Nausea & Vomiting

Question 1

What are the 5 common causes of nausea and vomiting?

Answer 1

1. GI disorders (influenza)
2. CNS disorders
3. Pain (acute or chronic)
4. Excessive intake of anything (food or alcohol)
5. Pregnancy

Question 2

What are the treatment-induced causes of N/V?

Answer 2

• cancer chemotherapy
• radiation therapy
• anesthesia
• N/V associated with procedures

Question 3

What drugs can cause N/V?

Answer 3

• anti-neoplastic agents
• Iron
• Abx
• NSAIDs

Question 4

What are non-pharmacological options to address N/V?

Answer 4

• put the gut to rest (clear liquid diet)
• avoid fatty, fried, sweet, and spicy foods
• avoid odors

Question 5

What is the key to treating motion sickness?

Answer 5

prevention

Question 6

What are the treatment options for motion sickness?

Answer 6

• scopolamine
• dimenhydrinate
• meclizine

Question 7

Which drugs are used to treat N/V secondary to gastroenteritis or pain?

Answer 7

• ondansetron - 4-8mg q8-12h prn
• promethazine - 12.5 - 25mg q 4-6h prn

Question 8

What are the key factors that can increase the risk of post-operative nausea and vomiting (PONV)?

Answer 8

• being female
• non-smoker
• Hx of PONV
• Hx of motion sickness

Question 9

Which drug is used for treatment of PONV?

Answer 9

• Aprepitant (Emend)
• 40 mg po 1-3 h before anesthesia

Question 10

Which agents are used for the prevention of chemotherapy induced NV (CINV)?

Answer 10

• 5-HT3 antagonist (ondansetron)
• NK-1 antagonist (aprepritant)
• corticosteroid
• olanzapine
• lorazepam

Question 11

Which agents are more effective?

Answer 11

The -trons (newer agents) are more effective because they target central and peripheral receptors.

Question 12

Which serotonin antagonist has the longest duration of action (half-life)?

Answer 12

palonosetron (half-life = 40 hours)