Aspiration Prophylaxis Flashcards
Reglan uses:
Treatment of diabetic gastroparesis,
GERD,
OB,
Usually given in preop for aspiration prophylaxis.
Reglan (___)
(Metoclopramide)
Vistaril MOA:
Blocks ACh in the vestibular apparatus.
Blocks H1 receptors in the solitary tract, antihistamine
Pepcid (___)
(Famotidine)
Vistaril uses:
N/V,
Pruritus (pregnancy),
Antianxiety
Reglan MOA:
- Gastrointestinal prokinetic
- Increases LES tone,
- Enhances response to ACh in upper GI tract to enhance gastric motility and accelerate gastric emptying/reducing gastric volume - antiemetic probably d/t dopamine antagonist effect.
- Inhibition of dopamine receptors within the CNS - crosses the BB
Why doesn’t Dr. Rogers give Reglan to anyone who is elderly?
They might have an undiagnosed movement disorder (inhibits dopamine receptors) and b/c it crosses the BBB, it makes them “swirly” like scopolamine.
Reglan s/e:
Can cause:
Sedation,
Restlessness,
Extrapyramidal symptoms (tardive dyskinesia)
Pepcid drug class and MOA:
H2-receptor antagonist
Inhibits gastric acid secretion/fluid volume and raises gastric pH
Vistaril (___)
(Hydroxyzine)
Which of the aspiration prophylaxis drugs DOES NOT ALTER GASTRIC FLUID pH?
Reglan — >it acts as a prokinetic
Reglan Contraindicated in:
Bowel obstructions,
Parkinson’s,
Restless leg syndrome, or
Movement disorders related to dopamine inhibition or depletion
Vistaril s/e:
sedation, & pain on injection
By what MOA does Reglan provide some antiemetic action?
Probably due to antagonism of dopamine-agonist effects in the chemoreceptor trigger zone (CTZ).
What is a potentially adverse effect of Reglan? And due to what?
Potential for Neuroleptic Malignant Syndrome
(d/t inhibition of dopamine receptor):
This is a life-threatening idiosyncratic (adverse) reaction to neuroleptic or antipsychotic drugs.
Neuroleptic Malignant Syndrome symptoms:
And adverse effect of what med?
High fever
Autonomic disfunction
Sweating
Stupor
Unstable BP
Muscle rigidity
Similar to: Malignant Hyperthermia
Adverse effect of Reglan.
Neuroleptic Malignant Syndrome patho:
caused by a reaction to drugs with dopamine receptor antagonistic properties —> causes increased Ca++ release from SR in cells.
Neuroleptic Malignant Syndrome treatment:
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
Take caution when giving Vistaril to which patients?
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.
Reglan inhibits ___ receptors within the CNS, which is why it is contraindicated in patients with what CNS disorders?
Dopamine;
Parkinson’s,
Restless leg syndrome,
Movement disorders related to dopamine inhibition or depletion..
Why do we give Pepcid? When should we give it?
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.
Reglan dose:
Onset:
Duration:
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
Vistaril dose:
When do we give it?
25 mg mixed with Ephedrine 25 mg IM
- give 20 mins before the end of surgery.
(careful in HTN patients/outpatients)
Characteristics of aspirated content that alter the severity of pulmonary complications following aspiration:
Volume of gastric contents
Acidityof the aspirated gastric contents.
