What are the treatment goals for Nausea and Vomiting?
- prevent or relieve symptoms
- prevent complications
When selecting drugs what are the things to consider?
- cause of nausea/vomiting
- severity of symptoms
- route of admin
- comorbidities
- previous response
What are the common adverse effects of NonCytotoxic agents?
- opioids
- tramadol
- antibiotics
- estrogens
- metformin
- cannabis
What are the signs of drug toxicity of causative agents?
- digoxin
What are the 5 drug classes of Anti-emetics?
- dopamine antagonists
- anticholinergics
- corticosteroids
- sedating antihistamines
- substance P antagonists
- 5ht3 Antagonists
What is the drug class for Domperidone, Metoclopramide, droperidol?
Dopamine Antagonists
What is the drug class of Hyoscine Hydrobromide?
Anticholinergics
What is the drug class for Promethazine/cyclizine?
Sedating Anti-histamine
What is the drug class for Palonosetron/Ondansetron?
5HT3 Antagonists
What is the drug class for Netupitant/aprepitant?
Substance P antagonists
What is the drug class for Dexamethasone?
Corticosteroid
What are the risk factors for PONV?
Patient Characteristics:
- pre-operative nausea and vomiting
- Female gender
- History of PONV or motion sickness
- Non-Smoking
- Age
- History of chemotherapy-induced nausea and vomiting
What are the anaesthetic factors?
- technique
- use of volatile anaesthetics
- duration
- administration of postoperative opiods
What are the prevention for PONV?
Zero Primary risk factor = prophylaxis not usually required
One or Two risk factors = use 1 or 2 drugs
3+ Risk factors = use combination therapy with at least two drugs (ensure baseline risk factors are minimised)
What are the TG for prevention of PONV?
- a 5HT3-receptor antagonist intravenously
- Dexamethasone 4mg intravenously as a single dose at the start of anaesthesia
- Droperidol 0.5-0.625mg intravenously as a single dose at the end of anaesthesia
If antiemetic was given for prophylaxis then what should be done?
Use from a different class
What is the diverticulosis?
Small buldge in the colon
What is Diverticulitis?
When the small buldge within the colon becomes inflamed.
What are the risk factors for Diverticula?
- low fibre diet = constipation
- smoking
- overweight/obese
- Genetics
What are the 5 diverticulitis managements?
- computed tomography
- antibiotics
- high fibre diet
- pain management
- surgical removal
