Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Anaesthetic FRCA Primary - eLFH Pharmacology > eLFH - Antiemetic drugs > Flashcards

eLFH - Antiemetic drugs Flashcards

1
Q

How to assess risk for PONV after anaesthesia

A

Patient factors

Anaesthetic factors

Surgical factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Patient risk factors for PONV

A

Apfel score - in adults

POVOC score - in chlidren (Post Operative Vomiting of Children)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Apfel score components

A

Each score 1 point

Female
Non smoker
History of motion sickness or prev PONV
Use of post operative opioids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Apfel score interpretation

A

0 risk factors: 10% incidence of PONV

1 risk factor: 20% incidence of PONV

2 risk factors: 40% incidence of PONV

3 risk factors: 60% incidence of PONV

4 risk factors: 80% incidence of PONV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

POVOC score components

A

Each score 1 point

Surgery duration 30 mins or more
Age 3 years or older
Strabismus surgery
History of PONV in the child or relatives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

POVOC score interpretation

A

0 risk factors: 9% incidence of POV

1 risk factor: 10% incidence of POV

2 risk factors: 30% incidence of POV

3 risk factors: 55% incidence of POV

4 risk factors: 70% incidence of POV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anaesthetics risk factors for PONV

A

Volatile use

Nitrous oxide use

Opioid use

Duration of anaesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Surgical risk factors for PONV

A

Ophthalmological surgery (inc squint surgery)

Gynaecological surgery

ENT / middle ear surgery

Neurosurgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Number needed to treat for dexamethasone to reduced PONV

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Number needed to treat for TIVA to reduce PONV

A

5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Pathways involved in emesis

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Location of chemoreceptor trigger zone

A

Area postrema at base of fourth ventricle
Within medulla oblongata

Outside of blood brain barrier - able to detect toxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Location of nucleus tractus solitarius

A

Area postrema and lower pons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Location of vomiting centre

A

Medulla oblongata

Controls vomiting through stimulation by other pathways

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Strategies for managing PONV

A

Non pharmacological management

Pharmacological management

Anaesthetic alterations

Prophylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Non pharmacological methods to reduced PONV

A

Avoid gastric distention with bag mask ventilation

Minimise patient movement

Ensure adequate hydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Anaesthetic alterations to reduce PONV

A

TIVA

Regional anaesthesia

18
Q

Main types of pharmacological antiemetics used for PONV

A

Steroids
5-HT3 receptor antagonists (Serotonin)
H1 receptor antagonists (Histamine)
D2 receptor antagonists (Dopamine 2)
Neurokini-1 receptor antagonists

(TIVA)

19
Q

Steroid antiemetic examples

A

Dexamethasone

Technically 5-HT3 receptor antagonists are also steroids

20
Q

Dexamethasone mechanism of action

A

Unclear mechanism of antiemesis

21
Q

Caution with dexamethasone use

A

Diabetics

22
Q

Use of dexamethasone

A

Prophylaxis of PONV

Little use in acute management of PONV

Also associated with reduced post operative pain

23
Q

5-HT3 receptor antagonist examples (first generation)

A

Ondansetron

24
Q

5-HT3 receptor antagonist examples (second generation)

A

Palonosetron

Mainly used for N/V associated with chemotherapy

25
Q

Uses of Ondansetron

A

Antiemetic

Reduces post operative shivering and itch of opioids

If given prior to propofol may reduced injection pain

26
Q

Side effects of Ondansetron

A

Constipation

Prolonged QT

Serotonin syndrome risk with other serotonergic drugs

Headache

27
Q

Ondansetron pharmacokinetics

A

Large volume of distribution (140 L)

Moderately plasma protein bound (70 - 76%)

95% Hepatic metabolism and clearance
5% Renal clearance unchanged

Elimination half life ~ 3 hours

28
Q

H1 receptor antagonist examples

A

Cyclizine

Promethazine

29
Q

Cyclizine elimination half life

A

~ 20 hours

29
Q

Side effects of Cyclizine

A

Tachycardia
Dry mouth

Result from anticholinergic activity

30
Q

Administration of cyclizine

A

IV, IM or PO

IV cyclizine is diluted to 5 mg/ml

31
Q

D2 receptor antagonist examples

A

Metoclopramide

Prochlorperazine (mainly D2, but also H1 and muscarinic receptor action)

32
Q

Prochlorperazine pharmacokinetics

A

Large volume of distribution

Lipophilic

Highly membrane and protein bound

Terminal half life ~ 7 hours

33
Q

Side effects of prochlorperazine

A

Sedation
Dry mouth
Hypotension
Exacerbates Parkinson’s sx
Extrapyramidal SEs
Neuroleptic malignant syndrome

34
Q

Metoclopramide effects

A

Antiemetic

Prokinetic - therefore may be contraindicated in certain surgeries

35
Q

Side effects of Metoclopramide

A

Exacerbates Parkinson’s sx

Young females can cause oculogyric crisis - extrapyramidal SEs

36
Q

Neurokinin 1 receptor antagonist examples

A

Aprepitant

New class of antiemetic - not widely used

37
Q

NK1 receptor antagonist side effects

A

Headache
Constipation
Raised ALT

38
Q

Antiemetics commonly used in pregnancy

Note many have lack of evidence so are not licensed

A

Ondansetron

Dexamethasone

Cyclizine

Metoclopramide

Propofol

39
Q

Antiemetics NOT recommended for use in children

A

Metoclopramide

Prochlorperazine

Cyclizine

40
Q

Antiemetics used in children and doses

A

Ondansetron - 0.1 mg/kg (max 4 mg)

Dexamethasone - 0.15 mg/kg

Anaesthetic FRCA Primary - eLFH Pharmacology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions