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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
metoclopramide brand name
Reglan
26
metoclopramide dose
10-20 mg over 3-5 min. faster = abd cramping.
27
Metoclopramide onset
10 min
28
metoclopramide duration
2 hrs
29
Metoclopramide moa
Dopamine receptor antagonist increase motility increase esophageal sphincter tone decrease duodenum and pylorus tone ** diabetic gastroparesis
30
metoclopramide side effects
sedation, hypotension, increased prolactin, neuroleptic malignant syndrome decrease ACHe
31
scopolamine dose
patch priming dose 140 mcg 1.5 mcg over the next 72 hrs
32
scopolamine onset
2-4 hrs
33
scopolamine duration
72 hrs
34
scopolamine MOA
Anticholinergic muscarinic antagonist; block ach crosses BBB antisialgogue prevents motion sickness
35
Scopolamine side effects
mydriasis/ light sensitivity/ blurry vision confusion sedation dry mouth
36
Propfol for antiemetic dose
10-15 mg IV followed by 10 mcg/kg/min
37
Prop moa for antiemetic
decreases subcortical pathways and has direct effect on vomiting center
38
PONV risk factors
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
PONV treatment basic risk factors
0 = 10% = non pharmacologic 1= 20% = 1 drug 2= 40% = 2 drugs 3 = > 60% = 3+ drugs
40
Where is the "vomiting center"
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
benedryl dose
25-50 mg
42
Benedryl MOA
1st gen H1 receptor antagonist antimuscarinic good for motion sickness because it inhibits the afferent area of the oculo-emetic reflex
43
Side effects amongs all histamine blockers
Blurred vision urinary retention dry moth drowsiness (1st gen)
44
Cimetidine trade name
Tagamet
45
Cimetidine dose
150-300 mg IV 1/2 in renal pts
46
Cimetidine MOA
H2 receptor antagonist
47
Cimetidine Side effects
Brady/ hypotension with rapid infusion inc prolactin impotence inhibits metab of many meds
48
Ranitidine trade name
Zantac
49
Ranitidine dose
50 mg dilutes in 20 cc over 2 min 1/2 in renal pts
50
Why do we half the dose of H2s in renal pts
H2R antag increase creat by 15%
51
H2 receptor antagonist side effects
Skm pain dec gastric mucosa confusion (elderly) bradycardia
52
Ranitidine MOA
H2R antag
53
Famotidine trade name
Pepcid
54
Famotidine dose
20 mg 1/2 in renal pts
55
famotidine side effects
interferes w/ phos absorption = hypophosphatemia
56
PPI side effects
bone fractures SLE acture intersititinal nephritis C diff b12/ mag deficiency dec warfarin metab dec plavix metab (prodrug) = wont work
57
Omeprazole trade name
Prilosec
58
Omeprazole dose
40 mg in 100 ml / 30 min PO > 3hr prior to OR Prodrug
59
Omeprazole side effects
Confusion, agitation, ha abd pain, n/v, flatulence, small bowel bacteria overgrowth
60
Omeprazole MOA
PPi
61
MOA of PPi
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
Pantoprazole trade name
protonix
63
pantoprazole dose
40mg/100 ml 2-15 min give 1 hr prior to OR
64
Particulate antacids
dont give on full stomach aspiration - acid aspiration aluminum and mag based
65
non particulate antacids
sodium, carbonate, citrate, bicarbonate neutralize acids Sodium citrate (bicitrate)
66
Bicitrate dose
15-30 ml PO
67
What drug is FDA approved for morning sickness
Pepcid
68
Emend (Aprepitant)
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
Scopolamine reversal
Physostigmine 1 mg moa = increase ACH in nmj by inhibiting ACHe. consider bradycardia and bronchoconstriction effects.

Clinical prep (21 decks)

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