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Pharm Fall 2019 > Ex5 Antiemetics > Flashcards

Ex5 Antiemetics Flashcards

1
Q

N/V occurring within 24h of surgery

A

Postop Nausea and vomiting (PONV)

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2
Q

Early PONV

A

Within 6h of emergence of anesthesia

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3
Q

Late PONV

A

Within 6-24h of emergence from anesthesia

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4
Q

PDNV

A

Post discharge nausea and vomiting

From 24h post-discharge up to 72h

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5
Q

Forceful expulsion of gastric contents through nose/mouth

A

Vomiting

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6
Q

Similar to vomiting but no gastric contents enter pharynx

A

Retching

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7
Q

“Dry heaves”

A

Retching

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8
Q

Emetic episode

A

> or = 1 episode of vomiting and/or retching separated by no more than 1 minute

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9
Q

Consequences of PONV

A 
Prolonged stay in PACU
Aspiration of gastric contents 
Unplanned hospital admissions 
Decreased patient satisfaction
Dehydration
Electrolyte imbalance
Wound dehiscence
Bleeding
Esophageal rupture
Airway compromise
SubQ emphysema
Pneumothorax
Increased abdominal pressure
Increased parasympathetic response or sympathetic response
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10
Q

Leading cause of unplanned hospital admissions in outpatient surgery

A

PONV

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11
Q

Emesis center lies in the

A

Medulla oblongata

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12
Q

How does the emesis center receive information?

A

Receives impulses from sensory centers

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13
Q

Sensory centers

A
  1. Chemoreceptor trigger zone (CTZ)
  2. Vagal input from gut/pharynx
  3. Cerebral cortex
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14
Q

Location of CTZ

A

Bottom of 4th ventricle

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15
Q

CTZ contains

A

Receptors that module activity

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16
Q

CTZ detects

A

Noxious chemicals in bloodstream + activates emesis center in brainstem

17
Q

Once emesis center detects input, what occurs?

A

Sends impulse to salivation center, respiratory center, pharyngeal, GI, abdominal muscles —> vomiting

18
Q

What is located in emesis center/CTZ/GI tract?

A

Neurotransmitters

19
Q

Neurotransmitters located in emesis center

A

Cholinergic, histaminic, dopamine 2, opiate, serotonin-5HT, neurokinin type 1, benodiazepine

20
Q

Patient risk factors for PONV

A 
Women
Previous episode of PONV
Non smokers
History of motion sickness
History of migraine
Age < 50 years
21
Q

Surgical risk factors for PONV

A

Length of procedure

Certain surgeries: gynecological surgery, laparoscopic procedures, ENT, breast, plastics, orthopedic

22
Q

Anesthetic risk factors for PONV

A

Volatile anesthetics (dose dependent, <6h postop)
Duration of anesthetic
Intra/postop opioids
Nitrous oxide
Large doses of neostigmine (>2.5mg, controversial)
General anesthesia

23
Q

Each ________ in duration of anesthesia increases risk for PONV

A

30 minute increase

24
Q

Independent factors predictive of PONV

A 
Women
Previous episode of PONV
Younger age (<50y/o)
Opioid use in PACU
Nausea in PACU
Non-smokers

Pharm Fall 2019 (33 decks)

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