Ch. 26 Nausea and Vomiting

Question 1

What are generally the two first-line medications for nausea and vomiting? What is the difference?

Answer 1

Zofran and Reglan

Equal effectiveness, Reglan with more side effects

Question 2

What is the preferred anti-emetic in kids and what is dosing?

Answer 2

Zofran
0.15mg/kg
Generally not less than 6 months to a year in age

8–15kg 2mg
15–30kg 4mg
>30kg 8mg

Question 3

What is the first-line anti-emetic in pregnancy?

Answer 3

Pyridoxine (Vit. B6) 10–25mg q6–8hrs, max 200mg/day

Doxylamine + Pyridoxime 20mg of each QPM

Question 4

What are second-line anti-emetics in pregnancy?

Answer 4

Diphenhydramine, meclizine, dimenhydrinate

Question 5

What are third-line anti-emetics in pregnancy?

Answer 5

Reglan 10mg
Watch out for adverse effects
(zofran maybe causes problems in early pregnancy)

Question 6

What is the 4th-line anti-emetic in pregnancy?

Answer 6

Zofran (avoid in early pregnancy when possible)

Question 7

What are the most common side effects of zofran?

Answer 7

Headache, fatigue, constipation, drowsiness

Question 8

When should zofran be avoided in pregnancy and why?

Answer 8

Use caution <10wks

Possible very low risk of orofacial defects or VSD, but overall thought to be very safe

Question 9

In pregnancy, what else should be done to help with nausea and vomiting apart from anti-emetics?

Answer 9

Give antacids such as Aluminum hydroxide or Calcium carbonate in preference to bismuth or bicarbonate
Also remember that IV fluids alone can provide significant treatment

Question 10

In general adult patients, what is the first-line anti-emetic in the ED and dosing?

Answer 10

Zofran

4–8mg per dose with max of 16mg

Question 11

How should zofran administration be changed for elderly patients?

Answer 11

Max dose of 8mg and infusion is done over 15 minutes to avoid QT prolongation.

Question 12

With what other drugs can zofran have a bad reaction?

Answer 12

Serotonergics

Can lead to serotonin syndrome

Question 13

What is the dosing of reglan?

Answer 13

10–20mg IV

Question 14

Which of the anti-emetics is also a prokinetic agent?

Answer 14

Reglan

Question 15

Which two anti-emetics are most known for extra-pyramidal symptoms?

Answer 15

Phenergan and Compazine

These are also more sedating

Question 16

What should the general algorithm be to giving anti-emetics in the ED?

Answer 16

Zofran 4mg with IV fluids then,
Repeat zofran 4mg then,
Reglan 10mg and repeat in 30 minutes then,
Consider droperidol then,
Give compazine

Question 17

Which anti-emetic should be first for headaches?

Answer 17

Reglan, then compazine, then droperidol