GI Flashcards
early PONV
2-6h
late PONV
6-24h
delated PONV
> 24h post op
post discharge n/v
> 24h post dc
one risk factor %
20%
two risk factors %
40
three risk factors %
60
four risk factors %
80
post discharge NV risk factors
female, <50yo, hx of PONV, opiates in PACU, nausea in PACU
risk factors for children - procedure length
> 30min
risk factors for children - age
> 3 years
strabismus surgery is a risk factor for
children
child risk factor - history
history of PONV or PONV in relatives
who to pretreat?
moderate to high risk pt’s (3 or more risks)
which drug should you give before induction
dexamethasone
which drug do you give the evening before surgery or 4h prior to awakening
scop patch
which drug do you give 1-3 hours prior to surgery
aprepitant
impact trial
zofran+droperiodl vs dex…. both equally effective
which drugs are 5HT3 Antagonists
ondansetron, granisetron, dolasetron, palonosetron
what percent of gen pop experiences vomiting
30%
what percent of gen pop experiences nausea
50
top 3 PONC factors
female, history of PONV, non-smoker
GA has a __x higher risk of PONV than regional
9
every 30 min you increase PONV risk by
60%
___ of patients experience PONV post discharge
1/3
which med has a long onset and long duration
dexmethasone
neurokinen receptor antagonist
aprepitant
5HT3 receptor is primarily located in
GI tract
5HT3 receptor ___ afferents
vagal, chemosenstive center
how are 5ht3’s metablolized
liver. CYP3A4 450
Which 5HT3 is a prodrug
dolasetron
whats zofrans half life
4h
whats zofrans onset
15min IV, 30min PO
side effects of 5Ht3’s
constipation, diarrhea, nausea, dizziness
whats a prolonged QTc
450 milliseconds and above
what is 5HT3’s mechanism
antagonism
dexamethasone MOA
unknown, thought to be prostaglandin antagoinist, endorphin release.
side effects dex
impaired wound healing/infection, increased glucose, htn, edema, AMS
onset of dexamethasone
4-6h
half life of dexamethasone
35-54 h
what kind of drug is droperidol
anti-dopaminergic (D2)
droperiodl mildly works as
antihistamine, antiserotonergic
droperiold’s main receptor is D2 but also works in the
chemoreceptor trigger zone
black box warning for droperiol
QT prolongation at doses >5mg
side effects of droperiol
dysphoria, hypotension, EPS
droperidol metabolism
hepatic
droperidol half life
2.3
dopamine in the brain - balance between
movement disorders like parkinson’s and psychosis
which drugs are phenothiazines
promethazine (phenergan) and prochlorpromazine.
what is the MOA for phenothiazines
d2 receptor antagonist
how is phenothiazines metabolized
hepatic
what is the half life of phenothiazines
4-8h
issue with phenothiazines
highly sedating , EPS
what kind of drug is dimenhydrinate
h1 antagonist
what cranial nerve is associated with inner ear feeling - both cholinergic tracts and histimanergic tracts.
c8
which drug is also used to treat motion sickness
dimenhydrinate
BP effects of h1 antagonists like dimenhyrinate
may see htn since its anti-histamine
scopolamine is an ___ med
anticholinergic
when should you place scop patch
either prior to surgery or 4 hours prior to awakening
side effects of scop patch
blurred vision, dilated pupil on the same side patch is applied, constipation, urinary retention
what kind of drug is aprepitant (Emend)
neurokinin 1 receptor antagonist
where in the neuro system does aprepitatnt work
brain steam and dorsal vagal complex
what is the injectable form of Aprepitant called
fosaprepitant
substance P is blocked by
neurokinin 1 receptor antagonist (aprepitant )
aprepitant is reserved for
end of life, HIV, cancer, very serious GI upset, super expensive
what is substance p
hormonal type compound that is released in injury, trauma.
aprepitant side effects
few. generally pretty safe
aprepitant
cyp3A4 substrate and weak inhibitor
aprepitant half life
9-13h
aprepitant protein binding
highly
