GI

Question 1

causes of regurgitation

Answer 1

increased intragastric pressure

decreased LES tone

Question 2

drugs that decrease LES tone

Answer 2

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

Question 3

severity of aspiration

Answer 3

pH

amount

type of aspirate

Question 4

pretreatment for patients at risk for aspiration

Answer 4

reglan

h2 antagonists

non-particulate antacid

Question 5

reglan (metoclopramide)

Answer 5

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

Question 6

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

Answer 6

increased gastric pH and volume

30 ml 15-30 minutes before induction

avoid in renal failure patient

Question 7

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

Answer 7

blocks H2 receptors

Question 8

cimetidine (Tagamet)

Answer 8

300 mg IVPB

inhibits CYP450 and decreases hepatic blood flow

Question 9

famotidine (Pepcid)

Answer 9

20 mg IV

Question 10

ranitidine (Zantac)

Answer 10

50 mg IVPB

Question 11

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

Answer 11

inhibit secretion of H+ ions by parietal cells

*caution with malabsorption of other drugs

Question 12

Nausea Receptors

Answer 12

vestibular system

chemoreceptor trigger zone: dopamine, histamine, serotonin, acetylcholine

Question 13

Dopamine Antagonists

Answer 13

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

Question 14

Serotonin Antagonists

Answer 14

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

*avoid Zofran with QT prolongation

Question 15

Histamine Antagonists

Answer 15

BENADRYL: 25-50 mg q4-6 hours

DRAMAMINE

Question 16

Anticholinergics

Answer 16

SCOPOLAMINE: 1.5 mg patch for 3 days

apply the night before surgery

Question 17

Corticosteroids

Answer 17

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

Question 18

Neurokinin 1 Receptor Antagonist

Answer 18

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

Question 19

risk factors PONV

Answer 19

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

Question 20

risk factors PDNV

Answer 20

female
age>50
history of PDNV
PONV