post op N/V Flashcards

1
Q

RF for PONV

A

female, motion sickness,

previous PONV, non-smoker

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2
Q

what are some factors that affect PONV?

A

anesthesia techniques: inhalation agents, NO, high does of neostigmime (anticholestinerase) , opioids

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3
Q

what does neostigmine do?

A

reverse the affects of anesthesia

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4
Q

what are surgical RF for PONV?

A

type and longer duration

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5
Q

tx of PONV pre-op

A

BZD for anxiolysis

aprepitant, dexamethasone, pre-hydration

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6
Q

tx of PONV intra op

A

use of regional anesthetics, propofol, analgesia (non-opioid)

ketamine, NG tube, anti-emetic therapy

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7
Q

what are some types of post op tx of PONV

A

serotonin agonists, neurokinin inhibitors, steroids, antihistamines, benzo, butyrophenones, metoclopramide, scopalamine

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8
Q

serotonin agonists?

A

ondansetron, granistron

act at 5HT-3 receptor

ADR: HA, D, constipation, arrhythmia, serotonin syndrome

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9
Q

neurokinin inhibitor?

A

aprepitant, often used in GI surgery

  • Admin. pre-anesthesia reduces N/V up to 48 hours post-surgery
  • blocks substance P production
  • ADR: dizzy, D, HA, weakness
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10
Q

steroids?

A

dexamethasone

  • unclear MOA, possibly affect prostaglandins in brain
  • Clinically: reduce NV, may improve mood

•Adverse events: Dizziness, Mood change

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11
Q

antihistamines?

A

first gen (dimenhydrinate, promethazine)

  • Work at emesis center and CTZ to reduce vomiting
  • ADR: Sedation, confusion, dry mouth, urinary retention
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12
Q

Butyrophenones?

A

droperidol

  • Work at CTZ to block N/V and at the D2 receptor
  • ADRs: big deal; Prolonged QT (black box warning), hypotension, tachycardia, extra-pyramidal sx
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13
Q

how does metoclopramide work?

A

increases LES tone and promotes gastric emptying

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14
Q

what else needs to be considered in a pt with post op N?

A

MI especially in high risk cardiac pts

b/c N is a sx

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