Dopamine Blockers & Anti-Emetics (Ex1)

Question 1

Dopamine blocker GI use

Answer 1

Stimulate gastric motility (prokinetic)
-increased lower esophageal sphincter tone
-stimulates peristalsis
-relaxes pylorus and duodenum

Question 2

Dopamine blockers contraindicated

Answer 2

Parkinson’s (have dopamine depletion/inhibition)

Question 3

Dopamine blocker drugs

Answer 3

Metoclopramide (reglan)
Domperidone
Droperidol (inapsine)

Question 4

Metoclopramine trade name

Answer 4

Reglan

Question 5

Reglan #1 choice for

Answer 5

Diabetic gastroparesis

Question 6

Reglan side effects (6)

Answer 6

Hypotension
Abd pain
NMS
Decreased plasma cholinesterase
Sedation
Muscle spasm

Question 7

Decreased plasma cholinesterase significance

Answer 7

Slows metabolism of succynylcholine, mivacurium, ester local anesthetics

Question 8

Reglan dose and timing

Answer 8

10-20 mg IV over 3-5 min

15-30 min prior to induction

Question 9

Droperidol trade name

Answer 9

Inapsine

Question 10

Inapsine adverse effects (2)

Answer 10

Extrapyramidal symptoms
NMS

Question 11

Droperidol N/V effectiveness

Answer 11

More effective than reglan
Equally effective as zofran

Question 12

Droperidol black box

Answer 12

Prolonged QT => torsades

Question 13

Droperidol dose

Answer 13

0.625-1.25 mg IV

Question 14

Serotonin released from

Answer 14

Chromaffin cells of small intestine => causes vomiting through 5HT3 receptors

Question 15

5HT3 antagonist drugs (3)

Answer 15

Ondansetron (zofran)
Granisetron (kyrtril)
Dolasetron (anzemet)

Question 16

Ondansetron side effects

Answer 16

HA
diarrhea
Slight QT prolongation

Question 17

Zofran E 1/2 time

Answer 17

4 hours

Question 18

Zofran timing of administration

Answer 18

Give at end of case

Question 19

Zofran dose

Answer 19

4-8 mg IV

Question 20

Corticosteroids MOA for N/V

Answer 20

Unknown: anti-inflammatory => less postop pain & less opioid use

Question 21

Corticosteroid drug

Answer 21

Dexamethasone (decadron)

Question 22

Dexamethasone trade name

Answer 22

Decadron

Question 23

Decadron onset and duration

Answer 23

Onset: 2 hrs
Duration: 24 hrs

Question 24

Decadron administration timing

Answer 24

Give about 2 hrs before closing

Question 25

Decadron side effects

Answer 25

-Perineal itching/burning (rapid IV)
-Risk of hyperglycemia (minimal with 1 dose)

Question 26

Decadron dose

Answer 26

4mg / 8mg / more to prevent airway swelling

Question 27

Scopolamine MOA

Answer 27

Muscarinic antagonist - competitive antagonist of ACh

Question 28

Scopolamine patch onset and peak

Answer 28

Onset: 4 hr
Peak: 8-24 hr

Question 29

Scopolamine dose

Answer 29

1 patch for 24-72 hr

Question 30

Scopolamine patch location

Answer 30

Transdermal absorption area
Post-auricular

Question 31

Bronchodilator effects (Beta agonists)

Answer 31

Activate cAMP
Decrease Ca++ entry and decrease sensitivity to Ca++

Question 32

Beta agonist airway effects

Answer 32

Directly relax smooth muscle

Question 33

How much drug reaches lungs from inhaler? Through ETT?

Answer 33

~12%

ETT admin decreases by 50-70%

Question 34

Beta agonist side effects (3)

Answer 34

Tremor
Tachycardia
Hyperglycemia

Question 35

Beta2 agonist drugs

Answer 35

Albuterol (proventil)
Levo-albuterol (xopenex)

Question 36

Benefit of xopenex over albuterol

Answer 36

Less tachycardia
But less effective