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NADEEN ISMAHEL FY1 ANALGESIAANDANTI-EMETICSCONTENTS ANALGESIA ANTI-EMETICS Definition Definition Types Causes of vomiting Side effects Vomiting mechanism Analgesia ladder Types Tips and tricks Tips and tricksSCENARIO man who is complaining of a headache and would like some pain killers.e Mr Smith a 79 y/o What are some questions you’d like to ask the nurse prior to assessment of Mr Smith? - What was he admitted with? - What analgesia is he currently on? - What’s his NEWS score?ANALGESIA What does it mePainkillers - relieve different types of pain Non-opioids OpioidsANALGESIA-NON-OPIOIDS Types: NSAIDS Anti-pyretic, anti-inflammatory - Paracetamol Anti-pyretic Not CNS depressants Vital signs should be normalANALGESIA-OPIOIDS Opioids Anti-pyretic, anti-inflammatory CNS depression Reduced GCS, heart rate, respiratory rateANALGESIA-NSAIDS Bronchospasm Examples: Peptic ulcer Ibuprofen GI bleeding Naproxen - Aspirin Worsening - kidney function Mechanism of action - Block prostaglandin synthesis by blocking COX-1 and COX-2ANALGESIA-P ARACET AMOL Nausea Bleeding risk Mechanism of action? Uncertain Liver damage Blocks prostaglandin synthesis by blocking COX-3 in the brain ANALGESIA-OPIOIDS Examples: Withdrawalerance Morphine CNS depression and RRd HR - Codeine and oxycodone - Fentanyl and alfentanil - Tramadol - Buprenorphine Nausea - Methadone Constipation painanism of action - Bind to opioid receptors in the brain and spinal cord reducingANALGESIA-WHOLADDER Weak opioid Strong opioid Codeine Tramadol - Buprenorphine - Methadone  - Morphine - OxycodoneANALGESIA-TIPSANDTRICKS - IV paracetamol - Consider PPI for a patient on aspirin and additional NSAID - Paracetamol and NSAIDs can be given simultaneously - Consider oral routes before IV routes - Consider prescribing a laxative alongside opioids - Avoid ibuprofen in orthopaedic patients as it inhibits bone healingANTI-EMETICS What does it mean?Anti-sickness - relieves nausea and vomiting Common causes: Chemotherapy induced - Post-operative - Pregnancy - Vertigo and motion sickness - Gastritis and gastroenteritis - Bowel obstruction - Medicatione - Migraine -VOMITINGMECHANISM Dopamine Serotonin Cerebral cortex Histamine Acetylcholine Substance P GI tract Inner earANTI-EMETICS Neuroleptics Dopamine 5HT3 antagonists Serotonin Anti-histamines Histamine Anticholinergics Acetylcholine Pro-kineticsANTI-EMETICS Pro-kinetics Anticholinergics Anti-histamines 5HT3 antagonists Neuroleptics Metochlopramide Cyclizine Ondansetron Metochlopramide Hyoscine Prochloperazine Dicyclomine Mesalazine Granisetron Prochloperazine Domperidone Promethazine Dolasetron Domperidone Haloperidol OlandapineANTI-EMETICS Pro-kinetics Anticholinergics Anti-histamines 5HT3 antagonists Neuroleptics Metochlopramide Hyoscine Cyclizine Ondansetron Metochlopramide Prochloperazine Dicyclomine Mesalazine Granisetron Prochloperazine Domperidone Promethazine Dolasetron Domperidone Haloperidol OlandapineANTI-EMETICS Cyclizine Ondansetron Metochlopramide Prochloperazine Dystonic reactions Dystonic reactions QT prolongation Bowel obstruction Bowel obstruction ANTI-EMETICS Cyclizine Ondansetron Metochlopramide Prochloperazine Gastroenteritis Gastroenteritis Vestibular causes Gastroenteritis Post-operative Opioid induced Opioid induced Opioid induced Pregnancy Chemotherapy induced Chemotherapy induced Chemotherapy induced Post-operative Post-operative Post-operative Pregnancy Migraine Migraine Vestibular causes Vestibular causes Pregnancy PregnancyANTI-EMETICS-ENDOFLIFE https://www.palliativecareguidelines.scot.nhs.uk/ANTI-EMETICS-TIPSANDTRICKS - Avoid IV cyclizine in patients with substance misuse - In patients with difficult IV access use oral or SC route - Anti-emetics from different groups can be used simultaneously - Steroids are used in end of life patients - Consider prescribing anti-emetic alongside opioidsQUESTIONS Which of the following should be used first line in a patient complaining of pain? A. Codeine B. Morphine C. Ibuprofen D. FentanylQUESTIONS Which of the following should be used first line in a patient complaining of pain? A. Codeine B. Morphine C. Ibuprofen D. FentanylQUESTIONS Which of the following drugs can cause CNS depression? A. Codeine B. Paracetamol C. Ibuprofen D. AspirinQUESTIONS Which of the following drugs can cause CNS depression? A. Codeine B. Paracetamol C. Ibuprofen D. AspirinQUESTIONS Which of the following is a common side effect of opioids? A. Increased risk of bleeding B. Constipation C. Liver damage D. Worsening renal functionQUESTIONS Which of the following is a common side effect of opioids? A. Increased risk of bleeding B. Constipation C. Liver damage D. Worsening renal functionQUESTIONS Which of the following analgesics should be avoided in orthopaedic patients? A. Paracetamol B. Codeine C. Ibuprofen D. MorphineQUESTIONS Which of the following analgesics should be avoided in orthopaedic patients? A. Paracetamol B. Codeine C. Ibuprofen D. MorphineQUESTIONS Which of the following analgesics is in the third step of the WHO analgesic ladder? A. Paracetamol B. Codeine C. Ibuprofen D. MorphineQUESTIONS Which of the following analgesics is in the third step of the WHO analgesic ladder? A. Paracetamol B. Codeine C. Ibuprofen D. MorphineQUESTIONS Which of the following neurotransmitters is not associated with vomiting A. Acetylcholine B. Antihistamine C. Adrenaline D. DopamineQUESTIONS Which of the following neurotransmitters is not associated with vomiting A. Acetylcholine B. Antihistamine C. Adrenaline D. DopamineQUESTIONS Which of the following is not a complication of vomiting A. Dehydration B. PH imbalance C. Electrolyte imbalance D. Fluid overloadQUESTIONS Which of the following is not a complication of vomiting A. Dehydration B. PH imbalance C. Electrolyte imbalance D. Fluid overloadQUESTIONS Which of the following anti-emetics should be avoided in bowel obstruction? A. Prochlorperazine B. Ondansetron C. Cyclizine D. PromethazineQUESTIONS Which of the following anti-emetics should be avoided in bowel obstruction? A. Prochlorperazine B. Ondansetron C. Cyclizine D. PromethazineQUESTIONS Which of the following anti-emetics should be avoided in patients with a history of substance misuse? A. Prochlorperazine B. Ondansetron C. Cyclizine D. PromethazineQUESTIONS Which of the following anti-emetics should be avoided in patients with a history of substance misuse? A. Prochlorperazine B. Ondansetron C. Cyclizine D. PromethazineQUESTIONS Match the drug to the drug class Prochlorperazine Anti-histamine Ondansetron Anti-cholinergic Cyclizine Neuroleptic Hyoscine 5HT3 antagonistQUESTIONS Match the drug to the drug class Prochlorperazine Anti-histamine Ondansetron Anti-cholinergic Cyclizine Neuroleptic Hyoscine 5HT3 antagonistQUESTIONS?QUESTIONS?