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Therapeutics > 68: Management of Nausea and Vomiting > Flashcards

68: Management of Nausea and Vomiting Flashcards

1
Q

Symptoms associated w N/V

A

-Pallor
-tachycardia
-diaphoresis

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2
Q

Etiology of N/V

A

-influenza
-intestinal pathogen
-ulcers/GERD
-pancreatitis
-cholecystitis
-obstruction
-tumors
-DM gastroparesis

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3
Q

Etiology of N/V

A

-CNS disorders: anxiety, tumors, HA
-acute or chronic pain
-excess food and alcohol
-pregnancy

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4
Q

Tx-induced causes of N/V

A

-chemo
-radiation
-anesthesia
-ab procedures

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5
Q

Drug-induced N/V

A

-anti-neoplastic agents
-opiod
-aspirin, NSAIDs
-iron
-some antibx (tetra, erythro)
-estrogens (high doses)
-anti-parkinsons meds
-SSRIs

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6
Q

Complications of N/V

A

-pt discomfort
-dehydration
-malnutrition
-aspiration pneumonia
-anxiety
-compromise therapy
-decreased QOL

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7
Q

Assessment of NV

A

-dehydration?
-severity on a scale of 0-10

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8
Q

Patho of nausea/vomitting

A

????

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9
Q

Non-pcol tx of NV

A
  1. determine cause and clear liuid + IV hydration
  2. Dietary
    -avoid fatty, fried, sweet, spicy, no hot (temp) foods
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10
Q

Nonpharma tx of NV

A

-avoid senses that trigger
-fresh air
-avoid sudden movements and bright lights
-acupressure 3 fingers above wrist

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11
Q

Relief band

A

-acupressure?
-helps tummy return to normal rhytym of 3 cycle/min
-nerve stimulation

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12
Q

Drug therapy for NV

A

-Antihistamines/anticholinergics
-phenothiazines
-serotonin antagonists
-Neurokinin-1 antagonists
-Butyrophenones
-Metoclopramide
-Corticosteroids
-Cannabinoids

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13
Q

Antihistamines-anticholinergics drugs

A

-Meclizine
-Dimenhydramine
-Scopolamine

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14
Q

Antihistamines-anticholinergics MOA

A

-block histamine/muscarinic receptors in CTZ and NTS centers
-interrupt visceral afferent pathways
-moderate to severe

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15
Q

Antihistamines-anticholinergics side effects

A

-drowsiness
-sedation
-dry mouth
-constipation
-blurred vision

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16
Q

Phenothiazines

A

-Prochloraperazine
-Promethazine
-Chlorpromazine

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17
Q

Phenothiazines MOA

A

-dopamine inhibition at CTZ
-std of care prior to 5-HT3 antagonists

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18
Q

phenothiazine side effects

A

-dizziness
-sedation
-dry mouth
-HYPOtension
-EPS

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19
Q

Serotonin antagonist Drugs

A

-ondansetron
-Franisetron
-Palonosetron
-Dolasetron

20
Q

Serotonin antagonist moa

A

-serotonin inhibition at CTZ, VC, and GI tract
-no suppository forms!

21
Q

serotonin antagonist side effects

A

-mild HA
-dizziness
-fatigue
-constipation
-maybe QT prolongation

22
Q

Ondansetron and Granisetron

A

-multiple dosage forms
-generic
-low cost

23
Q

Palonosetron

A

-longest DOA 40 h t1/2
-brand only $$
-no PO form

24
Q

Dolasetron

A

-PO only
-SS

25
Q

Neurokinin-1 ANTAgonists drugs

A

-Aprepitant
-Fosaprepitant
-Rolapitant

26
Q

NK-1 Antagonist moa

A

-neurokinin receptor inhibition at CTZ, VC, and GI
-used primarily for CINV

27
Q

NK-1 antagonist side effects

A

-fatigue, hiccups, constipation, dec appetite

28
Q

Butyrophenones

A

-Haloperidol and Droperidol
-dopamine inhibition at CTZ
-RARELY use risk of EKG probs

29
Q

Metoclopramide

A

-dopamine inhibition
-serotonin inhibition at high dose
-EPS at high dose, give w bendryl

30
Q

Corticosteroids (dexamethasone)

A

-inhibit cortical input into vomit center ?
-enhances the efficacy of any other antiemetics!

31
Q

Cannabinoids

A

-bind cannabinoid receptor in brain
-sedation, dry mouth, euphoria, dysphoria, flushing, visual changes

32
Q

Route admin RANKED

A
  1. PO tablet
  2. ODT
  3. PR
  4. IV
  5. IM
33
Q

Tx of motion sickness

A

-Scopolamine
-Dimenhydrinate
-Meclizine

34
Q

Scopolamine (transderm scop)

A

-apply patch before needed
-72 hours
-motion sickness

35
Q

Dimenhydrinate

A

-dramamine
-motion sickness
-50mg
-PO 30-60 min before

36
Q

Meclizine

A

-25mg
-Bonine, Dramamine less drowsy
-Zentrip
-PO 30-60 min before
-motion sickness

37
Q

Tx of NV secondary to gastroenteritis or pain

A

-ondansetron 4-8mg q8-12h PRN (IV/ODT/PO)
-Promethazine 12.5-25mg q4-6h prn (IV/IM/PO)

38
Q

Post-op NV (PONV)

A

-v common w older inhaled agents
-pt w multiple risk factors are highest risk
-most common complication associated w surgery

39
Q

Risk factors for PONV

A

-WOMAN
-nonsmoker
-hx of PONV
-hx of motion sickness

40
Q

Anesthetic risk factors of PONV

A

-intra opertaive use of volatile anesthetics (less w propofol)
-use of nitrous oxide
-type of surgery (laparoscopy, craniotomy, ENT)

41
Q

Tx of mod to high PONV

A

-1-2 agents
-only 1 if propofol is used
-5-HT3 antagonists are DOC
-all classes can be used
-drugs asmined at end of procedure

42
Q

tx of highest risk PONV

A

-always use 2 agents
-5-HT3 + metoclopramide or aprepitant

43
Q

Tx of breakthrough PONV

A

-use agent from dif class if within 6 hours of og dose
-amisulpride

44
Q

Aprepitant

A

-treat in pt at highest risk of PONV
-40mg PO 1-3 hours before anesthesia
-may be better than ondansetron 4mg at 24 and 48h post-op

45
Q

Amisulpride (Barhemsys)

A

-5-10mg IV infused over 1-2 mintures
-selective dopamine2 and 3 antagonist
-tx breakthrough PONV
-NOT indicated for prophylaxis
-QT prolongation

46
Q

Monitoring efficacy of antiemetic therapy

A

-volume
-freq and duration
-nausea rating
-ability to eat
-PRN doses
-QOL ratings

47
Q

monitoring toxicity of antiemetic therapy

A

-sedation/drowsiness
-dizziness
-diarrhea
-HA
-anticholinergic SE
-EPS

Therapeutics (78 decks)

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