Management of Nausea and Vomiting Flashcards
Symptoms associated with nausea and vomiting
- pallor
- tachycardia
- diaphoresis (sweating)
- nausea occurs in ___ % of pregant women
- begins ___ - ___ week after last menstrual period
- usually resolves by ___ week
- 80%
- 4th-7th
- 20th
T or F: anti-neoplastic drugs rarely cause N/V
False; anti-cancer drugs cause N/V
If N/V is associated with chest pain, theres a good chance it is a ___
myocardial infarctions
drug therapy
antihistamines and anticholinergics (3)
MOA: blocks receptors in CTZ/NTS
- meclizine
- dimenhydrinate
- scopolamine
antihistamines and anticholinergics SE
Drowsiness, Sedation, Dry mouth, Constipation; burred vision
Phenothiazines (2)
MOA: ___ receptor inhibition in CTZ
- Prochlorperazine
- Promethazine
- dopamie
Phenothiazines SE
Dizziness; sedation; dry mouth; EPS; hypotension
Serotonin Antagonists (4)
MOA: serotonin inhibition at CTZ, VC, and GI Tract
- ondansetron
- granisetron
- palonosetron
- dolasetron
serotonin antagonists SE
Mild HA; Dizziness; Fatigue; Constipation; Recent concern about QT prolongation
Neurokinin-1 Antagonists (3)
MOA: ___ receptor inhibition at CTZ, VC, and GI tract
- Aprepitant
- Fosaprepitant
- Rolapitant
- neurokinin
Neurokinin-1 Antagonists SE
fatigue, hiccups, decreased hiccups
Buterophynones (2)
MOA: ___ receptor inhibition in CTZ
SE:
- Haloperidol and Droperidol
- dopamine
- drowsiness; EPS; EKG
Metoclopramide
MOA: ___ receptor inhibtion in CTZ; ___ inhibition at high dose
SE:
give with benadryl
- dopamine
- serotonin
- diarrhea, EPS at high dose
Cannabinoids (2)
MOA: binds with cannabinoid receptors in brain
SE:
- Dronabinol
- Nabilone
- Sedation; dry mouth; euphoria; dysphoria; may stimulate appetite
Corticosteroids (1)
MOA: inhibition of ___ input into VC
SE:
- Dexamethasone
- cortical
- Potentiates action of other agents
Thienobenzodiazepine (1)
MOA: ___ and ___ receptor inhibition in CTZ
SE:
- dopamine and serotonin
- Drowsiness; constipation; dry mouth
which serotonin antagoinst has the longest duration of action?
A) ondansetron
B) granisteron
C) dolasetron
D) palonosetron
palonosetron
t 1/2 = 40 hrs
what is the peak age range ___ years
12-21
Treatment of motion sickness
prevention is key
Scopolamine
* apply patch before needed
* duration = ___ hours
72 hours
treatment of motion sickness
dimenhydrinate 50 mg
“___”
take po ___ min before needed
Dramamine
30-60 min
treatment of motion sickness
meclizine 25 mg
“ ___ “ and “ ___”
* dramamine less drowsy
* take po ___ min before needed
- Bonine and Zentrip
- 30-60 min
Treatment of NV Secondary to Gastroenteritis or Pain
treat symptoms while treating the ___
* Ondansetron ___ - ___ mg q8-12h prn
* Promethazine ___-___ mg q4-6h prn
cause
* 4-8 mg
* 12.5-25 mg
T or F: if you are a woman and or a non-smoker you have a lower risk for N/V PONV
False; if you are a woman and do not smoke, you have a higher risk
Risk Factors for PONV
Intra-operative use of ___ anesthetics
* use of ___
* type of surgery
volatile
* nitrous oxide
moderate-high PONV
* drug of choice ___ antagonists
* drugs administered at ___ of procedure
- 5-HT3
- end
highest risk PONV
* 5-HT3 + ___ or ___
- metoclopramide
- aprepitant
Treatment of PONV
Aprepitant ( ___ )
* ___ mg PO 1-3 hours before anesthesia
* may be better than ondansetron
Emend
40 mg
Prevention of CINV
- 5-HT3 Antagonist ___
- NK-1 Antagonist ___
- Corticosteroids ___
- olanzapine ___
- lorazepam
- +
- +/-
- +/-
