Nausea/Vomiting Flashcards
N/V causes
general gastroenteritis pancreatitis disorders of balance (vertigo, dizziness, motion sickness) preggo post-op N/V (PONV) radiatoin induced (RINV) chemo-induced (CINV)
Abfil’s Risk score use
scoring
female non-smoker hx motion sickness hx PONV expected use of opioids
= 1 no tx needed
2-3 pts 5HT3 antag at end of op
>/= 4 high risk: scopolamine patch 2 hr before anesthesia + IV dexamethasone – op – + 5HT3 antag at end of surgery
PONV rescue therapies for 2-3pts or >/=4pts
A. 5HT3 antag if not already or >8h B. diff class if got option A already
antihistamines (AHs) drugs
dymenhydraminate (Benadryl) dimenhydramine (Dramamine) meclizine doxylamine + B6 (Diclegis is DR, Bonjesta is ER) scopolamine (TD patch q72h) hydroxyzine
AHs MOA and use
H1 antags not H2!
balance disorders, NVP
AHs AE
SEDATION dry mouth constipation paradoxical effect insomnia irritability
Phenothiazines MOA and use
–| dopamanergic histamine and muscarinic receptors
general NV, rescue po NV, lower line NVP
Phenothiazines meds and ROA
promethazine (PO,IM)
prochlorperazine (PO, IM, PR)
chlorpromazine (PO, IM)
Phenothiazines AE
tissue damage (IV), hypotension (esp slow IV), QT prolongation, dystonia, EPS
5HT3 antags drugs
Ondansetron(Zofran) = #1 (PO,IV,ODT)
Dolansetron
granisetron
palonosetron
5HT3 antags MOA and use
5HT3 antags in gut
general NV, po NV, lower line NVP
5HT3 antags AE
constipation, HA, QT prolongation
prokinetics drugs
erythromycin
metoclopramide
prokinetics MOA and use
erythromycin: motilin receptors
Metoclopramide: D2 antag, speeds emptying
USE
M: general NV, rescue po NV, lower line NVP, gastroparesis
prokinetics AE
E: NVD, QT prolongation
M: EPS, QT prolongation, diarrhea
