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620 Advanced Pharmacology > Antiemetics > Flashcards

Antiemetics Flashcards

1
Q

What are the 3 mechanisms of Glucocorticoids?

A
  1. Anti-inflammatory effects
  2. Direct central action at the solitary tract nucleus
  3. Interaction with the neurotransmitter serotonin, receptor proteins tachykinin (NK-1 & NK-2, alpha-adrenaline, prostaglandins)
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2
Q

Where does 1/3 of aspiration occur

A

1/3 occurs during laryngoscopy & intubation
1/3 occurs during the procedure
1/3 occurs during extubation

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3
Q

What is the volume that determines aspiration pneumonitis

A

15 - 25 mLs

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4
Q

What is the #1 thing patients complain about after surgery?

A
  1. emesis
  2. gagging on the ETT during extubation
  3. pain
  4. intraoperative recall
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5
Q

True or False: if your patient experiences nausea or has emesis within 24 hrs of a surgical procedure that required anesthesia, your patient was considered “under anesthesia”

A

True

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6
Q

What is the most important complaint following surgery & the leading cause of unanticipated hospital admissions following outpatient surgery

A

PONV

- along with pain

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7
Q

Where is the vomiting center found?

A

Lies in the nucleus tractus solitarus within the medulla & parts of the reticular formation

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8
Q

The vomiting center receives sensory input from what three locations:

A
  1. Chemoreceptor trigger zone (CTZ)
  2. Vestibular apparatus
  3. GI tract
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9
Q

How does the CTZ receive noxious stimuli ?

A

It detects noxious chemical in the bloodstream because it is outside the BBB

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10
Q

Once the vomiting center is activated how is the signal transmitted?

A

Efferent signals travel via CN. V, VII, IX, X, & sometimes XII through the vagal parasympathetic fibers & sympathetic chain to skeletal m. through alpha motor neurons

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11
Q

True or False: Treating PONV is easier than preventing it.

A

False.
It is easier to prevent PONV than actually treating it.
- this is completely the anesthesia role

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12
Q

What are the most common patient risk factors for PONV?

A
  1. Female
  2. Non-smoker
  3. Hx of motion sickness
  4. Previous PONV
  5. Youth > elderly
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13
Q

What are 5 anesthetic risk factors for PONV?

A
  1. Halogenated agents
  2. N2O
  3. Opioids
  4. Etomidate
  5. Neostigmine
  • Also the longer the procedure the > the risk
  • Laparotomies, GYN, & Laparoscopic procedures
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14
Q

Why do women have an increased risk of PONV?

A

Progesterone & estrogen in the CTZ or on the vomiting center itself

  • PONV varies within the menstrual cycle & is reduced after menopause
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15
Q

When should you give Decadron and why?

A

Give during induction once the patient is asleep b/c it will feel like their genitals are on fire

(even though the text says to give 1 hr prior to anesthesia)

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16
Q

When might you see an increase in blood glucose after giving decadron?

A

6-12 hrs post-op

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17
Q

When should you administer zofran?

A

Ondansetron 4mg should be given 30 minutes of the case finishing up

18
Q

When is Zofran not effective?

A

Serotonin receptor antagonists are NOT effective in the treatment of motion-induced nausea & vomiting

19
Q

What is the gold standard antiemetic?

A

(Ondansetron) Zofran

20
Q

If you give the higher dose of Zofran what can happen?

A

QT prolongation & Torsades de pointes

21
Q

If you combine Zofran with Decadron & Emend what will happen?

A

the efficacy increases

= Synergistic effect

22
Q

Neurokinin-1 receptor antagonists

A

(Emend) Aprepitant
(Emend) Fosaprepitant = pro-drug
(Akynzeo) Netupitant
(Varubi) Rolapitant (P/NK-1 receptor antagonists)

  • Work if your patient has a hx of emesis & motion sickness
23
Q

What are the common side effects of scopolamine?

A
  • Blurred vision
  • Dizziness
  • Dry mouth
24
Q

What is the only drug used for gastroparesis?

A

(Metoclopramide) Regalan

- gastrointestinal prokinetic drug that increases lower esophageal sphincter tone & stimulates motility

25
Q

Where does (Metoclopramide) Reglan work and what should you be cautious of?

A

Reglan is a Dopaminergic (D2) & serotonergic (5-HT3), peripheral 5-HT4 at higher doses antagonists that works in the area of postrema

  • Contraindicated in Parkinson’s disease b/c of EPS &
    patients with bowel obstruction
  • Patients with restless leg synd.
  • patients with movement disorders related to dopamine inhibition or depletion
26
Q

What are the most common EPS (extrapyramidal symptoms)

A
  • Rigid muscles in the limbs
  • Tremors
  • Increased salivation
  • Changes in one’s posture or gait
  • 20-40% of pts taking antipsychotics develop Parkinsonian symptoms
27
Q

If you give your patient Reglan and they become hypotensive & Tachycardic what do you want to give?

A

Phenylephrine

28
Q

Droperidol has a black box warning for what?

A

association with QT prolongation

29
Q

True or False: Droperidol is not as effective as Decadron or Zofran in preventing & treating PONV

A

False.

If there is no concern for your patient having dopamine antagonism Droperidol is just AS effective

30
Q

What are the most commonly used H2 receptor antagonists and what are they used for?

A

Most commonly used:

  • Cimetidine (Tagamet)
  • Famotidine (Pepcid)
  • Ranitidine (Zantac)
  • Nizatidine (Axid)

All used for GERD

31
Q

What is the most potent H2 receptor antagonist?

A

Famotidine is the most potent

- Cimetidine is the least potent

32
Q

If you discontinue your H2 receptor antagonist with is a side effect to be expected?

A

Discontinuation lead to hyper-secretion of gastric acid

33
Q

Oral antacids contain aluminum and this may interfere with what?

A

Interfere with the absorption of tetracyclines and poss. digoxin

34
Q

What drug class is the most effective drugs at controlling gastric acidity & volume?

A

Proton pump inhibitors (PPI)

- Omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole

35
Q

What is the mechanism behind gastric acid secretion and PPI Moa?

A

The final step in gastric acid secretion is the membrane enzyme proton pump that moves hydrogen ions across the gastric parietal cell membrane in exchange for POTASSIUM IONS**

PPI stops the pump for transporting

36
Q

What is Aminophylline?

A

A bronchodilator

  • relieves cough, wheezing, SOB, & trouble breathing by increasing the flow of air into the bronchial tubes
  • works as a phosphodiesterase inhibitor (inhibits cAMP = bronchodilation)**
  • it CONTROLS symptoms but does NOT CURE them**
37
Q

Why is Aminophylline not used very often?

A
  • Cannot take with caffeine, coffee, tea, chocolate

- NTI & has a ton of adverse side effects that increase 30-day mortality rates

38
Q

Chronic treatment of asthma with a Beta 2 agonists can lead to what?

A

Tachyphylaxis

39
Q

Ipratropium (Atrovent)

A

Inhaled antimuscarinic (short acting)

  • related to Atropine
  • given with an MDI (meterdosed inhaler) to promote bronchodilation w/o appreciable systemic anticholinergic effects
40
Q

What is Doxapram

A

Respiratory agent that stimulates the CNS

- acts centrally & peripherally to augment breathing efforts (increase TV & increase MV)

41
Q

Which agent primarily targets the chemoreceptor trigger zone?

a. Ondansetron
b. Scopolamine
c. Dexamethasone
d. Hydroxyzine

A

a. Ondansetron = 5-HT3 receptor antagonist
- treats PONV by antagonizing serotonin receptors in 2 places: CTZ (area of postrema) & peripheral receptors in the GI tract & vagus n.

42
Q

A patient with Parkinson’s disease is scheduled for a mastoidectomy under general anesthesia. Select the MOST appropriate antiemetic drug classes to reduce the risk of postoperative nausea & vomiting (Select 2):

a. Anticholinergics
b. Phenothiazine
c. Neurokinin-1 antagonists
d. Butyrophenones

A

a. Anticholinergics
c. Neurokinin-1 antagonists

  • Antidopaminergic drugs are contraindicated in patients w/ Parkinson’s they can exacerbate extrapyramidal effects. These drugs include:
    • Metoclopramide
    • Butyrophenones (Haloperidol & Droperidol)
    • Phenothiazines (promethazine)
  • Anticholinergics are very useful for patients undergoing middle ear surgery

620 Advanced Pharmacology (9 decks)

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