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Top Drawer > Antiemetics/Aspiration Prophylaxis > Flashcards

Antiemetics/Aspiration Prophylaxis Flashcards

1
Q

What is PONV?

A
  • postop nausea/vomiting
  • N/V within 24 hours of surgery
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2
Q

What are the highest complaints and leading cause of unanticipated hospital admission after outpatient surgery?

A
  • pain
  • PONV
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3
Q

PONV occurs in _____% of patients without prophylaxis after general anesthesia

A

40%

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4
Q

PONV occurs in _____% of HIGH RISK patients without prophylaxis

A

80%

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5
Q

What are some patient risk factors for PONV?

A
  • female (strongest indicator)
  • nonsmoker
  • hx of PONV or motion sickness
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6
Q

What are some surgical risk factors for PONV?

A
  • longer procedures
  • GYN procedures
  • larparoscopic procedures
  • ENT procedures
  • breast/plastics procedures
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7
Q

What are anesthetic risk factors for PONV?

A
  • inhalational agents
  • nitrous (esp in women under 35yo)
  • neostigmine
  • opioids
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8
Q

What is the difference in PONV between kids and adults?

A
  • kids: weak association with age
  • adults: risk decreases with age
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9
Q

What is the greatest association to PONV in children?

A

the surgical procedure
- hernia; tonsils/adenoids; strabismus sx; male genitalia

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10
Q

What factors is PONV associated with?

A
  • dehydration
  • electrolyte imbalance
  • wound dehiscence
  • bleeding
  • airway compliance
  • UNPLANNED ADMISSIONS
  • PATIENT DISCOMFORT
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11
Q

What type of approach should we consider when preventing PONV?

A

multimodal approach

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12
Q

When is scopalamine used?

A
  • prevent motion induced nausea
  • PONV
  • trauma patients
  • motion sickness from simulation of vestibular apparatus
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13
Q

What agents increase vestibular sensitivity to motion?

A
  • opioids
  • morphine
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14
Q

How is scopalamine administered?

A

transdermally

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15
Q

What are the effects of administering scopalamine transdermally?

A
  • sustained plasma concentration
  • less sedation
  • drying of secretions
  • cycloplegia (paralysis of ciliary muscle of the eye; dilation of pupil and paralysis of accommodation)
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16
Q

What is cycloplegia and what agent cause produce this as a side effect?

A
  • paralysis of ciliary muscle of the eye; dilation of the pupil and paralysis of accommodation
  • transdermal scopalamine can cause this
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17
Q

What is the mechanism of action of ondansetron?

A

selective 5-HT3 receptor antagonist in the GI tract and chemoreceptor trigger zone

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18
Q

When is ondansetron used?

A
  • preventative and rescue treatment for N/V; used in chemo
  • lots of debate on when to give it
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18
Q

What are some side effects of ondansetron?

A
  • headaches
  • diarrhea
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18
Q

Ondansetron Dosing

A

4 mg IV

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18
Q

Ondansetron duration

A

4-6 hours

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19
Q

What is a potential cardiac effect with ondansetron?

A

prolonged QT interval (can lead to torsades)

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20
Q

How is ondansetron extensively metabolized?

A

hepatic metabolism

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21
Q

T/F: ondansetron use in OB is questionable

A

true

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22
Q

What is dexamethasone used for?

A
  • N/V prevention
  • ENT
  • traumatic intubations
  • lower surgical inflammation
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23
Q

What class of drug is dexamethasone?

A

corticosteroid

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24
Q

What are the side effects of dexamethasone?

A
  • gential itching/burning (give to patient while asleep, not awake!!)
  • hyperglycemia (however new studies say no)
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25
Q

Careful use with dexamethasone in ________ because of hyperglycemia

A

diabetics
- they can potentially have wound healing issues

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26
Q

Dexamethesone Dosing

A

4 - 12 mg on induction

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27
Q

Dexamethasone duration

A

24 hours

28
Q

Dexamethasone can be used in combination with ____________

A

antiemetics

29
Q

What is the mechanism of action of dexamethasone?

A
  • mechanism is actually unclear
  • may centrally inhibit prostaglandin synthesis and control endorphin release
30
Q

What is the trade name of ondansetron?

A

Zofran

31
Q

What is the trade name of dexamethasone?

A

Decadron

32
Q

What is the trade name of promethazine?

A

Phenergan

33
Q

Which antiemetic is no longer on US formulary?

A

IV phenergan (promethazine)

34
Q

What is promethazine used for?

A
  • N/V
  • anxiety
35
Q

What are the side effects of promethazine?

A
  • sedation
  • potentiates sedative effects of benzos and opioids (C section)
  • hypotension
  • extrapyramidal symptoms (Akathisia)
36
Q

Promethazine Dosing

A

12.5 - 25 mg IV
- DILUTED and given SLOWLY

37
Q

Promethazine onset and duration

A

Onset: 3-5 min
Duration: 4-6 hours

38
Q

Promethazine is considered a ___________________ due to sedation potential

A

first-generation H1 receptor antagonist

39
Q

What class is promethazine under?

A
  • phenothiazine
40
Q

What are the mechanisms of action of promethazine?

A
  • H1 receptor antagonist (antihistamine)
  • anticholinergic action (motion sickness)
  • D2 antagonist in chemoreceptor trigger zone
41
Q

What two factors are associated with pulmonary complications of aspiration?

A
  • volume of gastric acid contents
  • acidity of aspirated gastric contents
42
Q

What is the trade name of metoclopramide?

A

Reglan

43
Q

Metoclopramide is considered a gastrointestinal ____________

A

gastrointestinal prokinetic

44
Q

How does metoclopramide work?

A
  • increases LES tone
  • enhances repsonse to ACh in upper GI tract to enhance gastric motility and accelerate gastric emptying, thus reducing gastric volume
45
Q

Where does the antiemetic action of metoclopramide come from?

A

antagonism dopamine-agonist effects in the chemoreceptor trigger zone

46
Q

What action does metaclopramide have on the CNS?

A

inhibition of dopamine receptors within the CNS (crosses the BBB)

47
Q

What are the side effects of metaclopramide?

A
  • sedation
  • restlessness
  • extrapyramidal symptoms (tardive dyskinesia)
48
Q

When is metaclopramide contraindicated?

A
  • bowel obstruction
  • Parkinson’s disease
  • restless let syndrome
  • movement dysorders related to dopamine inhibition or depletion
49
Q

What is metaclopramide used for?

A
  • preop for aspiration prophylaxis
  • treatment of diabetic gastroparesis
  • GERD
  • OB
50
Q

T/F: Metaclopramide alters gastric fluid pH

A

false
- metaclopramide does NOT alter gastric fluid pH

51
Q

Metaclopramide Dosing

A

5-10 mg IV in preop

52
Q

Metaclopramide onset and duration

A

Onset: 1-3 min
Duration: 1-2 hours

53
Q

Metaclopramide has potential for _____________ syndrome

A

Neuroleptic Malignant Syndrome

54
Q

What is neuroleptic malignant syndrome?

A
55
Q

How is neuroletpic malignant syndrome treated?

A
56
Q

What other syndrome is neuroleptic malignant syndrome similar to?

A
57
Q

What are the five hyperthermic toxidromes that can occur in anesthesia?

A
  • sympathomimetic
  • anticholinergic
  • serotonin syndrome
  • neuroleptic malignant
  • malignant hyperthermia
58
Q

What drug class does famotidine fall under?

A

H2 receptor antagonist

59
Q

What is the trade name of famotidine?

A

Pepcid

60
Q

How does famotidine work?

A
  • inhibits gastric acid secretion/fluid volume
  • raises gastric pH
61
Q

Why would famotidine be given in anesthesia?

A

given in preop to decrease risk of pulmonary aspiration in risk patients

62
Q

Famotidine Dose

A

20 mg IV

63
Q

Famotidine onset

A

Onset: 30 min - 1 hour

64
Q

What is the trade name of hydroxyzine?

A

Vistaril

65
Q

What is the mechanism of action of hydroxyzine?

A
  • blocks ACh in the vestibular apparatus
  • blocks H1 receptors in the solitary tract
66
Q

What drug class does hydroxyzine fall under?

A

antihistamine

67
Q

When is hydroxyzine used?

A
  • PONV
  • pruritus (pregnancy)
  • antianxiety
68
Q

What are the side effects of hydroxyzine?

A
  • sedation
  • pain on injection
69
Q

Hydroxyzine Dosing

A
  • 25 mg IV mixed with Ephedrine
  • 25 mg IM 20 min before the end of surgery
70
Q

What cases should we be careful in with hydroxyzine use?

A

hypertension

71
Q

T/F: there is a current national shortage of hydroxyzine

A

true

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