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1Fall24 PoA II > PONV pt2 > Flashcards

PONV pt2 Flashcards

1
Q

What is P-6 stimulation?

A

Radial compression

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2
Q

How is P-6 manipulation thought to treat PONV?

A

P-6 compression → Hypophyseal secretion of β-endorphins → inhibition of CTZ.

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3
Q

Is P-6 manipulation good at treating nausea and vomiting?

A

Not really, better at inhibition. More time-limited

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4
Q

What are the subtypes of anti-dopaminergics that are used to treat PONV?

A
  • Butyrophenones (haloperidol, droperidol…)
  • Phenothiazines (promethazine, chlorpromazine…)
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5
Q

What are the side effects of dopamine receptor antagonists? (2)

A
  • Drowsiness/sedation
  • Extrapyramidal s/s [parkinsonism, dystonia, dyskinesia]
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6
Q

What mentioned drugs are butyrophenones? (2)

A
  • Haloperidol
  • Droperidol
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7
Q

What black box warning exists for Droperidol?

A

Torsades de Pointes and sudden death.

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8
Q

More than ______mg of droperidol should never be given.

A

0.625mg

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9
Q

Droperidol is as effective as ___________ for treatment of PONV.

A

Ondansetron 4mg

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10
Q

Droperidol also has effects as a ______________ thus resulting in hypotension.

A

weak ⍺ blocker ⇒ hypotension

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11
Q

What drugs are phenothiazines that were mentioned? (3)

A
  • Prochlorperazine
  • Chlorpromazine
  • Promethazine
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12
Q

What black box warnings are there for promethazine? (2)

A
  • Tissue damage
  • Resp arrest for < 2yo’s
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13
Q

What receptors does promethazine act on? (4)

A
  • Anti-dopamine
  • Anti-histamine
  • ⍺ adrenergic antagonist
  • muscarinic cholinergic antagonist
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14
Q

What are known side effects of promethazine? (3)

A
  • Sedation
  • Hypotension
  • Extrapyramidal side effects (EPS)
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15
Q

How do 5HT3 Antagonists work in the treatment of nausea/vomiting?

A

Antagonize serotonin receptors on the vagal nerve and CTZ

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16
Q

Chronic use of 5HT3 antagonists can result in mild elevation of what? Other side effects include? (2)

A
  • elevation of Liver enzymes
  • headache
  • constipation
17
Q

What timeframe should ondansetron be given?

A

4mg within 15 - 20 min of surgery end.

18
Q

What anticholinergic is given for PONV prophylaxis?
What dose and route is utilized? How long should it be left in place? What are some side effects that may occur? (3)

A

Scopolamine

  • 1.5mg transdermal patch
  • Should be left in place for 48-72 hours
  • May cause drowsiness, dizziness, or dry mouth
19
Q

What is the PONV rescue dose of dexamethasone?

A

Trick question. Dexamethasone should be used for prophylaxis only, not useful as a rescue.

20
Q

What timeframe is dexamethasone given and what dosage is utilized?

A
  • Given during or immediately after induction (~2hours before end of surgery).
  • 4mg (just as effective as 8mg)
21
Q

How does metoclopramide combat PONV? What dose is given? What side effects can occur?

A
  • Increases LES tone and GI motility.
  • 10 - 20mg IV
  • May cause restlessness, EPS

Less efficacious than droperidol, studies showing 50% effect compared to placebo.

22
Q

What NK-1 antagonist is given for PONV? How does it work?

A

Aprepitant:

  • antagonizes substance P in the emetic center.
  • Depresses Nucleus tractus solitarius neural activity
  • Blocks afferent messages from enterochromaffin cells
23
Q

What is the aprepitant dose? What time frame should it be given?

A
  • 40mg or 125mg
  • given 2-3 hours prior to induction (preop)
24
Q

How does propofol prevent/treat PONV?

A

Blocks serotonin release in subhypnotic doses.

May also inhibit CTR? CTZ?.

25
Q

What is the subhypnotic dose of propofol?

A

16.7 mcg/kg/min

26
Q

What drug needs to be given alongside propofol? Why?

A

Glycopyrrolate (to counteract bradycardia)

27
Q

______ ______ has been associated with a 50% reduction in nausea.

A

Isopropyl alcohol

28
Q

Droperidol can be given with _____ to provide better effect

A

Droperidol can be given with metoclopramide 10mg to provide better effect

29
Q

What are other 5HT3 antagonist drugs that were mentioned along with ondansetron? (3)

A
  • Dolasetron (anzemet)
  • Granisetron (kytril)
  • Palonosetron
30
Q

What should be considered when choosing to administer aprepitant?

A
  • has greater anti-vomiting effects than anti-nausea
31
Q

What other complications should be considered by the CRNA as causes of N/V? (5)

A
  • Hypotension
  • Hypoxemia
  • ↑ICP
  • Gastric bleeding
  • Hypoglycemia
32
Q

What overall anesthetic management changes can be made to reduce the risk of PONV?

A

1Fall24 PoA II (34 decks)

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