ANTIEMETICS

Question 1

· Ondansetron (Zofran)

Answer 1

o Dose Range: 4mg IV, 8-16mg PO, 8mg IV for pruritus from neuraxial morphine, 8mg max for liver disease.
o Concentration: 2mg/mL
o Onset: rapid
o Duration: 6-12 hours
o C/I: responsiveness decreased by variations in CYP2D6 activity. Congenital QT prolongation may lead to torsades de pointes.
o Precautions: Administer 30min prior to emergence. ECG monitor for patients with hypoK+, hypoMg2+, CHF, bradyarrhythmias, or other QT interval prolonging meds.

Question 2

· Dexamethasone (Decadron)

Answer 2

-PONV Adult: 4-8mg
-PONV Peds: 0.25mg/kg max of 4mg.
-ENT Peds: 8-12 mg
-Cranies/backs; cerebral/spinal edema: 10mg
-Shock: up to 40mg
-Airway Edema: 4-12mg (ENT or difficult intubations)
“4mg = 4mg Ondansetron (Zofran) = 0.625 mg Droperidol”
o Concentration: 4mg/mL
o Onset: 2 hours. Give after induction.
o Duration: Efficacy persists for 24 hours.
o Anesthesia Indications: prophylaxis for PONV and allergic reactions, airway swelling, difficult intubations, and EENT cases. To decrease cerebrospinal swelling in crani and back surgeries. Larger doses help with shock.

Question 3

· Metoclopramide (Reglan) (Uncommon at ARMC)

Answer 3

o Dose Range:10-20 mg IV over 3-5 min Q6 (admin 15-30 minutes prior to induction). Usually given with Pepcid.
o Concentration: 5mg/mL
o Onset: 3 minutes
o Duration: 1-2 hours
o C/I: extrapyramidal symptoms, parkinsonism, seizure disorder, GI obstruction.
o Precautions: elderly re: agitation