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GI FINAL > Nausea And Vomiting > Flashcards

Nausea And Vomiting Flashcards

1
Q

Subjective feeling of a need to vomit

A

Nausea

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2
Q

Oral expulsion of GI contents due to contractions of the gut and abdominal wall musculature

A

Vomiting

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3
Q

To ensure that the patient is not dehydrated due to nausea and vomiting what should you give?

A

IV fluids

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4
Q

If the GI is the origin of N/V, what should you use?

A

Metoclopramide

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5
Q

What is recommended first line if the cause is unknown?

A

Prochlorperazine

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6
Q

What are two ADEs of prochlorperazine?

A

Hypotension and extrapyramidal side effects

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7
Q

What drug is second line if the cause is unknown?

A

Metoclopramide

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8
Q

What drug is third line if the cause is unknown?

A

Ondansetron

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9
Q

What is postoperative nausea and vomiting?

A

Nausea and/or vomiting within 24 hours after surgery

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10
Q

What are 3 risk to PONV?

A
  1. Female, non smoker, history of PONV, motion sickness
  2. Anesthetic/ medications
  3. Surgical
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11
Q

What are 4 ways to prevent PONV?

A
  1. Avoidance of general anesthesia
  2. Avoidance of volatile anesthetic and nitrous oxide
  3. Minimize intra-operative and post-operative opioids
  4. Adequate hydration
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12
Q

What are 3 alternative therapies to post-op opioids?

A
  1. IV Ketorolac
  2. Acetaminophen (IV or ORAL)
  3. Ketamine
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13
Q

How much normal saline should be given to ensure hydration?

A

10-30 ml/kg/hr

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14
Q

What is recommended for patients who have diabetes or a prolonged procedure but need hydration?

A

D5 1/2 NS

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15
Q

If a patient is at a medium risk, what is recommended for prophylaxis?

A

1-2 interventions

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16
Q

If a patient is at low risk what is recommended for prophylaxis?

A

Not recommended

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17
Q

If a patient has high risk, what is recommended for prophylaxis?

A

> 2 interventions/multimodal approach

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18
Q

What 2 antiemetics can cause QTC prolongation?

A
  1. Ondansetron
  2. Granisetron
19
Q

What class of drugs is recommended as first line therapy for prevention and treatment of PONV?

20
Q

What antiemetics are given at the end of surgery?

A
  1. Ondansetron
  2. Granisetron
21
Q

What antiemetics are given at the start of surgery?

A

Palonosetron

22
Q

What is Aprepitant?

23
Q

What are 3 ADEs of aprepitant?

A
  1. Fatigue
  2. Headache
  3. Hiccups
24
Q

When is aprepitant administered?

A

Within 3 hours of the start of surgery

25
When is aprepitant recommended?
As an add on in severe cases
26
What adverse effects can corticosteroids cause?
Severe hyperglycemia
27
What is the first line therapy in combination therapy?
Corticosteroids
28
What patients are corticosteroids not recommended in?
Those with labile diabetes
29
What does the use of steroids decrease?
Opioid consumption and muscle pain
30
What butyrophenones have a black box warning of QTc prolongation?
Droperidol
31
What butryphenone is not recommended for children?
Haloperidol
32
What butryphenone has QTc sedation as an ADE?
Haloperidol
33
What is significant about droperidol dosing in PONV?
It is significantly lower
34
What is the place in therapy of the butryphenones?
Second line
35
What are the 3 antihistamines used in PONV?
1. Dimenhydrate (Dramamine) 2. Meclizine 3. Hydroxyzine
36
When should a transdermal scopolamine be placed?
24 hours prior to surgery
37
What are 3 SEs of Metoclopramide?
1. Tardive dyskinesia 2. QTc prolongation 3. Sedations
38
Monotherapy for low risk only: what medications can be used?
1. Ondansetron 2. Granisetron 3. Palonosetron 4. Dexamethasone
39
What is the 1st line regimen for combination therapy- moderate and high risk?
5HT3 antagonist + Dexamethasone
40
What other 2 regimens can be used for combination therapy- moderate and high risk?
1. 5HT3 + Droperidol 2. Droperidol + Dexamethasone
41
If there is no N/V prophylaxis, what is first line therapy?
5HT3 antagonists
42
When prophylaxis fails, what should be done?
Choose a therapeutic option the patient did not already receive
43
When can you repeat initial prophylaxis therapy?
If N/V occurs 6 hours after the initial dose
44
If there is refractory N/V while still in the PACU, then what should be used?
Propofol 20 mg IV PRN

GI FINAL (6 decks)

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