Nausea And Vomiting Flashcards
Subjective feeling of a need to vomit
Nausea
Oral expulsion of GI contents due to contractions of the gut and abdominal wall musculature
Vomiting
To ensure that the patient is not dehydrated due to nausea and vomiting what should you give?
IV fluids
If the GI is the origin of N/V, what should you use?
Metoclopramide
What is recommended first line if the cause is unknown?
Prochlorperazine
What are two ADEs of prochlorperazine?
Hypotension and extrapyramidal side effects
What drug is second line if the cause is unknown?
Metoclopramide
What drug is third line if the cause is unknown?
Ondansetron
What is postoperative nausea and vomiting?
Nausea and/or vomiting within 24 hours after surgery
What are 3 risk to PONV?
- Female, non smoker, history of PONV, motion sickness
- Anesthetic/ medications
- Surgical
What are 4 ways to prevent PONV?
- Avoidance of general anesthesia
- Avoidance of volatile anesthetic and nitrous oxide
- Minimize intra-operative and post-operative opioids
- Adequate hydration
What are 3 alternative therapies to post-op opioids?
- IV Ketorolac
- Acetaminophen (IV or ORAL)
- Ketamine
How much normal saline should be given to ensure hydration?
10-30 ml/kg/hr
What is recommended for patients who have diabetes or a prolonged procedure but need hydration?
D5 1/2 NS
If a patient is at a medium risk, what is recommended for prophylaxis?
1-2 interventions
If a patient is at low risk what is recommended for prophylaxis?
Not recommended
If a patient has high risk, what is recommended for prophylaxis?
> 2 interventions/multimodal approach
What 2 antiemetics can cause QTC prolongation?
- Ondansetron
- Granisetron
What class of drugs is recommended as first line therapy for prevention and treatment of PONV?
5HT3 RAs
What antiemetics are given at the end of surgery?
- Ondansetron
- Granisetron
What antiemetics are given at the start of surgery?
Palonosetron
What is Aprepitant?
NK1 RA
What are 3 ADEs of aprepitant?
- Fatigue
- Headache
- Hiccups
When is aprepitant administered?
Within 3 hours of the start of surgery
When is aprepitant recommended?
As an add on in severe cases
What adverse effects can corticosteroids cause?
Severe hyperglycemia
What is the first line therapy in combination therapy?
Corticosteroids
What patients are corticosteroids not recommended in?
Those with labile diabetes
What does the use of steroids decrease?
Opioid consumption and muscle pain
What butyrophenones have a black box warning of QTc prolongation?
Droperidol
What butryphenone is not recommended for children?
Haloperidol
What butryphenone has QTc sedation as an ADE?
Haloperidol
What is significant about droperidol dosing in PONV?
It is significantly lower
What is the place in therapy of the butryphenones?
Second line
What are the 3 antihistamines used in PONV?
- Dimenhydrate (Dramamine)
- Meclizine
- Hydroxyzine
When should a transdermal scopolamine be placed?
24 hours prior to surgery
What are 3 SEs of Metoclopramide?
- Tardive dyskinesia
- QTc prolongation
- Sedations
Monotherapy for low risk only: what medications can be used?
- Ondansetron
- Granisetron
- Palonosetron
- Dexamethasone
What is the 1st line regimen for combination therapy- moderate and high risk?
5HT3 antagonist + Dexamethasone
What other 2 regimens can be used for combination therapy- moderate and high risk?
- 5HT3 + Droperidol
- Droperidol + Dexamethasone
If there is no N/V prophylaxis, what is first line therapy?
5HT3 antagonists
When prophylaxis fails, what should be done?
Choose a therapeutic option the patient did not already receive
When can you repeat initial prophylaxis therapy?
If N/V occurs 6 hours after the initial dose
If there is refractory N/V while still in the PACU, then what should be used?
Propofol 20 mg IV PRN
