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Exam 3- Antiemetics And Adjuncts Flashcards

1
Q

What are the antihistamine receptors?

A

H1 and H2 receptor antagonists

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2
Q

Where do stimulation of H1 receptors occur?

A

In GI tract

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3
Q

What does H1 receptors lead to?

A

Contraction of intestinal smooth muscle

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4
Q

Where does the stimulation of H2 receptors occur?

A

In parietal cells

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5
Q

What does H2 receptors do?

A

Increase gastric acid secretion H+

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6
Q

What are H2 blockers used for (5)

A
  1. Duodenal and gastric ulcers
  2. Zollinger Ellison syndrome
  3. GERD
  4. IV for critical patients to prevent stress ulcers (stress ulcer prophylaxis)
  5. Reduce peri-op risk of aspiration pneumonia
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7
Q

What does H2 blockers effect?

A

pH (acid secretion)

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8
Q

How can H2 be used to reduce aspiration risk? (2)

A
  1. Given at bedtime the night before and 2 hours before procedure
  2. Depends on renal elimination
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9
Q

Are H1 blockers used primarily to prevent aspiration?

A

NO

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10
Q

What are H2 blockers (4)?

A
  1. Ranitidine
  2. Famotidine
  3. Nizatidine
  4. Crimetidine
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11
Q

What is Proton Pump Inhibitor (PPI) and how does it work?

A

Inhibit acid secretion by binding to the K+ H+ pump

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12
Q

What is PPI used for (3)?

A
  1. Duodenal ulcer
  2. GERD
  3. Stress ulcer prophylaxis
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13
Q

What are the 3 PPI?

A
  1. Pantoprazole
  2. Lansoprazole
  3. Omeprazole
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14
Q

What is metoclopramide?

A

Dopamine receptor antagonist -central

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15
Q

When is metoclopramide used for in chronic therapy?

A

Primarily for patients with diabetic gastroparesis

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16
Q

Where does metoclopramide elimination occur?

A

Renal

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17
Q

What do you treat metoclopramide adverse effects with?

A

Anti muscarinic (or diphenhydramine)

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18
Q

Patent related risk factors (3)

A
  • female
  • nonsmoking
  • history of PONV or motion sickness
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19
Q

Anesthetic related risk factors (3)

A
  • inhaled anesthetics
  • nitrous oxide
  • opioids
20
Q

Surgery related risk factors (2)

A
  • duration

- type of surgery

21
Q

Each 30 min of surgery relates to what PONV?

A

Increase risk of 60%

22
Q

5 neurotransmitter receptors:

A
  1. Muscarinic (M1)
  2. Dopamine (D2)
  3. Histamine (H1)
  4. Serotonin (5HT3)
  5. Neurokinin 1 (NK1) - substance P
23
Q

6 pharmacological options

A
  1. Antimuscarinic
  2. Dopamine (D2) receptor antagonist
  3. Antihistamine
  4. 5HT3 receptor antagonist
  5. NK1 receptor antagonist
  6. Corticosteroid
24
Q

Where and what can the nausea and emesis be triggered by?

A

Higher cortical centers communicating with the central pattern generator in the medulla

25
In peri-op the stimulation of what are central stimuli that may cause N&V?
Vestibular system
26
2 rescue antiemetic:
Use agent of another class - prochlorperazine - droperidol
27
Where are the 5HT3 receptors:
GI tract and CTZ (brain)
28
When are 5HT3 emesis attributable?
Vagal stimulation in post-op and chemo
29
When is 5HT3 receptor antagonists useful for?
Prevention and treatment of vomiting near end of surgery or rescue therapy in PACU
30
Do 5HT3 receptor antagonists have sedative side effects?
NO
31
What kind of metabolism does 5HT3 receptor antagonists have?
Liver
32
What is a risk of 5HT3 receptor antagonists?
Prolonged QT
33
4 5HT3 receptor antagonists?
1. Ondansetron 2. Granisetron 3. Dolasetron 4. Palonosetron
34
Of the 5HT3 receptor antagonists, which has the longest half life?
Palonosetron
35
Other use for dexamethasone?
Decrease ICP
36
2 possible risks for dexamethasone?
1. Impaired glucose tolerance | 2. Risk of wound infection
37
What is a antimuscarinic?
Scopolamine
38
Where do D2 receptor block?
CTZ
39
2 common D2 blockers?
Butyrophenones | Droperidol
40
Which dopamine blocker is not used in children (4)
Droperidol Perphenazine Promethazine Prochlorperazine
41
Box warning for droperidol?
QT prolongation risk | Arrhythmia tornadoes de pointe
42
Adverse effect of dopamine receptor blocker?
Acute dystonic reaction
43
How do you treat dopamine receptor blockers adverse effects?
Antimuscarinic (or diphenhydramine)
44
Where do NK1 antagonist inhibition occur?
At both central and peripheral receptors
45
What is a NK1 receptor antagonist?
Aprepitant
46
Acupuncture where can help with PONV
Median nerve

Pharmacology (14 decks)

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