Antiemetic/PONV Prophylaxis Drugs Flashcards

1
Q

Diphenhydramine (Benadryl)

MOA

A

Receptor
H1

MOA
Vestibular system; airway SM; cardiac endothelial cells

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2
Q

Diphenhydramine (Benadryl)

Dosing

A

IV: 25-50 mg

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3
Q

Diphenhydramine (Benadryl)

Onset
Peak
Half-life

A

Onset
Rapid

Peak
2 hrs

Half-life
7-12 hrs

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4
Q

Diphenhydramine (Benadryl)

Side Effects
&
Considerations

A

Sedation/drowsiness
Stimulates ventilation

Anticholinergic effects;
blurred vision, urinary retention,
dry mouth

Anti-emetic rescue

Anti-pyretic;
allergic response treatment

May have anti-emetic properties d/t inhibiting the oculo-emetic reflex

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5
Q

Promethazine (Phenergan)

MOA

A

Receptor
H1

MOA
Vestibular system; airway SM; cardiac endothelial cells
Class - Phenothiazine

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6
Q

Promethazine (Phenergan)

Onset
Half-life

A

Onset
5 min

Half-life
9-16 hrs

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7
Q

Promethazine (Phenergan)

Side Effects
&
Considerations

A

Anticholinergic effects;
blurred vision, urinary retention, dry mouth

Sedation/drowsiness;
Local site extravasation (Age <2); respiratory depression

Anti-emetic rescue

Reduces peripheral pain levels d/t anti-inflammatory effects

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8
Q

Metoclopramide (Reglan)

Drug Class
&
MOA

A

Drug Class
Dopamine Antagonist

MOA
Blocks D1 & ↑ doses block 5HT3 in CTZ in CNS; enhances Ach in ↑GI tract to increase motility

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9
Q

Metoclopramide (Reglan)

Dosing

A

IV: 10-20 mg
over 3-5 min

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10
Q

Metoclopramide (Reglan)

Onset

A

IV: 15-30 min

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11
Q

Metoclopramide (Reglan)

Side Effects
&
Considerations

A

Abd. cramping (rapid IV); muscle spasms; ↓BP; ↑prolactin release

Neuroleptic
Malignant Syndrome: ↑temp, muscle rigidity, ↑HR, confusion

↓ Cholinesterase levels: slows metabolism of succinylcholine, mivacurium, ester LA

Only drug FDA-approved for DM gastroparesis

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12
Q

Droperidol (Inapsine)

Drug Class
&
MOA

A

Drug class
Butyrophenones

MOA
Dopamine anatagonist
Blocks D2 in CTZ in CNS

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13
Q

Droperidol (Inapsine)

Dosing

A

IV: 0.625-1.25 mg

Anti-emetic

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14
Q

Droperidol (Inapsine)

Side Effects
&
Considerations

A

Extrapyramidal symptoms

Prolonged QTc intervals/torsades
in higher doses

More effective than metoclomapride & equally effective to 4 mg ondansetron

Avoid in other CNS depressants: barbituates, opioids, GA

Neuroleptic
Malignant Syndrome:
↑temp, muscle rigidity,
↑HR, confusion

Black box warning;
drug interactions to
amiodarone, diuretics, sotalol, mineralcorticoids, CCB

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15
Q

Ondansetron (Zofran)

Drug Class
&
MOA

A

Drug Class
5HT3 antagonist

MOA
Blocks 5HT3 PNS on vagal nerve terminals & CTZ in CNS

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16
Q

Ondansetron (Zofran)

Dosing

A

IV: 4-8 mg

17
Q

Ondansetron (Zofran)

Onset
Peak
Duration
Half-life

A

Onset
Rapid
Peak
15-30 min
Duration
4 hrs
Half-life
4 hrs

18
Q

Ondansetron (Zofran)

Side Effects
&
Considerations

A

HA; diarrhea

Slight QTc prolongation

Can be given prior to
neuraxial anesthesia
to prophylactically
treat hypotension

19
Q

Dexamethosane (Decadron)

Drug Class
&
MOA

A

Drug Class
Corticosteriod

MOA
Anti-inflammatory by
neutrophil suppression,
↓inflammatory mediators &
reverses capillary permeability;
antiemetic MOA unknown

20
Q

Dexamethasone (Decadron)

Dosing

A

Anti-emetic
IV: 4-8 mg
Inflammation
IV: 12-16 mg

21
Q

Dexamethasone (Decadron)

Onset
Peak
Duration
Half-life

A

Onset
Rapid
Peak
5-10 min
Duration
Short
Half-life
1-5 hrs

22
Q

Dexamethoson (Decadron)

Side Effects
&
Considerations

A

↑ BG; may not be clinicaly relevant;
perineal burning/itching

Increase effectiveness for
5HT3 antagonists & droperidol

Anti-inflammatory may result in
less post-op pain

23
Q

Scopolamine

Drug Class
&
MOA

A

Drug Class
Anti-Ach;
muscarinic antagonist

MOA
Blocks Ach at parasympathetic sites in smooth muscle, secretory glands, & CNS

24
Q

Scopolamine

Dosing

A

Topical: 1 Patch
140 mcg priming dose;
1.5 mg over 72 hrs

25
Q

Scopolamine

Onset
Peak
Duration

A

Onset
4 hrs
Peak
8-24 hrs
Duration
24-72 hrs

26
Q

Scopolamine

Side Effects
&
Considerations

A

Mydriasis;
Sedation;
Crosses BBB
*Apply 4 hrs prior to Sx