7 Case studiesPick the most appropriate antiemetic in each case
8 Management Treat reversible causes Remember unrelated causes e.g gastroenteritisChoose the most appropriate antiemetic for the causePrescribe the same antiemetic regularly and prnIf oral absorption in doubt, use sc routeRemember non-drug treatmentsConsider dexamethasoneREVIEW
9 Common anti-emetics Prokinetic for gastric stasis, functional bowel obstructionMetoclopramide 10mg tdsor 30-60mg/24hr CSCIActing on CTZ trigger zonefor chemical causes of vomiting eg morphine, renal failureHaloperidol 1.5-3mg stat/nocteor 2.5-5mg sc stat and mg/24hr CSCI
10 Common anti-emetics Antispasmodic and antisecretory if bowel colic and/or need to reduce GI secretionsBuscopan 20mg stat60 – 120mg/24hr CSCIActing in the Vomiting Centrefor raised ICP, motion sickness or mechanical bowel obstructionCyclizine 50mg tds150mg/24hr CSCIBroad-spectrumfor mechanical obstruction, or if others failLevomepromazine mg nocte
11 Nausea and Vomiting Cause Clinical Picture Rx Metabolic (drugs, uraemia, hypercalcaemia)Persistent nauseaHaloperidolLevomepromazineGastric stasisOcc. nausea relieved by vomitingMetoclopramideDomperidoneBowel obstruction(abdo. ca./autonomic neuropathy)Nausea relieved by vomiting ± colic ± faecal vomitBuscopan/ levomepromazineCyclizine↑ ICP, brainstem diseaseHeadacheCyclizine ± dex.Vestibular diseaseMovement related1)Cyclizine2) LevomepromazineBentley A, Boyd K. Palliative Medicine 2001;15:
12 SummaryTry to establish the cause and choose an appropriate antiemetic, rather than picking your favouriteAvoid combinations that may antagonise each otherChoose an appropriate route
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