Anti-emetics In brief Flashcards
Ondansetron significant concepts
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)
Palonsetron
0.75 mg, for chemo N/v because half life is 40 hours
Dolasetron
Serotonin antagonist, 12.5 mg IV, liver and KIDNEY, administer 15 minutes before end of case, QT prolongation
Scopolamine
1.5 mg transdermal patch behind the ear
many CNS side effects can be reversed with physostigmine
Muscarinic antagonist- competitively bonds and blocks Ach
Droperidol
Dopaminergic (D2)
QT prolongation have to monitor! And causes sedation
“Drop it like it’s hot”
Compazine/ prochlorperazine
Malignant neoplastic syndrome is a large concern, 5-10 mg IV before induction
Acts on histaminergic, muscarinic, dopaminergic, can cause extrapyramidal and anticholinergic effects
Metoclopramide
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
Midazolam
Give 2 mg IV
Ephedrine
Sympthamimetic agent 10-25 mg IV for N/v associated with postural hypotension in PACU
Promethazine
Histamine antagonist
Phenegran-risk for significant sedation
12.5-25 mg IM q4-q6
Dexamethasone
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
Aprepitant
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
Dimenhydrinate
Dramamine-histamine antagonist
Competes with histamine and blocks CTZ and vestibular stimulation
50-100 mg IV/IM Q4
Commonly causes sedation.