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5230 > GI > Flashcards

GI Flashcards

1
Q

causes of regurgitation

A

increased intragastric pressure

decreased LES tone

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2
Q

drugs that decrease LES tone

A 
atropine
glycopyrrolate
dopamine
nitroprusside
thiopental
tricyclic antidepressants
B-adrenergic stimulants
inhaled anesthetics
opioids
propofol
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3
Q

severity of aspiration

A

pH

amount

type of aspirate

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4
Q

pretreatment for patients at risk for aspiration

A

reglan

h2 antagonists

non-particulate antacid

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5
Q

reglan (metoclopramide)

A

increases LES tone and gastric emptying, anti-emetic (dopamine receptors)

10-20 mg IV over 3-5 minutes, 15-30 minutes before induction

avoid in Parkinsons, SBO, seizure disorder

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6
Q

non-particulate antacid (sodium citrate/citric acid/bicitra)

A

increased gastric pH and volume

30 ml 15-30 minutes before induction

avoid in renal failure patient

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7
Q 
H2 antagonists: 
cimetidine (Tagamet) 
famotidine (Pepcid)
ranitidine (Zantac)
Nizatidine (acid)
A

blocks H2 receptors

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8
Q

cimetidine (Tagamet)

A

300 mg IVPB

inhibits CYP450 and decreases hepatic blood flow

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9
Q

famotidine (Pepcid)

A

20 mg IV

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10
Q

ranitidine (Zantac)

A

50 mg IVPB

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11
Q 
proton pump inhibitors
omeprazole (Prilosec)
lansoprazole (Prevacid)
pantoprazole (protonix)
esomeprazole (nexium)
A

inhibit secretion of H+ ions by parietal cells

*caution with malabsorption of other drugs

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12
Q

Nausea Receptors

A

vestibular system

chemoreceptor trigger zone: dopamine, histamine, serotonin, acetylcholine

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13
Q

Dopamine Antagonists

A

REGLAN (benzamides)
DROPERIDOL (butyrophenones): 0.625-1.25 mg IV over 2-5 minutes, black box warning for QT prolongation

peripheral alpha antagonist = vasodilatation

can cause extrapyramidal side effects, contraindicated in Parkinson’s disease

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14
Q

Serotonin Antagonists

A

ZOFRAN: 4 mg
DOLASETRON: 12.5 mg
GRANISETRON: 0.35-1 mg
PALONOSETRON: 0.075 mg *long acting

*avoid Zofran with QT prolongation

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15
Q

Histamine Antagonists

A

BENADRYL: 25-50 mg q4-6 hours

DRAMAMINE

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16
Q

Anticholinergics

A

SCOPOLAMINE: 1.5 mg patch for 3 days

apply the night before surgery

17
Q

Corticosteroids

A

DECADRON: 4-8 mg IV, mechanism unknown, contraindicated in diabetics and cancer, most efficacious if given prior to induction, reduces pain

18
Q

Neurokinin 1 Receptor Antagonist

A

EMEND: inhibits receptor, metabolized by CYP 450, 40 mg IV 3 hours prior to induction

19
Q

risk factors PONV

A 
female 
age>50
history of PONV
high doses of opioids
surgery >1 hour
laparoscopic procedures
20
Q

risk factors PDNV

A

female
age>50
history of PDNV
PONV

5230 (12 decks)

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