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GI OP > Nausea/Vomiting > Flashcards

Nausea/Vomiting Flashcards

1
Q

Causes of N/V

A
  1. General N/V (Gastroenteritis, Pancreatitis)
  2. Balance Disorders
  3. Pregnancy
  4. Post-Operative [PONV]
  5. Gastroparesis
  6. Oncology
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2
Q

Dramamine (Generic, Class)

A

Dimenhydrinate
H1 Antagonist

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3
Q

Benadryl (Generic, Class)

A

Diphenhydramine
H1 Antagonist

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4
Q

Bonine

A

Meclizine
H1 Antagonist
Least Drowsy

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5
Q

Which H1 Antagonist causes the least drowsiness?

A

Meclizine

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6
Q

Unisom (Generic, Class)

A

Doxylamine
H1 Antagonist

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7
Q

Scopolamine (Class)

A

H1 Antagonist
72 hour patch

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8
Q

Hydroxyzine (Class)

A

H1 Antagonist
Not Common

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9
Q

H1 Antagonist Common ADE

A
  1. Drowsiness
  2. Dry Mouth
  3. Constipation

Caution in geriatics–> Fall Risk

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10
Q

What are the phenothiazines covered in this course?

A

Phenergan [Promethazine]
Compazine [Prochloroperazine]

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11
Q

Phenothiazine Mechanism

A
  1. Inhibits Dopamine Receptors
  2. Inhibits Muscarinic Receptors
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12
Q

Phenothiazine Common ADEs

A
  1. Hypotension [DO NOT GIVE AS IV BOLUS]
  2. QT prolongation
  3. EPS Symptoms
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13
Q

Phenergan (Generic, Class, BBW)

A

Promethazine
Phenothiazine
BBW: Tissue Damage upon IV Administration. Do not give IV.

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14
Q

Compazine (Generic, Class)

A

Prochlorperazine
Phenothiazine

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15
Q

Zofran (Generic, Class)

A

Ondansetron
5-HT-3 Antagonist

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16
Q

5-HT-3 Antagonist ADEs

A
  1. Constipation
  2. Headache
  3. QT prolongation (low risk at 8mg dose)
17
Q

When is dexamethasone most commonly used for nausea and vomiting?

A

Post-Operative N/V

18
Q

What is the mechanism for Dexamethasone in N/V?

A

Decrease prostaglandins and serotonin in the gut.

19
Q

What are our go-to non-QT prolonging anti-emetics?

A
  1. Dexamethasone
  2. Antihistamines

NO-order here

20
Q

Reglan (Generic, Class, Indications, Mechanism, ADE)

A

Metoclopramide
Prokinetic
Use: General, PONV, Gastroparesis
ADE: EPS, QT prolongation, Diarrhea
Mechanism: Inhibits Dopamine, Inhibits serotonin and enhances acetylcholine. —> speed motility, enhance gastric emptying, and increase esophageal tone.

21
Q

Erythromycin (Class, Mechanism, ADE)

A

Prokinetic

Mechanism: Agonizes Motlin receptors, increasing peristalsis

ADE: N/V, Diarrhea, QT prolongation

22
Q

How do we typically manage general N/V?What are the first line agents? What is the 2nd lin option?

A

1st Line = Ondansetron or Metoclopramide

2nd Line = Phenothiazines

23
Q

How do we typically manage N/V caused by gastroparesis?

A

1st Line = Metoclopramide

2nd Line = Erythromycin

24
Q

What do we use to manage N/V caused by balance disorders?

A

Meclizine(well any antihistamine)

25
Q

How do we typically manage N/V of Pregnancy?

A

1st Line = Diclegis or Bonjesta

2nd Line = 5-HT-3 Antagonist or Metoclopramide

26
Q

What is the Apfels Risk Score Used for and what are the componets.

A

Apfels is for determining risk for Post-Operative Nausea and Vomiting.

Females = +1
Non-smokers = +1
Hx of motion sickness or PONV = +1
Planned use of opioids post-op = +1

High Risk = 4 points
Moderate Risk = 2-3 Points
Low Risk = 1 or less

27
Q

How do we treat patients who are at high risk for PONV (4 points)?3 OPTIONS

A
  1. Scopolamine Patch (2 hours before induction)
  2. IV-Dexamethasone (After induction)
  3. 5-HT-3 Antagonist (Post-Op)
28
Q

How do we manage patients who are moderate risk for PONV? (2-3 points)

A

5-HT-3 Antagonist

29
Q

How do we manage patients who are low risk for PONV?

A

No planned anti-emetic.

30
Q

Describe how rescue therapy works for PONV. For example, what would we do if a patient is still vomiting despite preventative treatment.

A

If treated with a 5-HT-3. Ask has it been longer than 4-6 hours since the last dose. Yes = redose. No = add agent with different mechanism of action.

If a 5-HT-3 has not been added yet, then it should be added.

GI OP (18 decks)

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