Antiemetics and Diuretics

Question 1

Odansetron Class

Answer 1

5-HT3 receptor antagonist

Question 2

Odansetron Use

Answer 2

postop nausea and vomiting, chemotherapy n/v, carcinoid syndrome

Question 3

Odansetron MOA

Answer 3

inhibits serotonin both peripherally on the vagus nerve terminals and centrally in the medulla’s chemoreceptor trigger zone

Question 4

Odansetron Dose

Answer 4

4 - 8 mg IV

Question 5

Odansetron Pharmacokinetics

Answer 5

Onset = rapid
DOA = 6 - 12 hours
Metabolism: liver (CYP450)
Elimination: kidney

Question 6

Odansetron Contraindications

Answer 6

Can prolong QT interval, do not admin with known prolongation or severe electrolyte abnormalities

Question 7

Odansetron Considerations

Answer 7

Side effects = headache, drowsiness, constipation

Question 8

Dexamethasone Class

Answer 8

Synthetic glucocorticoid steroid

Question 9

Dexamethasone Use

Answer 9

decreasing risk for postop n/v, edema, postop pain

Question 10

Dexamethasone MOA

Answer 10

↓ inflammation by inhibiting prostaglandin synthesis

Question 11

Dexamethasone Dose

Answer 11

4 - 12 mg IV

Question 12

Dexamethasone Pharmacokinetics

Answer 12

Onset = 10 - 30 min
DOA up to 72 hours
Metabolism: liver
Elimination: renal

Question 13

Dexamethasone Contraindications

Answer 13

systemic fungal infections, hypersensitivity

Question 14

Dexamethasone Considerations

Answer 14

Side effects = delayed wound healing, HPA axis suppression, hyperglycemia
Best to give at start of case

Question 15

Furosemide Class

Answer 15

loop diuretic

Question 16

Furosemide Use

Answer 16

treatment for hypertension, heart failure, peripheral and pulmonary edema, ICP and renal failure

Question 17

Furosemide MOA

Answer 17

inhibits reabsorption of sodium, chloride, and potassium in the ascending loop of Henle

Question 18

Furosemide Dose

Answer 18

Start with 5mg and up titrate as needed

Question 19

Furosemide Pharmacokinetics

Answer 19

Onset = 5 min 
DOA = 2 hours 
Metabolism = hepatic 
Elimination = renal

Question 20

Furosemide Contraindications

Answer 20

Hypersensitivity, severe dehydration, anuria

Question 21

Furosemide Considerations

Answer 21

Hypotension
Electrolyte abnormalities, low potassium, magnesium and chloride
Ototoxic
Potentiates neuromuscular blockers

Question 22

Mannitol Class

Answer 22

Osmotic diuretic

Question 23

Mannitol Use

Answer 23

treat increased ICP, and increase renal perfusion

Question 24

Mannitol MOA

Answer 24

• increases osmolarity of plasma that draws fluid in from the ICF and ECF and out of the brain
• Increased plasma mannitol is filtered, not reabsorbed, and draws fluids and electrolytes into the urine, increasing urine output

Question 25

Mannitol Dose

Answer 25

0.25 - 1g/kg over 30-60min

Question 26

Mannitol Pharmacokinetics

Answer 26

Onset = 15 min 
DOA = 3 - 6 hours 
Metabolism = not metabolized 
Elimination = renal (100% unchanged)

Question 27

Manntiol Contraindications

Answer 27

Severe renal disease, active head bleed and severe dehydration

Question 28

Mannitol Considerations

Answer 28

Risk for hypovolemia, electrolyte abnormalities, pulmonary edema