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My Pharm 1 > Quiz 9 > Flashcards

Quiz 9 Flashcards

1
Q

General population N/V risks? High risk Pts? How long can increase discharge time?

A

Nausuea 50%
Vomiting 30%

High risk: 70-80% N or V

25%

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2
Q

Places where sensory of n/v can originate?

A 
Medulla
Chemoreceptor Trigger Zone
Neural pathway in vestibular system
Reflex afferent pathways
Midbrain afferents
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3
Q

all vomiting signals sent to?

A

medulla

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4
Q

What sensory areas are effected by Chemotherapy? by Radiotherapy?

A

Chemo: CTZ, stomache/small intestines

Radio: Stomach/small intestines

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5
Q

neural pathways of stomach/small intestine?

what drugs effect which paths?

A

to CTZ and Medulla (everything else just goes to medulla)

  • sphincter modulators and 5HT3 antagonists effect to CTZ
  • 5HT3 antagonists effect to Medulla
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6
Q

sensory imput such as pain, smell, site, memory, fear, anticipation, all effect what?

What drugs effect its path?

A

Higher cortical centers

-Benzos

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7
Q

What drugs effect the CTZ pathways?

A
  • Histamine antagonists
  • Muscarinic antagonists
  • Dopamine antagonists
  • Cannabanoids
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8
Q

times of early, late, delayed, and post-discharge post-op n/v?

A

early: 2-6 hours
late: 6-24 hours
delayed: > 24 hours
post-discharge: 24 hours post-discharge

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9
Q

PONV risk factors (18yo or older):

which actually proven?

A
  1. Female
  2. History of PONV - or motion sickness
  3. Non-smoker
  4. Age <50
  5. General vs regional
  6. Volatile anesthetics and Nitrous oxide
  7. Post-op opioids – best data to optimize NSAIDS use
  8. Duration of procedure
  9. Type of procedure (cholecystectomy, gynecologic, laparoscopic) – high incidence
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10
Q

risk factors and compounding percentages?

beyond one risk factor do what?

A

Ppl with no risk factors still 10%

One risk factor = 20%, two = 40%. Three = 60%, 4 = 80%

Beyond 1 risk factor should give at least 2 meds, beyond 3 risks give 3 meds

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11
Q

Post Discharge NV risk factors

A 
Female 
< 50yo
Hx of PONV
Opiates in PACU
Nausea in PACU
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12
Q

Risk factors for Children (which is highest):

A

Procedure >30 minutes
Age >3 years
Strabismus surgery (highest risk factor)
Hx of PONV or PONV in relatives

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13
Q

who pre-treat n/v meds?

A

moderate to high risk pts

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14
Q

Anesthesia considerations:

A

Propofol reduces by 20%

Regional vs General Anesthesia (If use TIVA can reduce by 20%)

NSAIDs over Opiates

No longer recommended to reduce Neostigmine dose just use normal dose

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15
Q

Pretreatment options:

A 
Dexamethasone
Droperidol
5HT3 antagonists
Scopolamine Patch
H1 blockers
NK1 antagonists
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16
Q

Rescue meds:

A

Reglan
D2 blockers
H1 blocker
5HT3 antagonists

(as long as different MOA than pretreatment med)

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17
Q

When to give zofran? dexamethasone? scop patch? aprepitant?

A

end of procedure

pre-induction

at least 4h before

1-3 hours before

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18
Q

which 3 drugs were equally effective and what percentage improvement?

A
  • zofran
  • droperidol
  • dexamethasone

25%

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19
Q

5HT3 antagonists?

A

(serotonin antagonists) (in gut and CNS)

the “-setrons”

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20
Q

5HT3 antagonists info: metab, prodrug, half-lives

A

Metabolism: CYP450 3A4 substrate
Prodrug: Dolasetron

Half life
O: 4 hours so given Q8 (2 half lives)
G: 9-11 hours
D: 7-9 hours
P: 40 hours
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21
Q

Dexamethasone: side effects?

A

Impaired wound healing/infection
Increased glucose (bacteria loves glucose)
Hypertension, edema
Altered mental status (agitation)

(Rare with 1x dose)

22
Q

Dexamethasone is what with other antiemetics?

A

synergistic

23
Q

Most potent D2-blockers? (2) (dopamine antagonists)

concerns?

A

Droperidol
Haloperidol

qTc prolongation and torsades

24
Q

D2 blocker side effects:

A

Dysphoria
Hypotension
EPS (tardive dyskinesia: Parkinson like symptoms. If used for too long, these can become permenant)

25
Q

Phenothiazines?

what class?

what metabolism?

A

the “-zines”

D2-receptor antagonist

hepatic

26
Q

what drugs are highly sedating compared to Haldol/droperidol?

side effects?

A

Phenothiazines

EPS

27
Q

H1 antagonists:

A

Dimenhydrinate (Dramamine)
Vistaril
benadryl

28
Q

What can compound opiate constipation?

A

H1 antagonists

29
Q

anticholinergic med?

A

Scopolamine

30
Q

Neurokinin 1 Receptor Antagonist

used for?

effects?

A

Aprepitant

Chemo induced n/v

substance P

31
Q

metoclopramide actions:

A
  • Increase L.E.S. tone. (Lower esophageal sphincter)
  • Enhance peristalsis
  • Accelerates gastric emptying.

Dopamine antagonist

32
Q

metoclopramide metabolism

A
  • hepatic with extensive first-pass effect
  • renal - impairment prolongs so need dose adjustment
  • crosses BBB and placenta
  • excreted in breast milk
33
Q

metoclopromide side effects

A

Abdominal cramping with rapid I.V. administration (< 3 minutes). **

Akathesia can occur with preoperative I.V. administration.

  • Feeling of unease. But don’t show movement
  • Restlessness in the lower extremities. Very extreme, need to move so bad or something bad will happen

Dystonic extrapyramidal reactions (oculogyric crisis, opisthotonus, trismus, torticollis) <1% of patients.

  • Chronic oral treatment.
  • Oral doses 40 to 80 mg/day.
34
Q

Metoclopramide: Interactions and Cautions

A

May prolong the activity of succinylcholine and mivacurium.*
May slow metabolism of ester anesthetics.

May increase the sedative actions of CNS depressants.

May increase the extrapyramidal reactions caused by certain drugs.

  • Avoid administering in combination with:
  • Phenothiazines or butyrophenones.

Avoid administration to:

  • Patients with a history of seizures or preexisting extrapyramidal symptoms.
  • Patients with mechanical gastric outlet obstruction
35
Q

how does reglan help with aspiration risks

A

Preoperative decrease of gastric fluid volume.

-10 to 20 mg I.V. over 3 to 5 minutes administered 15 to 30 minutes before the induction of anesthesia.

36
Q

h2 Receptor antagonists

A

The “-tidines”

37
Q

H-2 Receptor Antagonists: Inhibition of ________ binding to the receptors on gastric ________ cells

A

histamine

parietal (ATP driven so lets less H+ ions in when blocked)

38
Q

Look at slide 45

A

.

39
Q

What to do with patients undergoing procedures associated with an increased likelihood of allergic reactions?

A

Administer orally an H1 antagonist (diphenhydramine 0.5-1 mg/kg) and H2 antagonist (cimetidine 4mg/kg) q. 6 hrs. 12-24 hours prior.

40
Q

a specific side effect for h2 antagonists?

A

thrombocytopenia (decreased platelets)

41
Q

only drug that effects lower esophageal sphincter tone?

A

metoclopramide

42
Q

look at slide 48

A

.

43
Q

drug interactions of other drugs with h2 blockers?

A

cimetidine and rinitidine - INHIBITS P-450 slowing metabolism of drug causing toxicity

44
Q

h2 blockers alter absorption of some drugs by _______ the gastric fluid pH. decreases absorption of what? give what with it to increase absorption?

A

increasing

magnesium, b12, ketoconazole, iron products, calcium carbonate

vitamin C

45
Q

When to administer PPI?

A

3 hours pre-surgery

pantoprazole and rinitidine combo can be given 1 hour prior

46
Q

adverse effects of PPI

A

C.difficile diarrhea (secondary to acid depressant)
Kidney injury
Dementia
Reduced absorption

47
Q

Acts as surfactant, changes water gradient to pull more water into stool – doesn’t help with motility

A

stool softeners, aka - colace, docusate

48
Q

change water flow gradient far greater than stool softeners and some contraction increase

A

Osmotic Laxatives: Miralax (polyethylene glycol 3350), Magnesium (hydroxide, citrate), Glycerin, Fleets enema (sodium phosphate), Lactulose

49
Q

look at slide 56-57

A

.

50
Q

constipation regiment

A

Senna S first, then add miralax, then add 5HT4 agonist

My Pharm 1 (10 decks)

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