Post-Opp N/V Flashcards
What is the 1st line treatment of N/V with unknown cause?
Proclorperazine COMPAZINE
What are SEs with Proclorparazine?
hypotension
EPS
What is the 2nd line treatment of N/V with unknown cause?
Metoclopramide
What is the 3rd line treatment of N/V with unknown cause?
Ondansetron
What are patient-specific risk factors for PONV?
female
non-smoker
hx of PONV
motion sickness
What are medication-associated risk factors for PONV?
volatile anesthetics
nitrous oxide
opioids
How do we minimize modifiable risk factors to prevent PONV?
- avoid general anesthesia
- avoid volatile anesthetics and nitrous oxide
- minimize intra- and post-operative opioids
- adequate hydration
How do we minimize post-operative opioids?
- IV ketorolac (NSAID)
- Acetaminophen IV/PO
- Ketamine
How much NS is given to maintain hydration?
10-30 ml/kg/hr
What reasons is D5 1/2 NS given instead of NS for hydration?
diabetes
prolonged procedure
How many agents are given to a medium-risk patient for PONV prophylaxis?
1-2, usually 2
How many agents are given to a high-risk patient for PONV prophylaxis?
> 2 with different MOAs
What are SEs with 5HT-3 antagonists?
Headache
Constipation
QTc prolongation
What 5HT-3 antagonists are more associated with QTc prolongation?
Ondansetron
Granisetron
When should Ondansetron and Granisetron be given because of fast onset and short duration?
at the end of surgery
When should Palonosetron be given because of its slow onset and long duration?
start of surgery
When is Aprepitant EMEND used to prevent PONV?
not recommended 1st line should be used in severe cases
When is Aprepitant administered to prevent PONV?
w/in 3 hours of the start of surgery
What are SEs with Aprepitant?
headache
fatigue
hiccups
When are corticosteroids used to prevent PONV?
1st line in combination therapy
What patients should corticosteroids be avoided in?
labile diabetes
What corticosteroids are used to prevent PONV?
Dexamethasone
Methylprednisolone
What is a SE with corticosteroids?
severe hyperglycemia 6-12 h post-operative
What is the MOA of Butyrophenones?
blocks dopamine
What are SEs with Droperidol?
BBW: QTc
What are SEs with Haloperidol?
QTc
Sedation-dose dependent
What form of Haloperidol is not FDA approved for PONV?
IV
What patients cannot get Haloperidol?
children
When should Droperidol be administered?
at the end of surgery
What role does Droperidol have in PONV?
2nd line
What antihistamines are recommended in combination in PONV?
Dimenhydramine DRAMAMINE
Meclizine
Hydroxyzine
What are SEs with antihistamines?
sedation
headache
drowsiness
dizziness
When should Scopolamine patch be placed for PONV?
24h prior to surgery
What are SEs with Scopolamine?
anticholinergic effects:
dry mouth
visual disturbances
constipation
What dose of Metoclopramide is needed in PONV?
50mg
What are SEs with Metoclopramide?
tardive dyskinesia
QTc prolongation
sedation
What is a serious ADE with IV Proclorparazine and Promethazine?
extravasation
What are SEs with Proclorparazine and Promethazine?
sedation
hypotension
dizziness
What are NOT effective antiemetic therapies?
music therapy
PPIs
intra-operative gastric decompensation
ginger root
cannabinoids
What is usually given to low-risk patients?
5HT3- usually Ondansetron
What is 1st line therapy in moderate to high risk PONV?
5HT3 antagonist + Dexamethasone
What therapy should be used in moderate to high risk PONV if Dexamethasone is CI?
5HT3 antagonist + Droperidol
What therapy should be used in moderate to high risk PONV if 5HT3 antagonist is CI?
Droperidol + dexamethasone
What should be given to patients with refractory NV?
- choose med with different MOA
- repeat initial therapy if >6h since last dose
What should be given to patients with refractory NV in the PACU?
Propofol 20mg IV prn