnesium carbonate
  • mainly for food induced N/V
  • Neutralize gastric acidity
  • take with food
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11
Q

Antacids adverse effects

A
  • Mg causes diarrhea
  • Ca causes constipation
  • be careful with your renal pts b/c can lead to Na, Mg, and Ca overload
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12
Q

Antihistamines / Anticholinergics

A
  • Block receptors in vestibular system and on the vomiting center
  • for motion sickness / vertigo, PINV, pediatrics
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13
Q

age limit for Dimenhydrinate (Dramamine)

A

≥ 2 years old

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14
Q

age limit for Diphenhydramine (Benadryl)

A

≥ 2 years old

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15
Q

age limit for meclizine

A

≥ 12 years old

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16
Q

age limit for Scopolamine

A

≥ 12 years

17
Q

Antihistamines and Anticholinergics Adverse Effects

A
  • anti-SLUDGE

- blurred vision, dry mouth, urinary retention

18
Q

Under which conditions should you be cautious with when dispensing scopolamine?

A
  • BPH
  • narrow angle glaucoma
  • asthma
  • elderly (CNS sedating)
19
Q

H2-Receptor Antagonists

A
  • 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
20
Q

age limit for H2-Receptor Antagonists

A

not for use in age <12 years

21
Q

adverse effects of H2-Receptor Antagonists

A
  • diarrhea / constipation
  • headache
  • lethargy
  • inhibition of cyp450
22
Q

5-HT3 Antagonists

A
  • rarely for simple n/v; more for complex
  • lack extrapyramidal symptoms
  • well tolerated; lack EPS
23
Q

adverse effects of 5-HT3 Antagonists

A
  • HA
  • QTc prolongation
  • constipation
24
Q

What has a long half-life (40hr)?

A

Palonosetron (Aloxi)

25
Q

5-HT3 Antagonist example

A

Ondansetron (Zofran)

26
Q

Phenothiazines

A
  • most commonly used
  • simple N/V
  • block dopamine
  • should be last line treatment of motion sickness
27
Q

adverse effects of Phenothiazines

A
  • sedation
  • hypotension
  • EPS
28
Q

Phenothiazines examples

A
  • compazine: Prolonged QT interval, sedation, tardive dyskinesia
  • phenergan: Drowsiness, sedation contraindicated < 2 YO
29
Q

Metoclopramide (Reglan®)

A
  • safer than the other meds in kids 2 and under
  • high EPS
  • inhibit dopamine and 5HT3
30
Q

Bismuth Salts

A
  • 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
31
Q

adverse effects of Bismuth Salts

A
  • black mouth, tongue, stool
  • ringing of ears, confusion, seizure
  • increases bleeding with other antiplatelet / anticoag. therapies
32
Q

Phosphate Solutions

A
  • Hyperosmolar solution has direct local action on hyperactive GI tract wall
  • PINV, motion sickness
33
Q

adverse effects of Phosphate Solutions

A

large doses of fructose = adb pain and diarrhea

34
Q

motion sickness

A
  • Ach and histamine receptors activated
  • most common in ages 2-12 and females
  • drugs taken prophylactically
  • use anticholin. and antihista
35
Q

PINV

A
  • hormones; hCG levels
  • at risk for dehydration
  • replace thiamine prior to dextrose; if you don’t, your brain can swell
36
Q

Diclegis (doxylamine + vitamin B6)

A
  • FDA approved for PINV
37
Q

Alternative Therapy of PINV

A

Pyridoxine (recommended first-line)

OU PharmCare Fall 2017 (22 decks)

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