Aspiration Prophylaxis

Question 1

Reglan uses:

Answer 1

Treatment of diabetic gastroparesis,
GERD,
OB,
Usually given in preop for aspiration prophylaxis.

Question 2

Reglan (___)

Answer 2

(Metoclopramide)

Question 3

Vistaril MOA:

Answer 3

Blocks ACh in the vestibular apparatus.
Blocks H1 receptors in the solitary tract, antihistamine

Question 4

Pepcid (___)

Answer 4

(Famotidine)

Question 5

Vistaril uses:

Answer 5

N/V,
Pruritus (pregnancy),
Antianxiety

Question 6

Reglan MOA:

Answer 6

1. Gastrointestinal prokinetic
2. Increases LES tone,
   - Enhances response to ACh in upper GI tract to enhance gastric motility and accelerate gastric emptying/reducing gastric volume
3. antiemetic probably d/t dopamine antagonist effect.
4. Inhibition of dopamine receptors within the CNS - crosses the BB

Question 7

Why doesn’t Dr. Rogers give Reglan to anyone who is elderly?

Answer 7

They might have an undiagnosed movement disorder (inhibits dopamine receptors) and b/c it crosses the BBB, it makes them “swirly” like scopolamine.

Question 8

Reglan s/e:

Answer 8

Can cause:
Sedation,
Restlessness,
Extrapyramidal symptoms (tardive dyskinesia)

Question 9

Pepcid drug class and MOA:

Answer 9

H2-receptor antagonist
Inhibits gastric acid secretion/fluid volume and raises gastric pH

Question 10

Vistaril (___)

Answer 10

(Hydroxyzine)

Question 11

Which of the aspiration prophylaxis drugs DOES NOT ALTER GASTRIC FLUID pH?

Answer 11

Reglan — >it acts as a prokinetic

Question 12

Reglan Contraindicated in:

Answer 12

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

Question 13

Vistaril s/e:

Answer 13

sedation, & pain on injection

Question 14

By what MOA does Reglan provide some antiemetic action?

Answer 14

Probably due to antagonism of dopamine-agonist effects in the chemoreceptor trigger zone (CTZ).

Question 15

What is a potentially adverse effect of Reglan? And due to what?

Answer 15

Potential for Neuroleptic Malignant Syndrome
(d/t inhibition of dopamine receptor):
This is a life-threatening idiosyncratic (adverse) reaction to neuroleptic or antipsychotic drugs.

Question 16

Neuroleptic Malignant Syndrome symptoms:
And adverse effect of what med?

Answer 16

High fever
Autonomic disfunction
Sweating
Stupor
Unstable BP
Muscle rigidity

Similar to: Malignant Hyperthermia

Adverse effect of Reglan.

Question 17

Neuroleptic Malignant Syndrome patho:

Answer 17

caused by a reaction to drugs with dopamine receptor antagonistic properties —> causes increased Ca++ release from SR in cells.

Question 18

Neuroleptic Malignant Syndrome treatment:

Answer 18

Treatment:

1) stop suspected offending drug.

2) aggressive hydration

3) treat hyperthermia (cooling blankets and ice)

4) if severe, give bromocriptine (dopamine agonist) and dantrolene sodium (muscle relaxant that inhibits Ca++ release from SR)

this in adverse reaction that occurs with reglan

Question 19

Take caution when giving Vistaril to which patients?

Answer 19

Careful in HTN patient/outpatients:

it is mixed with 25 mg Ephedrine and only used to treat symptoms like N/V and itching; so don’t drive their BP up unnecessarily for that.

Question 20

Reglan inhibits ___ receptors within the CNS, which is why it is contraindicated in patients with what CNS disorders?

Answer 20

Dopamine;

Parkinson’s,
Restless leg syndrome,
Movement disorders related to dopamine inhibition or depletion..

Question 21

Why do we give Pepcid? When should we give it?

Answer 21

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

** Must give this ASAP in preop b/c it only affects the pH of what is produced AFTER it has been administered.

Question 22

Reglan dose:

Onset:

Duration:

Answer 22

5-10 mg IV in preop

Onset: 1-3 mins

(can be used as a rescue drug in PACU —>; 10-20 mg propofol is also good rescue)

Duration: 1-2 hrs

Question 23

Vistaril dose:

When do we give it?

Answer 23

25 mg mixed with Ephedrine 25 mg IM
- give 20 mins before the end of surgery.

(careful in HTN patients/outpatients)

Question 24

Characteristics of aspirated content that alter the severity of pulmonary complications following aspiration:

Answer 24

Volume of gastric contents

Acidityof the aspirated gastric contents.