Anti-emetics In brief

Question 1

Ondansetron significant concepts

Answer 1

Ondansetron- 4 mg IV before case ends, potential QT prolongation, adjust for hepatic impairment (phase 1 and 2 in the liver) 
Modulates vagal (stomach) and CTZ in NTS (ion channels)

Question 2

Palonsetron

Answer 2

0.75 mg, for chemo N/v because half life is 40 hours

Question 3

Dolasetron

Answer 3

Serotonin antagonist, 12.5 mg IV, liver and KIDNEY, administer 15 minutes before end of case, QT prolongation

Question 4

Scopolamine

Answer 4

1.5 mg transdermal patch behind the ear
many CNS side effects can be reversed with physostigmine
Muscarinic antagonist- competitively bonds and blocks Ach

Question 5

Droperidol

Answer 5

Dopaminergic (D2)
QT prolongation have to monitor! And causes sedation
“Drop it like it’s hot”

Question 6

Compazine/ prochlorperazine

Answer 6

Malignant neoplastic syndrome is a large concern, 5-10 mg IV before induction
Acts on histaminergic, muscarinic, dopaminergic, can cause extrapyramidal and anticholinergic effects

Question 7

Metoclopramide

Answer 7

Dopaminergic receptor antagonist
Centrally acting as dopamine receptor anatagonist in the CTZ
Contraindicated in pheochromocytoma
10 mg over 1-2 minutes
Ineffective at lower doses unless used in combo

Question 8

Midazolam

Answer 8

Give 2 mg IV

Question 9

Ephedrine

Answer 9

Sympthamimetic agent 10-25 mg IV for N/v associated with postural hypotension in PACU

Question 10

Promethazine

Answer 10

Histamine antagonist
Phenegran-risk for significant sedation
12.5-25 mg IM q4-q6

Question 11

Dexamethasone

Answer 11

Corticosteroid- 4-10 mg .2-.5 mg/Kg children, given at the beginning of a case
Can cause perineal priorities
Don’t give with uncontrolled infections, cerebral malaria, fungal infection, or current treatment with a live virus

Question 12

Aprepitant

Answer 12

Neurokinin 1 receptor antagonist (inhibits substance P at central and peripheral receptors)
40-80 mg PO period
If administered with dexamethasone reduce dose by half to maintain dexamethasone plasma concentrations

Question 13

Dimenhydrinate

Answer 13

Dramamine-histamine antagonist
Competes with histamine and blocks CTZ and vestibular stimulation
50-100 mg IV/IM Q4
Commonly causes sedation.