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Advanced Pharm Final > GI/Postop NV > Flashcards

GI/Postop NV Flashcards

34, 35 5 questions

1
Q

What five neurotransmitters contribute to nausea and vomiting?

A

muscarinic M1,
dopamine D2, histamine H1, 5-hydroxytryptamine (HT)-3 serotonin, and neurokinin 1 (NK1) -substance P

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2
Q

What are some complications associated with postopnv?

A

wound dehiscence, esophageal
rupture, aspiration, dehydration, increased intracranial pressure, and pneumothorax.

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3
Q

How long following surgery is nausea and vomiting considered postoperative?

A

24 hours

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4
Q

T/F length of surgery affects post opnv

A

True

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5
Q

What two classes are most useful in vestibular stimulation nausea and vomiting?

A

Antihistamines and anticholinergics

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6
Q

what is the preferred reversal agent in a patient with history of postop NV?

A

sugammadex (high doses of neostigmine cause NV)

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7
Q

What type of pediatric surgery exhibits high risk of postop nausea and vomiting?

A

strabismus surgery

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8
Q

How many antiemetic agents does every patient recieve?

A

at least 2

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9
Q

PONV is easier to ______ than to _____.

A

prevent, treat

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10
Q

What are the 4 major patient risk factors for PONV?

A

female
nonsmoker
hx of motion sickness
previous episode

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11
Q

What are the two surgical risk factors for developing PONV?

A

length of procedure (longer, worse), certain surgeries (inner ear)

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12
Q

What are the anesthetic risk factors for developing PONV?

A

Anesthetic: inhalation anesthetics, nitrous oxide, neostigmine, & opioids
Opioids and inhaled anesthetics
increase risk: opioid-sparing, regional anesthesia, TIVA (propofol), still give an antiemetic

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13
Q

What are the 4 pediatric risk factors of PONV?

A
  1. > 30min surgery
  2. Age >3 years old
  3. Strabismus surgery
  4. Familial or personal history of PONV
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14
Q

What are 1st, 2nd, 3rd, and 4th line medications used for PONV?

A
  1. ondansetron 4-8mg
  2. dexamethasone 4-8mg
  3. scopolamine patch
  4. benadryl 12.5mg
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15
Q

When should a scopolamine patch be applied for PONV?

A

2-4hr prior to stimulus

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16
Q

When should ondansetron be given to prevent PONV?

A

prior to stimulus. immediately after giving fentanyl during induction

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17
Q

When should dexamethasone be given to prevent PONV?

A

once patient is asleep since it cause perineal dyscomfort

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18
Q

Why should 4mg or 8mg be the routine dexamethasone dosage intraoperatively?

A

4mg: due to increase in BG, in setting of uncontrolled DM or existing hyperglycemia which can lead to decreased acute wound healing and an increased risk of infection
8mg: doesn’t make a huge difference in BG. does many different things (antiemetic, analgesic, decreased immune response and anti-inflammatory)

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19
Q

What is the choice 5-HT3 antagonist?

A

ondansetron 4-8mg

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20
Q

What is the anticholinergic of choice in PONV management?

A

scopolamine patch

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21
Q

What is the choice antihistamine for PONV management?

A

Diphenhydramine 12.5mg use w caution postop due to sedative effect

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22
Q

What is the only benzodiazepine that can be given for PONV and a consideration?

A

midazolam, should not be given postoperatively due to major sedative effects

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23
Q

What is the cannabinoid derivative most frequently use?

A

Dronabinol

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24
Q

What corticosteroid is the best choice for PONV?

A

dexamethasone 4-8mg

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25
Q

What Dopamine (D2) antagonists is the best choice for PONV?

A

haloperidol 0.5-2mg IV

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26
Q

What are Neurokinin-1 antagonists good at treating?

A

chemo induced NV

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27
Q

What type of NV occurs in the frontal cortex of the brain and how is it best managed?

A

anxiety/psychogenic related, midazolam

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28
Q

What is hyperemesis 2/2 cannabis use managed?

A

must stop using cannabis substance

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29
Q

Why should ondansetron be given slowly?

A

rapid admin can cause a headache

30
Q

why is iv phenergan no longer given?

A

there is a high risk for thrombophlebitis which can damage IV integrity

31
Q

What H2 antagonist is commonly given in the setting of allergic reaction?

A

famotadine

32
Q

What is the MOA of ondansetron?

A

Blocks 5-HT3 Receptors from initiating the vomiting reflex

33
Q

What are the two common reactions to a bolus of fentanyl?

A

euphoria/relaxation OR spinning/vomiting due to vestibular dysfunction

34
Q

What is a cardiac related side effect of ondansetron?

A

QT-prolongation: cardiac arrhythmias

35
Q

What is the MOA of a scopolamine patch?

A

Prevents activation of muscarinic acetylcholine receptors in the vestibular system near the chemoreceptor trigger zone (CRTZ)

36
Q

What is a major patient teaching point regarding the use of scopolamine?

A

must remove when at home, not moving a lot. wash hands after removal

37
Q

What are the symptoms of anticholinergic OD?

A

dry mouth, difficulty talking/swallowing, blurred vision, photophobia, tachycardia, dry,flushed skin, rash on face, neck, & chest, Increased body temperature, Increased minute ventilation

38
Q

What are examples of anticholinergics that do and do not cross the BBB?

A

do: atropine, scopolamine
don’t: glycopyrrolate

39
Q

How should an anticholinergic overdose be treated?

A

physostigmine 15-60mcg/kg iv Q1-2H (same tx for central anticholinergic syndrome)

40
Q

What is the difference between an anticholinergic OD and central anticholinergic syndrome

A

AC OD is cause by too much medication while CAS is due to a weird reaction/metabolism of the medication

41
Q

What are the two frequently used histamine receptor antagonists and their side effects?

A

Dimenhydrinate (Dramamine): block oculo-emetic reflex 1mg/kg
Diphenhydramine (benadryl): 12.5mg
SE: effects vary w/ liver disease, dry mouth, somnolence

42
Q

What is the MOA of corticosteroids for PONV management?

A

prevents release of inflammatory mediators which prevents CTZ zone activation

43
Q

T/F steroid therapy should not be given to patients with diabetes for PONV management

A

False

44
Q

What class is droperidol in, MOA, dose, and side effects

A

dopamine antagonist
0.625-1.25mg
SE: qt prolong

45
Q

What is a requirement for droperidol use?

A

EKG monitoring 2-3hr post use due to potential of causing arrhythmias

46
Q

what is the choice antiemetic for a patient receiving cisplatin?

A

droperidol

47
Q

When should neurokinin-1 antagonists (aprepitant) be given to prevent PONV?

A

3 hours prior to induction

48
Q

What is the MOA ofa prepitant? what is the major pro and con of use?

A

antagonist of g-protein neurokinin receptor (prevents release of substance p)
good at tx chem NV, bad bc it doesnt treat vomiting
only prophylactic

49
Q

What is the MOA of metoclopramide (reglan)?

A

selective cholinergic stim of the gi tract, ^ lower esoph sphincter tone, increased gastric and SB motility, relaxes pylorus + duodenum

50
Q

When should metoclopramide (reglan) be given?

A

10-20mg iv/3-5min 15-30min prior to induction

51
Q

What are anesthesia concerns of metoclopramide (reglan)?

A

contrai: parkinsons, RLS, movement disorders, dystonic extrapyramidal reactions, neurologic dysfunction, caution w antipsychotic medications, akathisia
*Not indicated for Bowel/GI procedures

52
Q

What is a major concern regarding haloperidol use for PONV?

A

Sudden cardiac death related to prolonged QTc interval

53
Q

What is the MOA of cannabinoids such as nabilone and dronabinol?

A

Binds to cannabinoid receptor type 1 peripherally (suppressing intestinal motility) and centrally in the nucleus of the solitary tract.

54
Q

What patient population is at high risk of aspiration and what should they be given preop?

A

pregnant (due to increased progesterone causing esophageal sphincter relaxation), give oral antacids

55
Q

How do antacids work and what do they treat?

A

neutralize gastric hydrogen ions and decrease secretion
GERD, stress gastritis, ulcers

56
Q

What are some anesthesia concerns related to antacid use?

A

Gastric alkalinization increases gastric emptying, resulting in a faster delivery of drugs into the small intestine, absorption effects, bioavailability effects

57
Q

What are side effects of antacid use?

A

bacterial overgrowth in the duodenum and small intestine, metabolic alkalosis, UTIs, acid rebound, phosphorus depletion

58
Q

What is the MOa of H2 antagonists (famotadine)?

A

selective and reversible inhibition of H2 receptor–mediated secretion of hydrogen ions by parietal cells in the stomach

59
Q

What are indications to give famotidine and it’s side effects?

A

procedures with Increased risk of aspiration, duodenal disease, decreases gastric fluid pH
Diarrhea, HA, fatigue, and skeletal m pain

60
Q

What is the mechanism of action for proton pump inhibitors and their anesthesia considerations?

A

decrease acid secretion in the stomach
omeprazole should be given >3 hours before induction for chemoprophylaxis.

61
Q

When should PPIs be d/ced prior to surgery?

A

they shouldn’t be ;)

62
Q

What are side effects of chronic H2 blocker use?

A

CNS effects: headache, confusion, sedation. cardiac: bradycardia, hypotension, CHB. acute pancreatitis, low plts

63
Q

What are indications for metoclopramide?

A

decrease gastric volume, antiemetic effect, tx gastroparesis, tx GERD, intolerance to enteral feedings in patients who are critically ill.

64
Q

What are side effects of metoclopramide?

A

abd cramping due to rapid IV administration (<3 minutes)
- hypotension
- tachycardia
- bradycardia
- cardiac arrhythmia

65
Q

Why is ondansetron the drug of choice for anesthesia?

A

because volatile anesthetics work in CNS which means they could hit the 5-HT3 receptor

66
Q

If a patient received ondansetron 6 hours ago, and has a event of N/V. what drug should be given?

A

an antiemetic in a different class is best, BUT if not available, can give ondansetron again

67
Q

Do oral antacids undergo first pass metabolism?

A

no, because the stomach is the target tissue

68
Q

Does the use of epidural anesthesia increase or decrease the risk of PONV?

A

decrease

69
Q

What random drug decreases the risk of PONV?

A

clonidine (systemic Alpha2 agonist)

70
Q
A

Advanced Pharm Final (5 decks)

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