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Top Drawer Medications > Antiemetics > Flashcards

Antiemetics Flashcards

1
Q

PONV defined as N/V within _______ hours of surgery

A

24`

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2
Q

Along with pain,____ is the highest complaint and leading cause of unanticipated hospital admission after outpatient surgery

A

PONV

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3
Q

__% of patients without prophylaxis have nausea who have general anesthesia

A

40

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4
Q

___% of high risk patients without prophylaxis experience PONMV

A

80

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5
Q

Risk Factors for PONV

A

patient factors: female, nonsmoker, hx PONV/motion sickness

surgical factors: long sx, certain procedures( GYN, laparoscopy, ENT, breast/plastics)

anesthetic factors: IA, N2O, neostigmine, opioids

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6
Q

Risk Factors for PONV in kids

A

weak association with age, greatest association is the surgical procedure :
- hernia,
- tonsils/adenoids/
- strabismus surgery,
- male genitalia

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7
Q

T or F: risk for PONV decreases with age

A

F - increases

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8
Q

PONV is associated with: (6)

A
  • dehydration
  • electrolyte abnormalities
  • wound dehiscence, bleeding
  • airway compromise
  • unplanned admissions
  • pt discomfort
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9
Q

Motion sickness is caused by stimulation of the

A

Vestibular apparatus

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10
Q

T or F: Opioids and morphine increase vestibular sensitivity to motion

A

T`

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11
Q

pt admionistered scopalamine may have visual disturbances due to

A

anisocoria (unequal pupil size)

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12
Q

indication scopalamine

A
  • motion induced nausea and PONV
  • trauma pt
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13
Q

Zofran acts on ___________ in GI tract and _________

A

Selective 5-HT3 receptor antagonist

Chemoreceptor Trigger Zone

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14
Q

S/E of Zofran

A

HA and diarrhea

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15
Q

cautious using zofran in what patients

A

prolonged QT interval: can lead to torsades

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16
Q

T or F: zofran safe in OB

A

F- questionable

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17
Q

Indications for Zofran

A

Preventative and rescue treatment for N/V,
used in chemo

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18
Q

Zofran

dose
DOA
metabolism

A

Dose: 4 mg IV
duration: 4-6 hours
extensive hepatic metabolism

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19
Q

Zofran (______)

A

Ondansetron

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20
Q

Decadron (________)

A

Dexamethasone

21
Q

indicatios for decadron

A

Nausea and Vomiting prevention, ENT, traumatic intubations…..

22
Q

MOA of decadron as antiemetic

A

Mechanism is unclear, proposed to centrally inhibit prostaglandin synthesis and control endorphin release

23
Q

S/E of decadron

A

genital itching/burning (give after patient asleep), hyperglycemia

24
Q

cautious using decadron in which patients

A

Careful in diabetics, wound healing issues

25
Q

dose and DOA of decadron for N/V/ PONV

A

Dose: 4-12 mg IV on induction
duration: about 24 hours

26
Q

Phenergan (________)

A

Promethazine

27
Q

MOA of phenergan

A
  • Phenothiazine,
  • H1 receptor antagonist (antihistamine),
  • Anticholinergic action (motion sickness),
  • D2 antagonist in CTZ
28
Q

why is phenergan considered a First-generation H1 receptor antagonist

A

due to sedation potential

29
Q

phenergan indications

A

N/v anxiety

30
Q

S/E of Phenergan

A
  • Causes sedation
  • potentiates sedative effects of benzos and opioids (Cesarean delivery)
  • hypotension
  • extrapyramidal symptoms (Akathisia)
31
Q

phenergan

dose
onset
DOA

A

Dose: 12.5-25 mg IV (diluted and given slowly in good IV);
onset: 3-5 min
duration: 4-6 hours

32
Q

Factors associated with pulmonary complications of aspiration: (2)

A
  1. Volume of gastric contents
  2. Acidity of the aspirated gastric contents
33
Q

REGLAN (______)

A

METOCLOPRAMIDE

34
Q

MOA of reglan and effetcs

A

MOA:

  • Antiemetic action probably due antagonism dopamine-agonist effects in the chemoreceptor trigger zone
  • Inhibition of dopamine receptors within the CNS….. Crosses the BBB

Effects:
- Gastrointestinal prokinetic,
- increases LES tone,
- enhances response to AcH in upper GI tract to enhance gastric motility and accelerate gastric emptying/reducing gastric volume

35
Q

S/E of reglan

A

Can cause sedation, restlessness, extrapyramidal symptoms (tardive dyskinesia)

36
Q

C/I of Reglan

A

Bowel obstructions and
Parkinson’s,
Restless leg syndrome, or
Movement disorders related to dopamine inhibition or depletion

37
Q

indications for reglan

A
  • Treatment of diabetic gastroparesis
  • OB
  • GERD
  • Usually given in preop for aspiration prophylaxis
38
Q

t or f: reglan alters gastric fluid pH

A

F – Does not alter gastric fluid pH

39
Q

reglan:

dose

onset

DOA

A

Dose: 5-10 mg IV in preop

onset: 1-3 minutes, can be used as a rescue drug in PACU

duration: 1-2 hours

40
Q

what adverse reaction can reglan cause

A

Potential for Neuroleptic Malignant Syndrome

41
Q

Pepcid (_________)

A

Famotidine

42
Q

MOA of pepcid

A
  • H2 - receptor antagonist,
  • inhibits gastric acid secretion/fluid volume and
  • raises gastric pH
43
Q

why is pepcid given in pre-op?

A

Given in preop to decrease risk of pulmonary aspiration in at risk patients

44
Q

dose and onset of pepcid

A

Dose: 20 mg IV
Onset: 30 min – 1 hour

45
Q

Vistaril (______)

A

Hydroxyzine

46
Q

MOA of Hydroxyzine

A

Blocks Ach in the vestibular apparatus, blocks H1 receptors in the solitary tract, antihistamine

47
Q

uses for vistaril

A

N/V, pruritus (pregnancy), antianxiety

48
Q

S/E of vistaril

A

sedation, pain on injection

49
Q

Vistaril

dose:

A

25 mg mixed with Ephedrine 25 mg IM 20 minutes before the end of surgery (careful in HTN patients/outpatients)

Top Drawer Medications (13 decks)

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