N/V

Question 1

N/V Causes (5)

Answer 1

1. General
2. Disorders of Balance
3. Pregnancy
4. Post-Op N/V
5. Gastroparesis (diabetes induced)

Question 2

When do you avoid agents that cause QT prolongation?

Answer 2

If QT interval is >450msec

Question 3

When should you decrease the dose or D/C an agent that causes QT prolongation?

Answer 3

Increase in the QT interval 60msec above baseline

Question 4

QT prolongation concern

Answer 4

Torsade’s - life threatening arrhythmia!!

Question 5

D/C an agent that causes QT prolongation when…?

Answer 5

QT interval >500msec
K > 4
Mg > 2

Question 6

General/gastroenteritis therapies (classes)

Answer 6

5-HT3 antagonists
Prokinetics
Phenothiazines

Question 7

Disorders of balance therapies (classes)

Answer 7

Antihistamines

Question 8

Pregnancy therapies (classes)

Answer 8

Antihistamines
5-HT3 antagonists

Question 9

Gastroparesis therapies (classes)

Answer 9

Metoclopramide
Erythromycin

Question 10

Apfels score points (4)

Answer 10

1. Female
2. Non-smoker
3. History of PONV, motion sickness
4. Planned use of post-op opioids

Question 11

PONV - Apfels score 4 therapies

Answer 11

Scopolamine patch before anesthesia
IV dexamethasone after anesthesia
5-HT3 antagonists at the end of surgery

Question 12

PONV - Apfels score 2-3 therapies

Answer 12

5-HT3 antagonists at the end of surgery

Question 13

PONV - Apfels score 0-1 therapies

Answer 13

None planned, but still be prepared

Question 14

PONV - RESCUE

Answer 14

5-HT3 or drug from another class
Metoclopramide
Phenothiazines

Question 15

Antihistamines - Drugs

Answer 15

Meclizine
Dimenhydrinate
Doxylamine
Scopolamine
Hydroxyzine

Question 16

Antihistamines - ADEs

Answer 16

Drowsiness
Dry mouth
Constipation
Increased fall risk (impaired cognition)

Question 17

Antihistamines - ROA

Answer 17

PO EXCEPT Scopolamine (patch)

Question 18

Best antihistamine?

Answer 18

Meclizine! Less sedating due to less crossing the BBB
Doxylamine for pregnancy (OTC & Rx)

Question 19

When could antihistamines help? (Which causes of N/V)

Answer 19

Disorders of balance
General
Pregnancy

Question 20

Phenothiazines - Drugs

Answer 20

Promethazine
Prochlorperazine
Chlorpromazine

Question 21

Phenothiazines - ADEs

Answer 21

Hypotension - use a slow push IV (30 min infusion), lie down during infusion and 30 mins after
QTc prolongation (less with prochlorperazine)
Dystonia (locked/rigid/can’t move)
EPS (tarditive dyskinesia, purposeless movements)
Tissue damage and irritation with IM —> Must be deep IM!!

Question 22

When could phenothiazines help? (Which causes of N/V)

Answer 22

General N/V
Rescue PONV

Question 23

Phenothiazines - ROA

Answer 23

PO/IV/DEEP IM

Question 24

5-HT3 Antagonists - Drugs

Answer 24

Ondansetron

Question 25

5-HT3 Antagonists - ADEs

Answer 25

Actually well tolerated, minimal side effects
Constipation
Headache
QT prolongation - of concern with high doses and IV admin

Question 26

When could 5-HT3 antagonists help? (Which causes of N/V)

Answer 26

General
PONV

Question 27

5-HT3 Antagonists - ROA

Answer 27

IV/PO/ODT

Question 28

Prokinetics - Drugs

Answer 28

Metoclopramide
Erythromycin

Question 29

Prokinetics - ADEs

Answer 29

Metoclopramide:
EPS (more so with IV)
Dystonia (more so with IV)
Diarrhea
QT prolongation

Erythromycin:
N/V (Ik weird right?)
Diarrhea
QT prolongation

Question 30

Prokinetics - ROA

Answer 30

PO/IV

Question 31

When could prokinetics help? (Which causes of N/V)

Answer 31

Metoclopramide: General, gastroparesis, rescue PONV
Erythromycin: Gastroparesis

Question 32

Corticosteroids - Drugs

Answer 32

Dexamethasone

Question 33

Corticosteroids - ADEs

Answer 33

Weight gain
Hyperglycemia
Insomnia
GI upset
Increased BP
Agitation
Ulceration with NSAIDs