Nausea/Vomiting

Question 1

PONV risk factors (Apfel score)

Answer 1

• Female, nonsmoker, history of motion sickness or previous PONV, expected use of post-op opioids
• 1 pt per criteria

Question 2

General N/V treatments

Answer 2

• Metoclopramide, Phenothiazines, 5-HT3 antagonists

- Specifically for gastroenteritis: OTC pedialyte - particularly in kids

Question 3

Disorders of balance treatments

Answer 3

-Largely antihistamines (H1), OTC treatments can be used

Question 4

NVP treatments

Answer 4

• OTC ginger
• Antihistamines (doxylamine + pyrodoxine (B6))
• 5 HT3 antagonists, metoclopramide, prochlorparazine

Question 5

PONV treatments

Answer 5

• Depends on risk score
• Score of 4 (high risk): scopolamine patch (applied 2 hr prior to anesthesia, IV dexamethasone after anesthesia induction, then 5HT3 antagonist at end of surgery)
• Score 2-3 (moderate risk): 5HT3 antagonist at end of surgery
• Score les than or equal to 1 (low risk): no therapy needed
• Rescue therapies: 5HT3 antagonist or drug from different class

Question 6

Antihistamines (drugs)

Answer 6

-Dimenhydronate, diphenhydramine, doxylamine, scopolamine, hydroxyzine

Question 7

Antihistamines (uses)

Answer 7

-Disorders of balance and NVP

Question 8

Antihistamines (SE)

Answer 8

• Sedation
• Dry mouth
• Constipation
• Paradoxical effect: insomnia, irritability (children)

Question 9

Phenothiazines (uses)

Answer 9

-general N/V, rescue PONV, lower line therapy for NVP

Question 10

Phenothiazines (drugs)

Answer 10

• Promethazine, prochlorparazine, chlorpromazine

- Deep IM injection preferred because severe tissue damage can occur

Question 11

Phenothiazines (SE)

Answer 11

• Tissue damage
• Hypotension (slow IV push, patient needs to lie down for 5 mins after admin.)
• QT prolongation
• Dystonia (rigidity)
• EPS (involuntary movement of the tongue)

Question 12

5HT3 antagonist (uses)

Answer 12

-general N/V, PONV, lowerline NVP

Question 13

5HT3 antagonist (drugs)

Answer 13

-Ondansetron, dolasetron, granisetron, palonosetron

Question 14

5HT3 antagonist (SE)

Answer 14

• Constipation
• HA
• QT prolongation

Question 15

Pro kinetics (drugs)

Answer 15

-Metoclopramide, Erythromycin

Question 16

Pro kinetics (Metoclopramide uses)

Answer 16

-General N/V, rescue PONV, lower line NVP, 1st line therapy in gastroparesis

Question 17

Pro kinetics (Metoclopramide SE)

Answer 17

-EPS, dystonia (given IV), QT prolongation, diarrhea)

Question 18

Pro kinetics (Erythromycin SE)

Answer 18

-N/V when used as abx, diarrhea, QT prolongation

Question 19

Corticosteroids (Dexamethasone)

Answer 19

• PONV

- SE: agitation, insomnia, inc appetite, inc HTN (short term)