Term
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Definition
inclination to vomit; feeling in throat or epigastric region alerting an individual vomiting is imminent;
precedes vomiting; |
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Term
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Definition
| labored movement of abdominal & thoracic muscles without expulsion; |
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Term
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Definition
| reverse movement of stomach contents into pharynx that stops short of expulsion |
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Term
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Definition
| forceful expulsion of stomach, esophageal, & oropharyngeal contents through the mouth |
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Term
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Definition
| mechanical obstruction, gastroparesis, ulcer, acute hepatitis, Crohn's disease, IBS, migraine, meningitis, seizure, head trauma, pregnancy, DM, anxiety disorders, anorexia, Drug withdrawal (opiates, benzodiazepines), infections (viral gastroenteritis), chemotherapy agents, analgesics, OC, antimicrobials, MI, CHF |
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Term
| Neurotransmitters involved in N/V |
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Definition
| dopamine (D2), histamine (H1), muscarinic (M1), 5-hydroxytryptamine (5HT3) |
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Term
| CNS areas involved in N/V |
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Definition
| Chemoreceptor Trigger Zone (CTZ), Solitary Tract Nucleus, Cerebellum |
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Term
| Mechanical Process of Vomiting |
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Definition
| Activation of vomiting center --> stomach relaxes & antral & intestinal peristalsis is inhibited (nausea) --> activation of spasmodic contractions of diaphragm & intercostal muscles & closure of glottis (retching) --> abdominal muscles contract --> gastric contents forced into upper gastric vault & lower esophagus --> abdominal muscles relax --> contents reenter gastric vault --> process repeated several times (regurgitation) --> abdominal muscles contract with elevation of diaphragm (vomiting) |
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Term
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Definition
self-limiting;
resolve spontaneously;
no lab tests needed |
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Term
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Definition
not resolved after antiemetics;
progressive deterioration of pt;
weight loss;
abdominal pain;
fever;
electrolyte imbalance; |
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Term
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Definition
| esophagitis; laceration; aspiration pneumonia; hypotension; muscle weakness; cardiac arrythmia; electrolyte abnormalities (dehydration, hypokalemia, hyponatremia, oliguria, acid-base disorders) |
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Term
| Nausea & Vomiting of Pregnancy (NVP, aka "Morning Sickness") |
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Definition
most common in 1st trimester;
Occurs in about 50% of pregnant women;
May have negative effects on relationships;
May cause depression;
May cause missed work; |
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Term
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Definition
| homemaker; age >35 y/o; first pregnancy; hx of infertility; migraine headaches; fat intake; female fetus; obesity; stress; history; estrogen OCs; unemployed; |
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Term
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Definition
severe N/V: persistent vomiting;
Medical complications: weigth loss >5% of pre-pregnancy weight, ketonuria;
Associated with: nulliparity, multiple gestation, high maternal body mass |
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Term
| Complications of Hyperemesis gravidum |
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Definition
dehydration/starvation;
weight loss;
volume contraction;
electrolyte abnormalities |
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Term
| Nonpharm Treatment of NVP |
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Definition
Lifestyle Modification:
- rest, fresh air, crackers, get out of bed slowly, shorten work day, emotional support, decreased smell of food, frequent small meals, avoid spicy/greasy/odorous foods, eat chilled/bland foods;
Take prenatal vitamins at bedtime; avoid triggers; |
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Term
| 1st Line Pharmacological Tx of NVP |
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Definition
Pyridoxine (vitamine B6) 25 mg PO TID;
- needed for lipid, CHO, & AA metabolism
Doxylamine (Unisom) 25 mg PO TID, give in combo w/ pyridoxine (doxylamine 10 mg/pyridoxine 10 mg - Take 2 tabs PO qHS PRN, up to 4 tabs QID PRN) |
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Term
| 2nd Line Pharmacological Tx of NVP |
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Definition
Dimenhydrinate 50-100 mg PO or PR q4-6 hr PRN;
Diphenhydramine 25-50 mg PO or 10-50 mg IV q4-6 hrs PRN;
meclizine 25 mg PO q4-6h PRN |
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Term
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Definition
Promethazine 12.5-25 mg PO q4 hr PRN;
Metoclopramide 10 mg PO/IV q8 hr PRN;
Prochlorperazine 5-10 mg PO q6 hr PRN; |
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Term
| 4th Line Pharm Therapy for NVP |
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Definition
| ondansetron 4-8 mg PO/IV q8h PRN |
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Term
| Last Line Pharm Tx of NVP |
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Definition
Methylprednisolone 16 mg IV/PO q8hr x 3 days then 2 wk taper;
**AVOID before 10 wks of gestation** |
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Term
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Definition
neural mismatch between visual & vestibular stimuli;
Associated with over-stimulation of labyrinth apparatus known as the semicircular canals; |
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Term
| Risk Factors for Motion Sickness |
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Definition
Females > males;
Age: starts at 2 yrs, peaks at 12 yrs old;
Hormones: pregnancy, OCs, menstrual cycle;
Pschological: expectations;
Low frequency motion;
Body positioning (standing up/sitting up);
Sensory illnesses |
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Term
| Symptoms of Motion Sickness |
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Definition
mild-moderate distress;
belching;
excessive salivation;
yawning;
restlessness;
dizziness;
flatulence;
cold sweats;
hyperventilation;
N/V; |
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Term
| Non-Pharm Tx of Motion Sickness |
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Definition
Control motion;
Keep line of vision straight ahead;
Stay where motion least expected:
- Car --> front seat;
- Plane --> by wings;
- Boat --> at sea level;
Avoid strong odors;
Look out window & focus on stable object;
Avoid visual stimuli (TV, reading);
Eat light meal <3 hrs before trip;
AVOID: protein, high calorie meals, sodium, EtOH;
Sit by windows/Open windows |
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Term
| scopolamine (Transderm Scop) |
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Definition
first line for prophylaxis of motion sickness;
anticholinergic;
Dose: Apply 1 patch (1.5 mg) behind ear q72 hrs;
Apply patch about 4 hrs before travel;
Wash hands after applying;
D/Cing can cause withdrawal; |
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Term
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Definition
phenothiazines (promethazine, prochlorperazine, chlorpromazine);
Antihistamines/anticholinergics (scopolamine, diphenhydramine, dimenhydrinate, cyclizine, trimethobenzamide); |
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Term
| Post-operative N/V (PONV) Complications |
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Definition
Increased risk of aspiration;
Suture dehiscence;
Esophageal rupture;
Subcutaneous emphysema |
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Term
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Definition
| occurs 0-6 hrs after inpatient surgery or occurs before discharge in outpatient surgery |
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Term
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Definition
| occurs within 6-24 hrs after inpatient surgery; |
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Term
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Definition
| occurs >24 hrs after inpatient surgery |
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Term
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Definition
| occurs after discharge and <24 hrs after outpt surgery |
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Term
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Definition
| occurs >24 hrs after discharged from outpatient surgery |
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Term
| Risk Factors for PONV/PDNV |
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Definition
Age 2-13 yrs old;
Females after puberty;
Non-smokers;
Hx of Motion Sickness/PONV;
Use of opiates during surgery;
Duration of >60 min of surgery;
Location of surgery;
Nitric oxide use; |
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Term
| Prophylaxis for Moderate Risk PONV/PDNV Pts |
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Definition
one antiemetic:
Give 1 dose of:
- dexamethasone 2-4 mg IV at induction
OR
- dolasetron 12.5 mg IV at end of surgery;
OR
- granisetron 0.25-1 mg IV at end of surgery;
- ondansetron 4-8 mg IV at end of surgery;
- tropisetron 5 mg IV at end of surgery |
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Term
| Prophylaxis of High Risk for PONV/PDNV pts |
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Definition
two antiemetics from 2 different classes;
Give 1 dose of each:
- dexamethasone 2-4 mg IV at induction
AND
- dolasetron 12.5 mg IV at end of surgery;
OR
- granisetron 0.25-1 mg IV at end of surgery;
- ondansetron 4-8 mg IV at end of surgery;
- tropisetron 5 mg IV at end of surgery |
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Term
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Definition
Use drug from different class for treatment;
1st Line - 5HT3 Antagonists (dolasetron, granisetron, ondansetron, tropisetron)
2nd Line - Phenothiazines;
3rd Line - Corticosteroids |
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Term
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Definition
5HT3 antagonist - 1st line therapy for tx of PONV/PDN;
Dose: 12.5 mg
If used as prophylaxis, wait 6 hrs before next dose; |
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Term
| granisetron (Granisol, Kytril) |
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Definition
5HT3 antagonist - 1st line therapy for tx of PONV/PDN;
Dose: 0.1 mg;
If used as prophylaxis, wait 6 hrs before next dose; |
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Term
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Definition
5HT3 antagonist - 1st line therapy for tx of PONV/PDN;
Dose: 1 mg q8hr for PONV & hyperemesis gravum;
If used as prophylaxis, wait 6 hrs before next dose; |
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Term
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Definition
5HT3 antagonist - 1st line therapy for tx of PONV/PDN;
Dose: 0.5 mg;
If used as prophylaxis, wait 6 hrs before next dose; |
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Term
| Goals of Treatment for PONV |
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Definition
Stop or prevent N/V;
Identify & correct underlying cause;
Avoid serious complications associated w/ N/V;
Minimize SEs associated w/ pharm agents;
Provide symptomatic relief; |
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Term
| AVOID SELF-TREATMENT of N/V if pt has: |
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Definition
food poisoning lasting >12 hrs;
severe abdominal pain;
stiff neck;
yellowing skin/eyes;
pregnant/breastfeeding;
head trauma;
positive urine ketones |
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Term
| scopolamine (Transderm Scop) |
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Definition
MoA: inhibit vestibular input to CNS & inhibit reflux vomiting;
Dose: Apply 1 patch (1.5 mg) behind ear q72 hrs;
Apply ~4 hrs before travel;
Wash hands after applying;
ADRs: blurry vision, urinary retention, dry mouth, constipation, EPS (tremor, dystonic reactions), anxiety, restlessness, drowsiness;
C/I: narrow angle glaucoma;
Precautions: glaucoma, BPH;
D/C can cause withdrawal; |
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Term
| metoclopramide (Reglan - RX only) |
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Definition
MoA: decreases gastric emptying time, decreases gastric relaxation, inhibits vestibular input to CNS & inhibits reflux vomiting;
Dose: Adults - 10 mg PO/IV TID-QID;
ADRs:
- EPS (tremors, dystonic rxns), anxiety, restlessness, drowsiness; |
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Term
| Phenothiazines (prochlorperazine [Phenergan], promethazine [Compazine], chlorpromazine [Thorazine]) |
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Definition
MoA: inhibits M1 & H1 receptors, inhibits D receptors in CTZ;
Most widely prescribed antiemetics;
ADRs:
- sedation, EPS, hypersensitivity in liver disease; |
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Term
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Definition
phenothiazine;
Adult Dose: 12.5-25 mg PO/IM/PR q4 hr PRN;
Preg. Cat. C;
ADRs: sedation, EPS, hypersensitivity in liver dx |
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Term
| prochlorperazine (Compazine) |
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Definition
phenothiazine - most widely used, low dose is OK in pregnancy;
Adult Doses (MAX 40 mg/day):
- 5-10 mg PO q6-8 hr PRN
- 5-10 mg IM q3-4 hr PRN
- 2.5-10 mg IV q3-4 hr PRN
- 25 mg PR q12 hr PRN;
ADRs:
- sedation, EPS, hypersensitivity in liver dx |
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Term
| chlorpromazine (Thorazine) |
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Definition
phenothiazine;
Adult Doses:
- 10-25 mg PO q4-6 hr PRN
- 25 mg IV/IM q4-6 hr PRN;
ADRs:
- sedation, EPS, hypersensitivity in liver dx |
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Term
| butyrophenones (haloperidol [Haldol], droperidol) |
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Definition
MoA: acts centrally to block D receptors in CTZ;
ADRs:
- somnolence
- EPS |
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Term
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Definition
butyrophenone;
Adult doses:
- 0.5-5 mg PO TID-QID PRN
- 2-5 mg IM q4-8 hr PRN
- 2-10 mg IV
ADRs:
- somnolence, EPS |
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Term
| Antihistamines/Anticholinergics -(meclizine [Antivert, Bonine, Dramamine Less Drowsy Formula], diphenhydramine [Benadryl], dimenhydramine [Dramamine], cyclizine [Marezine], trimethobenzamide [Tigan]) |
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Definition
MoA: blocks H1 receptors;
ADRs:
- drowsiness
- EPS
- dizziness
- paradoxical effect --> hyperactivity;
Precautions:
- respiratory conditions
- glaucoma
- BPH
- lactating women; |
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Term
| meclizine (Antivert, Bonine, Dramamine Less Drowsy Formula) |
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Definition
antihistamine/anticholinergic;
Adult & Children >12 yrs old Dosing:
- 25-50 mg PO q24 hr;
Decreased sedation than dimenhydrinate;
Take after meals;
Preg. Cat. B |
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Term
| diphenhydramine (Benadryl) |
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Definition
antihistamine/anticholinergic;
Adult Dose:
- 25-50 mg PO q6-8 hrs PRN
- 10-50 mg IV/IM per dose
- MAX Dose: 400 mg/day;
HIGHLY Sedating;
Preg. Cat. B |
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Term
| dimenhydrinate (Dramamine) |
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Definition
antihistamine/anticholinergic;
Adult Dose:
- 50-100 mg PO q4-6 hr PRN;
Preg. Cat. B |
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Term
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Definition
OTC & Rx antihistamine/anticholinergic;
Adult Dose: 50 mg PO/IM q4-6 hr PRN;
Preg. Cat. B;
Less sedation vs. other antihistamines;
**Teen drug of abuse** |
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Term
| trimethobenzamide (Tigan) |
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Definition
antihistamine/anticholinergic;
Adult dose:
- 300 mg PO TID-QID PRN
- 200 mg IM TID-QID PRN |
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Term
| Corticosteroids - (dexamethasone [Decadron], methylprednisolone [Solu-Medrol]) |
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Definition
injectable forms effective in PONV and hyperemesis gravidum;
NOT useful in simple nausea; |
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Term
| 5-HT3 Receptor Antagonists - (ondansetron [Zofran], granisetron [Kytril], dolasetron [Anzemet], palonosetron [Aloxi] |
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Definition
MoA: inhibits receptors on sensory vagal fibers in gut wall & brain, most prokinetic agent (decreases gastric emptying time);
ADRs:
- constipation
- HA
- asthenia |
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Term
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Definition
5-HT3 Receptor Antagonist;
Adult Dose:
- 8-32 mg PO/IV q8 hr PRN |
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Term
| Cannabinoids (nabilone, dronabinol, IM levonantradol) |
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Definition
studied in Chemo-induced N/V (CINV);
more effective when regimen was of moderate emetogenic potential;
MORE TOXIC:
- euphoria, drowsiness, desation, somnolence, dysphoria, hallucinations, paranoia, "The Munchies" |
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Term
| Non-Pharm Tx of PONV/PDNV |
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Definition
Dietary:
- bland diet
- cold food
- avoid large intake of solid/liquid in small amounts of time;
Avoid Triggers:
- overstimulation
- stress |
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