Symptoms Flashcards
D2 antagonists, cat. 1A
more potent and longer acting: haloperidol* (though IV formulations maybe less likely to prolong QTc than orals), olanzapine, chlorpromazine (thorazine, not first-line agent due to risk of sedation).
D2 antagonists, cat. 1B
weaker/shorter acting: examples include prochlorperazine (compazine)
D2 antagonists, cat. 1C
Promotility: metoclopramide* is a promotility agent for gastroparesis. Use for 3 months or more is associated with a risk for tardive dyskinesia, particularly in patients with renal/hepatic impairment, diabetes, or who are older than 70.
Meds besides opioids that constipate
anticholinergics (tricyclic antidepressants, scopolamine, oxybutinin, promethazine, diphenhydramine), lithium, verapamil, bismuth, iron, aluminum, calcium salts.
When patients have multi-organ failure, some paralytics may not be cleared for
2-18 hours. If in doubt, utilize a peripheral nerve stimulator, ok to extubate when you see muscle twitches with 4 consecutive nerve stimulations.
itch is mediated by
unmylenated C fibers
drugs that cause pruritis
opioids, aspirin, drug reactions
More direct cooling agent than calamine or methol
EMLA cream, a mixture of lidocaine and prilocaine
Best medications for itch
combined H1 (classics, first and second gen)/H2 (lower stomach acid, like famotidine)
TCA like doxepin if refractory
Antidepressants for itch, paraneoplastic pruritis
paroxetine, mirtazapine
Antidepressants for itch, CKD pruritis
sertraline, amitriptyline, doxepin (another TCA)
Antidepressants for itch, cholestatic pruritis
sertraline
Ondanstreon and other 5HT3 antagonists treat pruritis caused by
opioids, cholestatis and renal disease
peristent versus intractable hiccups
peristent, longer than 48 hours; intractable, longer than 1 month
hiccup etiologies (10)
gastric or esophageal distention, corticosteroids, idiopathic, post-surgical, chemotherapy, cancer, myocardial infarction, liver disease, uremia, and CNS lesions
Hiccups non-pharm treatments
SSMI (deep deep breathing), HiccAway, breath-holing, hyperventilation, vagal stimulation, carotid massage, rubbing C5 to disrupt phrenic nerve
The only FDA approved drug for hiccups
Chlorpromazine (thorazine) 25mg-50mg PO TID or QID
Anticonvulsants for hiccups (4)
Gabapentin 300-400mg TID
Phenytoin (central hiccups), VAL, CARB
Baclofen for hiccups
the only drug RTC’d, 5mg Q8H, symptomatic relief despite continued hiccuping
Hiccups from stomach distention treatment
metacloprmide 10 q6h
Interventions for refractory hiccups (3)
acupuncture, diaphragmatic pacing electrodes, surgical ablation of the reflex arc
Kaolin and Pectin (Kaopectate) indication and time to effect
diarhhea, 48h, may impair absorbtion of meds
diphenoxylate
Lomotil, opioid that treats diarrhea, more BBB crossing so more side effects than Loperimide (Immodium)
Lopermide (imodium) class and mechanism
opioid, reduces peristalsis, increases water reabsorbtion, only weakly crosses BBB, max dose of 16mg per day, (54mg have been used)