Nausea/Vomiting Flashcards
Causes of N/V
- General N/V (Gastroenteritis, Pancreatitis)
- Balance Disorders
- Pregnancy
- Post-Operative [PONV]
- Gastroparesis
- Oncology
Dramamine (Generic, Class)
Dimenhydrinate
H1 Antagonist
Benadryl (Generic, Class)
Diphenhydramine
H1 Antagonist
Bonine
Meclizine
H1 Antagonist
Least Drowsy
Which H1 Antagonist causes the least drowsiness?
Meclizine
Unisom (Generic, Class)
Doxylamine
H1 Antagonist
Scopolamine (Class)
H1 Antagonist
72 hour patch
Hydroxyzine (Class)
H1 Antagonist
Not Common
H1 Antagonist Common ADE
- Drowsiness
- Dry Mouth
- Constipation
Caution in geriatics–> Fall Risk
What are the phenothiazines covered in this course?
Phenergan [Promethazine]
Compazine [Prochloroperazine]
Phenothiazine Mechanism
- Inhibits Dopamine Receptors
- Inhibits Muscarinic Receptors
Phenothiazine Common ADEs
- Hypotension [DO NOT GIVE AS IV BOLUS]
- QT prolongation
- EPS Symptoms
Phenergan (Generic, Class, BBW)
Promethazine
Phenothiazine
BBW: Tissue Damage upon IV Administration. Do not give IV.
Compazine (Generic, Class)
Prochlorperazine
Phenothiazine
Zofran (Generic, Class)
Ondansetron
5-HT-3 Antagonist
5-HT-3 Antagonist ADEs
- Constipation
- Headache
- QT prolongation (low risk at 8mg dose)
When is dexamethasone most commonly used for nausea and vomiting?
Post-Operative N/V
What is the mechanism for Dexamethasone in N/V?
Decrease prostaglandins and serotonin in the gut.
What are our go-to non-QT prolonging anti-emetics?
- Dexamethasone
- Antihistamines
NO-order here
Reglan (Generic, Class, Indications, Mechanism, ADE)
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.
Erythromycin (Class, Mechanism, ADE)
Prokinetic
Mechanism: Agonizes Motlin receptors, increasing peristalsis
ADE: N/V, Diarrhea, QT prolongation
How do we typically manage general N/V?What are the first line agents? What is the 2nd lin option?
1st Line = Ondansetron or Metoclopramide
2nd Line = Phenothiazines
How do we typically manage N/V caused by gastroparesis?
1st Line = Metoclopramide
2nd Line = Erythromycin
What do we use to manage N/V caused by balance disorders?
Meclizine(well any antihistamine)
How do we typically manage N/V of Pregnancy?
1st Line = Diclegis or Bonjesta
2nd Line = 5-HT-3 Antagonist or Metoclopramide
What is the Apfels Risk Score Used for and what are the componets.
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
How do we treat patients who are at high risk for PONV (4 points)?3 OPTIONS
- Scopolamine Patch (2 hours before induction)
- IV-Dexamethasone (After induction)
- 5-HT-3 Antagonist (Post-Op)
How do we manage patients who are moderate risk for PONV? (2-3 points)
5-HT-3 Antagonist
How do we manage patients who are low risk for PONV?
No planned anti-emetic.
Describe how rescue therapy works for PONV. For example, what would we do if a patient is still vomiting despite preventative treatment.
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.
