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Clinical prep > meds; antiemetics > Flashcards

meds; antiemetics Flashcards

1
Q

Droperidol onset

A

1-5 min

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2
Q

Droperidol dose

A

0.625 mg

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3
Q

Droperidol duration

A

2-3 hrs

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4
Q

Droperidole MOA

A

Strong D2 antagonist

increase motility
increase esophageal sphincter tone
decrease duodenum and pylorus tone

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5
Q

Droperidole side effects

A

torsades/ prolonged QT
extrapyramidal syndrome
NMS
lots of drug interactions

avoid in dec dop levels (orthostatic hypotension, extrapyramidal syndrome, Parkinsons)

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6
Q

droperidol trade name

A

inapsine

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7
Q

Promethazine dose

A

6.25-25 mg

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8
Q

Promethazine onset

A

1-5 min

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9
Q

Promethazine duration

A

4-6 hrs

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10
Q

Promethazine brand name

A

Phenergan

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11
Q

promethazine MOA

A

1st generation Histamine 1 receptor antagonist

also reduces peripheral pain levels (anti-inflammatory)

effective as rescue

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12
Q

Promethazine Side effects

A

< 2yo = death
tissue necrosis
sedation
long QT

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13
Q

ondansetron dose

A

4 mg

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14
Q

ondansetron onset

A

10 min

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15
Q

ondansetron duration

A

4-9 hrs

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16
Q

ondansetron moa

A

competitive antagonist for 5hT3

prevent hypotension by inhibition of T1-T4/ bezold jarish reflex

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17
Q

ondansetron SE

A

Ha, Diarrhea, Long qt

not effective for motion sickness or vestibular stimulation

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18
Q

ondansetron peds dose

A

0.15 mg/kg

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19
Q

Dexamethasone dose

A

4 mg

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20
Q

Dexamethasone onset

A

10-30 min

can have a delayed onset up to 2 hrs

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21
Q

Dexamethasone duration

A

2-10 hrs

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22
Q

Dexamethasone peds dose

A

0.5mg/kg

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23
Q

Dexamethasone moa

A

corticosteroid

decrease endorphins and prostaglandins

increase effectiveness of 5ht3 antag and droperidol

antiinflammatory

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24
Q

dexamethasone SE

A

perineal burning
increase bg?

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25
Q

metoclopramide brand name

A

Reglan

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26
Q

metoclopramide dose

A

10-20 mg over 3-5 min. faster = abd cramping.

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27
Q

Metoclopramide onset

A

10 min

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28
Q

metoclopramide duration

29
Q

Metoclopramide moa

A

Dopamine receptor antagonist

increase motility
increase esophageal sphincter tone
decrease duodenum and pylorus tone
** diabetic gastroparesis

30
Q

metoclopramide side effects

A

sedation, hypotension, increased prolactin, neuroleptic malignant syndrome
decrease ACHe

31
Q

scopolamine dose

A

patch

priming dose 140 mcg
1.5 mcg over the next 72 hrs

32
Q

scopolamine onset

33
Q

scopolamine duration

34
Q

scopolamine MOA

A

Anticholinergic

muscarinic antagonist; block ach

crosses BBB
antisialgogue
prevents motion sickness

35
Q

Scopolamine side effects

A

mydriasis/ light sensitivity/ blurry vision

confusion
sedation
dry mouth

36
Q

Propfol for antiemetic dose

A

10-15 mg IV followed by 10 mcg/kg/min

37
Q

Prop moa for antiemetic

A

decreases subcortical pathways and has direct effect on vomiting center

38
Q

PONV risk factors

A

female, age < 40, hx of PONV or motion sickness
vertigo;

surgeries; laparotomy, laparoscopy, major breast, strabismus, intraocular, middle ear, tonsils, adenoids, neuro (intracranial, gynecologic, testicular, scrotum, kidney stones

39
Q

PONV treatment basic risk factors

A

0 = 10% = non pharmacologic
1= 20% = 1 drug
2= 40% = 2 drugs
3 = > 60% = 3+ drugs

40
Q

Where is the “vomiting center”

A

the chemoreceptor trigger zone is in the area postrema of the medulla

agonists for this site are; 5hT3, histamine, Muscarinic, dopamine and opioids

this stimulates the emetic center that results in nausea and voting.

41
Q

benedryl dose

42
Q

Benedryl MOA

A

1st gen H1 receptor antagonist
antimuscarinic

good for motion sickness because it inhibits the afferent area of the oculo-emetic reflex

43
Q

Side effects amongs all histamine blockers

A

Blurred vision
urinary retention
dry moth
drowsiness (1st gen)

44
Q

Cimetidine trade name

45
Q

Cimetidine dose

A

150-300 mg IV

1/2 in renal pts

46
Q

Cimetidine MOA

A

H2 receptor antagonist

47
Q

Cimetidine Side effects

A

Brady/ hypotension with rapid infusion
inc prolactin
impotence
inhibits metab of many meds

48
Q

Ranitidine trade name

49
Q

Ranitidine dose

A

50 mg dilutes in 20 cc over 2 min

1/2 in renal pts

50
Q

Why do we half the dose of H2s in renal pts

A

H2R antag increase creat by 15%

51
Q

H2 receptor antagonist side effects

A

Skm pain
dec gastric mucosa
confusion (elderly)
bradycardia

52
Q

Ranitidine MOA

53
Q

Famotidine trade name

54
Q

Famotidine dose

A

20 mg

1/2 in renal pts

55
Q

famotidine side effects

A

interferes w/ phos absorption = hypophosphatemia

56
Q

PPI side effects

A

bone fractures
SLE
acture intersititinal nephritis
C diff
b12/ mag deficiency
dec warfarin metab
dec plavix metab (prodrug) = wont work

57
Q

Omeprazole trade name

58
Q

Omeprazole dose

A

40 mg in 100 ml / 30 min

PO > 3hr prior to OR

Prodrug

59
Q

Omeprazole side effects

A

Confusion, agitation, ha

abd pain, n/v, flatulence, small bowel bacteria overgrowth

60
Q

Omeprazole MOA

61
Q

MOA of PPi

A

Histamine binds to the patiental cell and activates the H2R that activates the proton pump that sends one H+ into the stomach in exchange for a Potassium and the H+ binds the CL- = HCl (stomach acid)

62
Q

Pantoprazole trade name

63
Q

pantoprazole dose

A

40mg/100 ml 2-15 min

give 1 hr prior to OR

64
Q

Particulate antacids

A

dont give on full stomach
aspiration - acid aspiration
aluminum and mag based

65
Q

non particulate antacids

A

sodium, carbonate, citrate, bicarbonate
neutralize acids

Sodium citrate (bicitrate)

66
Q

Bicitrate dose

A

15-30 ml PO

67
Q

What drug is FDA approved for morning sickness

68
Q

Emend (Aprepitant)

A

Newer, expensive drug, for use in very high risk patients. A substance P/nk-1 antagonist (also a CTZ trigger). A previously unexplored pathway to prevent N/V

69
Q

Scopolamine reversal

A

Physostigmine 1 mg

moa = increase ACH in nmj by inhibiting ACHe. consider bradycardia and bronchoconstriction effects.

Clinical prep (21 decks)

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