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GI meds > GI meds > Flashcards

GI meds Flashcards

1
Q

% that experience PONV

A

20-30%

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2
Q

% of high risk that experience PONV

A

70-80%

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3
Q

name areas that can cause nausea and vomiting

A
  • medulla
  • CTZ
  • neural pathways in vestibular system
  • reflex afferent pathways
  • midbrain afferents
  • CN X- gag reflex
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4
Q

what area is known as the vomiting center?

A

medulla

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5
Q

what is considered EARLY PONV?

A

2-6 hours post- op

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6
Q

what is considered LATE PONV?

A

6-24 hours post-op

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7
Q

what is considered DELAYED PONV?

A

> 24 hrs post to D/C

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8
Q

what are 4 main risk factors for PONV?

A
  1. female 2. hx of PONV 3. hx of motion sickness 4. non smoker
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9
Q

other risk factors for PONV?

A

opiates, volatile anesthetics, nitrous oxide, age, duration of procedure, type of surgery (laparoscopy, ENT, neuro, plastics high incidence), neostigmine

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10
Q

who to pre-treat?

A

use risk assessment tools, moderate to high risk (3 or more)

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11
Q

considerations r/t anesthesia?

A

propofol- reduces PONV
regional lower incidence than general
NSAIDS over opiates
2mg IV versed 30 min prior

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12
Q

what should you do if you give one class of rescue medication and it doesn’t work?

A

try a different class, don’t give the same class again

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13
Q

name some classes of rescue meds we use?

A

5HT3 antagonists, D2 blockers, reglan, H1 blockers

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14
Q

post discharge what meds can be used for the patient for post discharge N/V?

A 
dexamethasone
scopolamine patch
education 
Zofran 
phenergan
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15
Q

which med is recommended to be given before induction?

A

dexamethasone

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16
Q

what med is recommended to be applied the evening prior or 4 hours before pt wakes from surgery?

A

scopolamine patch

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17
Q

what med is recommended 1-3 hours prior to surgery?

A

aprepitant

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18
Q

according to the impact trial, what 3 meds are all equally effective?

A

Zofran, droperidol, dexamethasone

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19
Q

what do the 5HT3 antagonists end in ?

A 
"setron"
ondansetron- Zofran
granisetron- Kytril
dolasetron- Anzemet
palonosetron- Aloxil
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20
Q

what are the 5HT3 antagonists class?

A

serotonin antagonists

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21
Q

where do 5HT3 antagonists work at and how?

A

vagal afferents, CNS (CTZ, STN)- meds block excitatory Na impulse to prevent vomiting

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22
Q

which 5HT3 antagonist is a prodrug?

A

dolasetron- prodrug needs broken down before it will work- inhibitor of 3A4 may cause it not to work

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23
Q

what are most common side effects of 5HT3 antagonists?

A

usually lower GI- constipation, diarrhea, nausea( with high doses)
dizziness, EKG changes, QTc prolongation- torsades

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24
Q

what is dexamethasone’s class?

A

corticosteroid

25
Q

what are possible mode of actions for dexamethasone?

A

endorphin release, prostaglandin antagonist

26
Q

what are some side effects of using dexamethasone?

A
  • impaired would healing/infection
  • increased glucose
  • hypertension, edema
  • altered mental status, delirium
27
Q

what is half life of dexamethasone?

A

35-54 hours- may augment other antiemetics providing more of a benefit

28
Q

what class is droperidol?

A

anti-dopaminergic (D2 receptors), mild : antihistamine and antiserotonergic

29
Q

where does droperidol work at?

A

CTZ

30
Q

what are side effects of droperidol?

A
  • dysphoric effects
  • **QT prolongation (black box warning) doses >5mg, - hypotension
  • EPS worsened in parkinsons
31
Q

name some phenothiazines?

A
  • promethazine (Phenergan)

- prochlorpromazine (Compazine)

32
Q

what class are phenothiazines?

A

D2 antagonists

33
Q

what are side effects of phenothiazines?

A
  • *highly sedating

- EPS

34
Q

name some H1 antagonists?

A

dimenhydrinate (Dramamine)

Benadryl

35
Q

what is a side effect of H1 antagonists?

A

**highly sedating

36
Q

what class is aprepitant (Emend)?

A

neurokinin 1 receptor antagonist, very expensive new drug used with chemo pts

37
Q

where does aprepitant work at?

A
  • brain stem, dorsal vagal complex
  • is also a CYP3A4 substrate and weak inhibitor, blocks substance P pathways
  • highly protein bound
38
Q

How does Reglan work in the GI tract?

A
  • increases L.E.S tone
  • enhances peristaltic contractions
  • accelerate rate of gastric emptying
39
Q

what class is Reglan?

A

dopamine antagonist on CTZ

40
Q

does renal impairment effect Reglan?

A

yes- requires decrease in dose b/c of prolonged half life

41
Q

does Reglan cross blood brain barrier and placenta?

is it excreted in breast milk?

A

YES

42
Q

what are side effects of Reglan?

A
  • cramping and diarrhea with rapid IV administration
  • akathesia with IV administration- felling of unease and restlessness of lower extremities
  • dystonic extrapyramidal reactions (oculogyric crisis, opisthonus, trismus, torticollis) in <1% pts
43
Q

what are cautions with Reglan use?

A
  • inhibitory effects on plasma cholinesterase (may prolong activity of succs and mivacurium, may slow metabolism of esters)
  • may increase extrapyramidal rxns of certain drugs
  • avoid use with phenothiazines and butyrophenones
  • avoid use with hx of seizures or preexisting EPS
  • avoid use with pts with gastric outlet obstruction (tumors, blockage, chronic constipation)
44
Q

do acid reducers alter pH?

A

YES

45
Q

what do H2 receptor antagonists end in ?

A 
"tidine"
cimetidine (Tagamet)
ranitidine (Zantac)
famotidine (Pepcid)
nizatidine (Axid)
46
Q

what are H2 receptor antagonists used for?

A

P.U.D and G.E.R.D

inhibits histamine binding to receptors on gastric parietal cells

47
Q

what are H2 receptor antagonists MOA?

edited card see new info

A

histamine activates adenylate cyclase by binding to H2 receptors on parietal cells. increases intracellular cAMP, activates proton pump to secrete hydrogen ions against concentration gradient in exhchange for potassium.
H2 receptor antagonists INHIBIT BINDING of Histamine to H2

48
Q

what type of inhibition occurs with H2 receptor antagonist?

A

selective and competitive inhibition

49
Q

is famotidine or cimetidine more potent?

A

famotidine is most potent

50
Q

clinical uses of H2 receptor antagonists?

A
  • chemoprophylaxis to increase pH of gastic fluid, decrease risk of acid pneumonitis
  • along with H1 for allergy pts
    • remember it does not influence pH of fluid currently in stomach, effects next cycle
  • *ability to decrease gastric fluid volume is unpredictable
51
Q

side effects of H2 receptor antagonists?

A
  • most common diarrhea, headache, fatigue, skeletal muscle pain.
  • rare thrombocytopenia
  • mental confusion sometimes in elderly with high doses of cimetidine IV
  • cardiac dysrhythmias - SB, arrest, complete AV block
    (H2s decrease cAMP- similar to taking a beta blocker)
    -bradycardia and hypotension with rapid IV admin.
52
Q

what are some drugs that can be inhibited by cimetidine?

A

diazepam, propranolol, meperidine, lidocaine

53
Q

what are some drugs that can have decreased absorption because of H2 receptor antagonists increasing gastic fluid pH?

A

ketoconazole, iron products, calcium carbonate

54
Q

what do the proton pump inhibitors end in?

A 
"azole"
omeprazole (Prilosec)
esomeprazole (nexium)
pantoprazole (protonix)
lansoprazole (prevacid)
rabeprazole (aciphex)
55
Q

what are PPIs used to treat?

A

P.U.D and G.E.R.D and hypersecretory disorders

56
Q

what do PPI do to gastic pH? and to gastric fluid volume?

increase or decrease

A

increase pH, decrease gastric fluid volume

57
Q

H2 vs PPI- which has better acid suppression?

A

PPI

58
Q

does PPI increase or decrease Mg levels?

A

decrease Mg levels- arrhythmias, hypokalemia

GI meds (1 decks)

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