The palliation of nausea and vomiting

Martin Leiper

instructions

• View in slide show mode
• Slides 2-6 are for teaching theory
• Start quiz at slide 7 the game board
• Click a question (1 is easy, 5 hard)
• Click in yellow space to get choice of answers a-d.
• Click on Answer to show correct response
• Click on Return to Game Board to get back to slide

7

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If you get lost press 7 key and then ENTER key

Cortex

Vomiting

Centre

Vestibular

apparatus

Cortex

Vomiting

Centre

Vestibular

apparatus

Cortex

Vomiting

Centre

Vestibular

apparatus

D₂

5HT

D₂

5HT

Prevention

1

3

2

4

5

1

3

2

4

5

1

3

2

4

5

1

3

2

4

5

1

3

2

4

5

Pharmacology

Diagnosis

Treatment

Trivia

What is the best dietary advice for nausea?

answer

Prevention for 1

Back to the Game Board

Prevention for 1

B - small meals

patient leaflet

To help the nauseated patient the family should:

answer

Prevention for 2

A - heat food quickly

C - offer lots of drinks

D - serve bland food at room temp.

B - cause distraction at meal times

Back to the Game Board

Prevention for 2

D - serve bland food at room temp.

Which is the best drug to prevent travel sickness?

answer

Prevention for 3

A - dexamethasone

C - hyoscine hydrobromide

D - ondansetron

B - metoclopramide

Back to the Game Board

Prevention for 3

C - hyoscine hydrobromide

Which is best to prevent nausea?

answer

Prevention for 4

A - cinnamon

C - mint

D - ginger

B - nutmeg

Back to the Game Board

Prevention for 4

D - ginger

Which for anticipatory nausea?

answer

Prevention for 5

A - lorazepam /diazepam

C - dexamethasone

D - ondansetron

B - metoclopramide

Back to the Game Board

Prevention for 5

A - lorazepam /diazepam

GABA

answer

Pharmacology for 1

A - limbic system

C - chemo receptor trigger zone

D - cerebral cortex

B - vestibular apparatus

Toxic substances stimulate the vomiting centre via :

Back to the Game Board

Pharmacology for 1

C - chemo receptor trigger zone

Hyoscine is active on :

answer

Pharmacology for 2

A - dopamine

C - gaba

D - acetylcholine

B - 5HT

Back to the Game Board

Pharmacology for 2

D - acetylcholine

Metoclopamide is active on:

answer

Pharmacology for 3

A - dopamine

C - gaba receptors

D - histamine and acetylcholine

B - 5HT

Back to the Game Board

Pharmacology for 3

A - dopamine

Corticosteroids are active on:

answer

Pharmacology for 4

A - dopamine

C - none of these

D - histamine and acetylcholine

B - 5HT

Back to the Game Board

Pharmacology for 4

C - none of these

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?

The new anti-emetic for chemo aprepitant is active on :

answer

Pharmacology for 5

A - gastric emptying

C - dopamine receptors

D - neurokinin receptors

B - cerebral cortex

• aprepitant, is a substance P/neurokinin 1 (NK1) receptor antagonist,
• used to prevent and control nausea and vomiting caused by chemotherapy treatment.
• used in combination with other anti-emetic agents.
• oral

Back to the Game Board

Pharmacology for 5

D - neurokinin receptors

The most reliable measure of nausea is:

answer

Diagnosis for 1

A - responsiveness to drugs

C - concurrent vomiting

D - patient’s ability to suppress it

B - patients self - report

Back to the Game Board

Diagnosis for 1

B - patients self - report

Eg MaGill nausea score

Which of these is the most important in nausea?

answer

Diagnosis for 2

A - serum phosphate

C - serum calcium

D – plasma protein

B - haemoglobin

Back to the Game Board

Diagnosis for 2

C - serum calcium

Treatment of hypercalcaemia

Rehydrate IV

IV pamidronate in saline over 2hrs

check calcium in ~ 4 days

NB it may recur

HIV patient is nauseated. No recent drug changes. What is the most likely cause?

answer

Diagnosis for 3

A - weakness

C - chronic anaemia

D - infection

B - weight loss

Back to the Game Board

Diagnosis for 3

D - infection

What else causes nausea in HIV/AIDS?

Which is most likely in a vomiting diabetic patient ?

answer

Diagnosis for 4

A - hypoglycaemia

C - ketoacidosis

D - euglycaemia

B - hyperglycaemia

Back to the Game Board

Diagnosis for 4

C - ketoacidosis

Don’t stop insulin

rehydrate

follow protocol

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answer

Diagnosis for 5

Which combination suggests bowel obstruction?

A - rigid abdomen & no bowel sounds

C - shifting dullness, vomiting

D - abdo pain and full rectum

B - faecal vomit/distended abdo

Back to the Game Board

Diagnosis for 5

B - faecal vomit/distended abdo

Suspect High obstruction

vomit after food

abdo not distended

normal bowel sounds

no colic

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Suspect Low obstruction

faecal vomit

abdo distended

abdo may be tender

loud bowel sounds

colic

rectum empty

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How do you know a naso gastric tube is in the stomach?

answer

Treatment for 1

A – put sterile water down the tube

C - measure markings on the tube

D - test aspirate for acid

B - listen over the stomach

Back to the Game Board

Treatment for 1

D - test aspirate for acid

What should the patient do before removal of ascites?

answer

Treatment for 2

A - empty bowels

C - empty bladder

D - remove all clothes

B – empty stomach

Back to the Game Board

Treatment for 2

C - empty bladder

Beware hypovolaemic shock if more than 4 litres removed quickly

Anti emetic of choice in bowel obstruction is:

answer

Treatment for 3

A - cyclizine

C - chlorpromazine

D - haloperidol

B - metoclopramide

Back to the Game Board

Treatment for 3

D -haloperidol

Which drug relieves constipation induced nausea/vomiting by promoting gastric emptying?

answer

Treatment for 4

A - cyclizine

C - metoclopramide

D - ondansetron

B - ginger

Back to the Game Board

Treatment for 4

C - metoclopramide

Which SC infusion to palliate colic of bowel obstruction?

answer

Treatment for 5

A - metoclopramide/dexamethasone

C - ondansetron

D - haloperidol

B - hyoscine butylbromide

Back to the Game Board

Treatment for 5

B - hyoscine butylbromide

Alternatives for other symptoms

Morphine + haloperidol

Morphine + hyoscine (Buscopan)

morphine + hyoscine butylbromide + octreotide (expensive)

morphine + levomepropazine (sedative in high doses!!!)

Which animal cannot vomit?

answer

Trivia for 1

A - lion

C - dog

D - cat

B - rabbit

Back to the Game Board

Trivia for 1

B - rabbit

Riverine rabbit

Where do you sit in a boat to avoid sea sickness?

answer

Trivia for 2

A - middle of boat

C - back of boat

D - below the water line

B - front of boat

Back to the Game Board

Trivia for 2

A - middle of boat

The incidence of chemo induced nausea is higher in

answer

Trivia for 3

A - men more than women

C - no previous history of nausea

D - patients with a history of anxiety

B - older than younger

Back to the Game Board

Trivia for 3

D - patients with a history of anxiety

And

Younger more than older

Women more than men

In which overdose should you discourage vomiting?

answer

Trivia for 4

A - paraffin

C - pethidine

D - penicillin

B - paracetamol

Back to the Game Board

Trivia for 4

A - paraffin

Which has been shown to be anti emetic in HIV patients?

answer

Trivia for 5

A - cannabis

C - ketamine

D - opium

B - heroin

Back to the Game Board

Trivia for 5

A - cannabis

Studies in HIV

Nabilone (cannabinoid)

Customizing the Quiz Show Template

The Blank Quiz Show Review is ready for you to customize. This presentation is designed to be a review for a unit. You make up the categories, questions and answers, then show the review to your class using a scan converter or projector. All the hyperlinks connecting the points on slide two to the correct questions have already been created. Once you have created one review, you can give the blank PowerPoint show and these directions to students and assign them to create the next review. Students, in groups of five, can make up 5 questions each: one for each category, or each in charge of a category of their own.

1. Double-click on the quiz show template file “Blank Quiz Show Review” to open it.

2. Click on File and Save As to give the quiz show template a new file name. This way you can save the blank copy to use again.

3. Change the view to Slide Sorter from the View Menu.

4. From the Edit menu, choose Replace. In the first line of the box that appears, type Prevention, then tab to the second line. Type in your first category name. Click on the Replace All button. You should get a message that 11 changes were made, and you should be able to see the changes in the slides.

5. Repeat this process to change all your general “topics” to your specific topic names. When you are finished, switch back to Slide View from the View Menu.

6. Go to Slide 3 by clicking on the double down-arrow at the bottom of the vertical scroll bar.

7. Click after the colon in the text box reading "Question:" to type in your first question.

8. Go to Slide 4. Click after the colon in the text box reading "Answer:" to type in the answer to your first question.

9. Repeat with all slides in the quiz show presentation. Don't forget to save your work every few minutes by clicking on the third icon on the top toolbar (looks like a floppy disk).

10. Showing the presentation: Open the new document in PowerPoint. From the View menu, choose Slide Show. To link to the questions from slide 2, move the mouse over a number so that a hand appears. Click on the number. You must do the same to go back to the gameboard on each answer slide. DO NOT click on the slide just ANYWHERE. That will take you to the next slide instead of back to the gameboard. Make sure ONLY to click when you see the hand indicating a hyperlink.

Click Here to go to First Slide

Jeopardy Quiz Game

Suggested instructions for playing the game with a class:

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1.      Project the game onto a large screen or use a large computer monitor at the front of the class.

2.      Divide the class into teams of up to four players. Have any other students count off 1 to 4 and sit in the audience.

3.      Provide each team with a flashlight, whistle, or other means of "buzzing-in" to indicate they know the answer.

4.      Appoint a scorekeeper.

5.      Appoint a reader to read each question to the group.

6.      The teacher or a student can act as moderator.

7.      Let the first team select a category.

8.      Once the question pops up, the first team to "buzz-in" gets to try to answer the question.

9.      Add or deduct the number of points corresponding to the number they selected under the category.

10.    If the first team misses, the remaining teams can buzz-in and answer the question.

11.    If no team knows the answer, the audience is given the opportunity to answer. The first person to raise his or her hand and answer correctly receives the points for the team that corresponds to their number.

12.    Go back to the game board and let the team who answered correctly select the next category and point value.

13. This power point may include a slide with a list of terms the teacher may wish to print out to assist the students during the game.

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Georgia Agricultural Education Curriculum Office

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Click Here to go to First Slide

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