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GI > Post-Opp N/V > Flashcards

Post-Opp N/V Flashcards

1
Q

What is the 1st line treatment of N/V with unknown cause?

A

Proclorperazine COMPAZINE

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2
Q

What are SEs with Proclorparazine?

A

hypotension
EPS

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3
Q

What is the 2nd line treatment of N/V with unknown cause?

A

Metoclopramide

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4
Q

What is the 3rd line treatment of N/V with unknown cause?

A

Ondansetron

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5
Q

What are patient-specific risk factors for PONV?

A

female
non-smoker
hx of PONV
motion sickness

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6
Q

What are medication-associated risk factors for PONV?

A

volatile anesthetics
nitrous oxide
opioids

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7
Q

How do we minimize modifiable risk factors to prevent PONV?

A
  1. avoid general anesthesia
  2. avoid volatile anesthetics and nitrous oxide
  3. minimize intra- and post-operative opioids
  4. adequate hydration
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8
Q

How do we minimize post-operative opioids?

A
  1. IV ketorolac (NSAID)
  2. Acetaminophen IV/PO
  3. Ketamine
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9
Q

How much NS is given to maintain hydration?

A

10-30 ml/kg/hr

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10
Q

What reasons is D5 1/2 NS given instead of NS for hydration?

A

diabetes
prolonged procedure

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10
Q

How many agents are given to a medium-risk patient for PONV prophylaxis?

A

1-2, usually 2

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11
Q

How many agents are given to a high-risk patient for PONV prophylaxis?

A

> 2 with different MOAs

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12
Q

What are SEs with 5HT-3 antagonists?

A

Headache
Constipation
QTc prolongation

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13
Q

What 5HT-3 antagonists are more associated with QTc prolongation?

A

Ondansetron
Granisetron

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14
Q

When should Ondansetron and Granisetron be given because of fast onset and short duration?

A

at the end of surgery

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15
Q

When should Palonosetron be given because of its slow onset and long duration?

A

start of surgery

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16
Q

When is Aprepitant EMEND used to prevent PONV?

A

not recommended 1st line should be used in severe cases

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17
Q

When is Aprepitant administered to prevent PONV?

A

w/in 3 hours of the start of surgery

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18
Q

What are SEs with Aprepitant?

A

headache
fatigue
hiccups

19
Q

When are corticosteroids used to prevent PONV?

A

1st line in combination therapy

20
Q

What patients should corticosteroids be avoided in?

A

labile diabetes

21
Q

What corticosteroids are used to prevent PONV?

A

Dexamethasone
Methylprednisolone

22
Q

What is a SE with corticosteroids?

A

severe hyperglycemia 6-12 h post-operative

23
Q

What is the MOA of Butyrophenones?

A

blocks dopamine

24
Q

What are SEs with Droperidol?

25
Q

What are SEs with Haloperidol?

A

QTc
Sedation-dose dependent

26
Q

What form of Haloperidol is not FDA approved for PONV?

27
Q

What patients cannot get Haloperidol?

28
Q

When should Droperidol be administered?

A

at the end of surgery

29
Q

What role does Droperidol have in PONV?

30
Q

What antihistamines are recommended in combination in PONV?

A

Dimenhydramine DRAMAMINE
Meclizine
Hydroxyzine

31
Q

What are SEs with antihistamines?

A

sedation
headache
drowsiness
dizziness

32
Q

When should Scopolamine patch be placed for PONV?

A

24h prior to surgery

33
Q

What are SEs with Scopolamine?

A

anticholinergic effects:
dry mouth
visual disturbances
constipation

34
Q

What dose of Metoclopramide is needed in PONV?

35
Q

What are SEs with Metoclopramide?

A

tardive dyskinesia
QTc prolongation
sedation

36
Q

What is a serious ADE with IV Proclorparazine and Promethazine?

A

extravasation

37
Q

What are SEs with Proclorparazine and Promethazine?

A

sedation
hypotension
dizziness

38
Q

What are NOT effective antiemetic therapies?

A

music therapy
PPIs
intra-operative gastric decompensation
ginger root
cannabinoids

39
Q

What is usually given to low-risk patients?

A

5HT3- usually Ondansetron

40
Q

What is 1st line therapy in moderate to high risk PONV?

A

5HT3 antagonist + Dexamethasone

41
Q

What therapy should be used in moderate to high risk PONV if Dexamethasone is CI?

A

5HT3 antagonist + Droperidol

42
Q

What therapy should be used in moderate to high risk PONV if 5HT3 antagonist is CI?

A

Droperidol + dexamethasone

43
Q

What should be given to patients with refractory NV?

A
  1. choose med with different MOA
  2. repeat initial therapy if >6h since last dose
44
Q

What should be given to patients with refractory NV in the PACU?

A

Propofol 20mg IV prn

GI (23 decks)

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