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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?

A

5HT3 RAs

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?

A

NK1 RA

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
Q

When is aprepitant recommended?

A

As an add on in severe cases

26
Q

What adverse effects can corticosteroids cause?

A

Severe hyperglycemia

27
Q

What is the first line therapy in combination therapy?

A

Corticosteroids

28
Q

What patients are corticosteroids not recommended in?

A

Those with labile diabetes

29
Q

What does the use of steroids decrease?

A

Opioid consumption and muscle pain

30
Q

What butyrophenones have a black box warning of QTc prolongation?

A

Droperidol

31
Q

What butryphenone is not recommended for children?

A

Haloperidol

32
Q

What butryphenone has QTc sedation as an ADE?

A

Haloperidol

33
Q

What is significant about droperidol dosing in PONV?

A

It is significantly lower

34
Q

What is the place in therapy of the butryphenones?

A

Second line

35
Q

What are the 3 antihistamines used in PONV?

A
  1. Dimenhydrate (Dramamine)
  2. Meclizine
  3. Hydroxyzine
36
Q

When should a transdermal scopolamine be placed?

A

24 hours prior to surgery

37
Q

What are 3 SEs of Metoclopramide?

A
  1. Tardive dyskinesia
  2. QTc prolongation
  3. Sedations
38
Q

Monotherapy for low risk only: what medications can be used?

A
  1. Ondansetron
  2. Granisetron
  3. Palonosetron
  4. Dexamethasone
39
Q

What is the 1st line regimen for combination therapy- moderate and high risk?

A

5HT3 antagonist + Dexamethasone

40
Q

What other 2 regimens can be used for combination therapy- moderate and high risk?

A
  1. 5HT3 + Droperidol
  2. Droperidol + Dexamethasone
41
Q

If there is no N/V prophylaxis, what is first line therapy?

A

5HT3 antagonists

42
Q

When prophylaxis fails, what should be done?

A

Choose a therapeutic option the patient did not already receive

43
Q

When can you repeat initial prophylaxis therapy?

A

If N/V occurs 6 hours after the initial dose

44
Q

If there is refractory N/V while still in the PACU, then what should be used?

A

Propofol 20 mg IV PRN

GI FINAL (6 decks)

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