Nausea & Vomiting

Question 1

True or False? Nonpharmacologic therapy for CINV is more favorable than PONV

Answer 1

False. Nonpharmacologic therapy for CINV is not recommended, but is favorable in PONV

Question 2

What medication is the 1st line therapy for motion sickness?

Answer 2

Scopolamine

Question 3

What are directions for use of scopolamine?

Answer 3

Apply day before traveling, wash hands after application, avoid contact with eyes

Question 4

What is the 2nd line therapy for motion sickness?

Answer 4

First generation antihistamines:
Antivert® (Meclizine)
Marezine® (Cyclizine)
Dramamine® (Dimenhydrinate)
Benadryl® (Diphenhydramine)
Hydroxyzine

Question 5

Use caution with antihistamines in patients with these conditions:

Answer 5

Respiratory conditions
Glaucoma
Benign prostate hyperplasia
Breast feeding

Question 6

The best treatment for ___ is prevention

Answer 6

CINV/PONV

Question 7

What are 4 examples of dopamine antagonists and which are okay to use in pregnancy?

Answer 7

Phenothiazines: prochlorperazine, promethazine (both used in pregnancy)
Benzamides: metoclopramide, trimethobenzamide

Question 8

What are adverse effects of dopamine antagonists?

Answer 8

Decreased blood pressure, increased heart rate, increased QT interval

Question 9

What types of NV are serotonin antagonists (5HT3-RA) effective?

Answer 9

All types of NV

Question 10

The onset of Zofran (ondansetron) takes ___ minutes

Answer 10

30

Question 11

Which serotonin antagonist (5HT3-RA) is available as a patch with a 24-48hr onset?

Answer 11

Granisetron

Question 12

What are examples of Neurokinin 1-Antagonists?

Answer 12

They end in -pitant

Question 13

What is a common adverse effect of Neurokinin 1-Antagonists?

Answer 13

Hiccups

Question 14

___ is a carbohydrate oral solution which is safe in pregnancy but should be avoided in diabetic patients?

Answer 14

Emetrol

Question 15

What is the 1st line therapy for NVP?

Answer 15

Pyridoxine (vit B6) 10-25mg TID alone or in combination with doxylamine 12.5-20mg 1-4 times a day (OTC)

Question 16

What are examples of serotonin antagonists (5HT3-RA)?

Answer 16

They end in -setron

Question 17

What is the 1st line therapy for CINV?

Answer 17

Serotonin antagonists (5HT3-RA)

Question 18

What is the 2nd line therapy for CINV?

Answer 18

Neurokinin 1-antagonists

Question 19

What medications are used for prophylaxis for RINV?

Answer 19

You would give serotonin antagonists (5HT3-RA) to all patients as well as dexamethasone to patients receiving radiation to their upper body, abdomen, or total body

Question 20

What is used for prevention in PONV?

Answer 20

Combination of 2 agents > monotherapy
Droperidol + 5-HT3 RA
Dexamethasone + 5-HT3 RA or droperidol

Question 21

If prophylaxis is not given to anticipate PONV, the best treatment for PONV is:

Answer 21

Low dose ondansetron

Promethazine, droperidol, dexamethasone

Question 22

What is therapy for more severe cases of NVP?

Answer 22

Ondansetron (1st), promethazine (2nd) or metoclopramide (3rd)

Question 23

What are 1st and 2nd line therapy options for gastroenteritis?

Answer 23

Dopamine antagonist (1st), 5HT3-RA (2nd)

Question 24

How do you treat CINV in children?

Answer 24

Dexamethasone plus 5HT3-RA

Aprepitant for adolescents (at adult dose)

Question 25

How do you treat PONV in children?

Answer 25

5HT3-RA (ondansetron)