week 2 antiemetics gi motility- 4 of 4

Question 1

T/F

pushing rapid IV raglan less than 3 minutes will cause abdominal cramping

Answer 1

true!

this is a side effect of rapid administration of IV reglan

Question 2

this side effect of reglan hammon talked about in class- his patients in the er would just jump up and leave

Answer 2

akathisia (feeling of unease an restlessness in lower extremities) This may result in canceling surgery or may manifest in PACU

Question 3

what are the cardiac side effects seen with reglan

Answer 3

hypotension, tachycardia, bradycardia, cardiac arrythmias

Question 4

these side effects of reglan are rarely seen after a single dose

Answer 4

sedation
dysphoria
agitation
dry mouth
glossal or periorbital edema
hirsutism
urticarial
maculopapular rash

Question 5

patients with breast cancer should not be treated chronically with what medication

Answer 5

reglan

Question 6

reglan rapidly crosses the placenta - do we see adverse fetal effects with single dose

Answer 6

no- not observed

Question 7

for a patient on chronic therapy of reglan that develops peripheral edema what should we assess?

Answer 7

sodium retention and hypokalemia.

*This is due to that fact reglan inhibits dopamine-

dopamine normally inhibits aldosterone-

BUT reglan inhibits dopamine=elevated aldosterone=hypokalemia and sodium retention

Question 8

reglan

May increase sedative actions of CNS depressants and the incidence of extrapyramidal reactions cause by certain drugs: Should avoid administering in combination with

Answer 8

Phenothiazine (prochlorperazine, promethazine, chlorpromazine)

Butyrophenone drugs (Doperidol and haldol)

Patients with preexisting extrapyramidal symptoms

Seizure disorders

Question 9

these two medication classes should be avoided in patients taking reglan

Answer 9

MOAI or Tricyclic antidepressants

Question 10

reglan decreases bioavailability of orally administered cimetidine by what percent

Answer 10

25-50%

Question 11

what type of gastric issues do we avoid giving reglan to

Answer 11

suspected or known mechanical obstruction to gastric emptying

Question 12

what GI surgery do we avoid administering reglan to?

why do we avoid reglan in these patients

Answer 12

pyloroplasty or intestinal anastomosis - it stimulates gastric motility and may delay healing

Question 13

what are the effects of reglan on ester LA

Answer 13

metabolism of ester LA could be slowed by reglan induced decreases in plasma cholinesterase activity.

Question 14

reglan inhibits plasma cholinesterase activity- which may prolong what two drugs

Answer 14

may cause prolonged responses to succinylcholine and mivacurium

Question 15

who is at an especially increased risk for developing this prolonged responses of inhibiting effect of plasma cholinesterase activity when administering reglan

Answer 15

Parturients may be at increased risk for developing this response, considering the already decreased plasma cholinesterase activity associated with pregnancy.

Question 16

BENZODIAZEPINES- ponv

Answer 16

May decrease PONV by decreasing synthesis and release of dopamine within the CRTZ.

Question 17

If using a benzo for PONV therapy like versed when do you administered it

Answer 17

toward the end of the surgical procedure

Question 18

if the patient is going to be ventilated in the ICU how can you administer the Versed for PONV

Answer 18

administer by continuous infusion

Question 19

Droperidol prophylactic dose

Answer 19

0.625-1.25mg IV PONV

Question 20

what was the primary reason droperidol was listed for a black box warning

Answer 20

the doses were MUCH higher than that necessary to treat PONV

Question 21

what is the dose of haloperidol that does not cause sedation but has antiemetic properties

Answer 21

0.5-2mg IV

Question 22

all meds that involve dopamine receptor blockade in the brain have a risk of “These” symptoms

Answer 22

extrapyramidal symptoms

Question 23

due to the extrapyramidal symptoms caused from dopamine receptor blockade in the brain- caution should be used for what 3 disease types

Answer 23

parkinsons disease

RLS

Disease R/T dopaminergic activity

Question 24

what type of drug is dexamethasone

Answer 24

corticosteroids

Question 25

what is the mechanism of action for the use of dexamethasone as an antiemetic

Answer 25

unclear MOA

Question 26

what has been proposed as the moa for dexamethasone for the use as an antiemetic

Answer 26

centrally inhibit prostaglandin synthesis and control endorphin release

Question 27

``` one time use of dexamethasone will produce ... -minimal? -moderate? -maximum? side effects ```

Answer 27

minimal side effects

Question 28

these two patient populations are at risk for perioperative hyperglycemia when they receive a single dose of dexamethasone

Answer 28

Diabetics (brittle/labile) and Obese

Question 29

antagonism of 5-HT3 receptors=

Answer 29

antiemetic effect

Question 30

which antiemetic receptor is an Excitatory ligand-gated nonselective cation.

Answer 30

5-HT3 Receptor Antagonists

Question 31

5ht3 receptors are extensively distributed on enteric neurons in what two places

Answer 31

Gi and brain

Question 32

what stimulates the vagal Afferents through 5-HT3 receptor and initiates the vomiting reflex

Answer 32

serotonin which is release from the enterochromaffin cells of the small intestines

Question 33

T/F | 5-HT3 receptor antagonist are highly specific and have minimal side effects

Answer 33

True

Question 34

this drug class has been proven to be effective in prevention and treatment of PONV

Answer 34

5HT3 receptor antagonist

Question 35

in addition to 5HT3 receptor antagonist being proven to be effective in prevention and treatment of PONV- what other types of N/V situation are they useful for as prophylaxis.

Answer 35

prophylaxis and treatment of chemotherapy and radiation therapy induced N/V

Question 36

% protein bound - 5HT3 receptor antagonist

Answer 36

moderate | 60-70%

Question 37

metabolism of 5HT-3 receptor antagonist

Answer 37

different subtypes of the cytochrome P450

Question 38

metabolites of 5HT3 receptor antagonist are excreted by what organ

Answer 38

primarly renal excretion

Question 39

5HT3 receptor antagonist are readily absorbed - do they cross the BBB

Answer 39

yes they readily cross the BBB | IV administration=max brain concentration quickly

Question 40

ondansetron 4mg dexamethasone 4mg droperidol 1.2mg these drugs administered prophylactically before induction of general anesthesia are equally effective in decreasing PONV by what percent

Answer 40

26%

Question 41

ondansetron - name the two most common side effect

Answer 41

headache | diarrhea

Question 42

ondansetron therapeutic blood concentrations are achieved in how many minutes

Answer 42

30-60 minutes

Question 43

how is ondansetron metabolized ? what is the elimination half time

Answer 43

metabolized by liver elimination half time is 3-4 hours

Question 44

ondansetron is derived from _______ and structurally related to ________

Answer 44

carbazalone serotonin

Question 45

ondansetron possess specific 5-HT3 subtype receptor antagonist properties without altering what 4 receptor activity

Answer 45

dopamine, histamine, adrenergic or cholinergic receptor activity

Question 46

what cardiac issues have been reported after IV zofran and reglan

Answer 46

cardiac arrhythmia and conduction disturbances (Atrioventricular block)

Question 47

T/F | ondansetron can cause QT interval prolongation but not to the extent as droperidol

Answer 47

true

Question 48

for every 100 patients receiving ondansetron for prevention of PONV 20 will not vomit who would have vomited without treatment- what will 3 of those 100 patients develop who would not have this adverse effect without the drug

Answer 48

3 - headache? why do we have to know this?

Question 49

ondansetron significant feature

Answer 49

free of side effects

Question 50

zofran 4-8mg IV over 2-5 minutes immediately before the induction of anesthesia is highly effective in decreasing the incidence of ponv in susceptible pt population such as..

Answer 50

ambulatory gyno surgery, middle ear surgery

Question 51

oral zofran for pre adolescent children dose

Answer 51

0. 15mg/kg-PO | 0. 05-0.15mg/kg- IV

Question 52

what surgeries do we want to especially pre medicate children for

Answer 52

tonsillectomy and strabismus surgery ambulatory surgery

Question 53

Name the drug that is almost as effective as ondansetron in preventing PONV 19-26%

Answer 53

propofol

Question 54

dimenhydrinate (dramamine) dose for adult decreases vomiting after

Answer 54

20mg IV outpatient surgery

Question 55

dimenhydrinate (dramamine) dose for children decreases incidence of vomiting after?

Answer 55

0.5mg/kg IV strabismus surgery

Question 56

name the 4 medications Nonspecific antihistamines likely acting on H1 receptors include:

Answer 56

Diphenhydramine Dimenhydrinate Cyclizine promethazine

Question 57

what are the 3 subtypes of histamine

Answer 57

H1-H2-H3

Question 58

Histamine acting through H1 receptors and inositol phospholipid hydrolysis evokes

Answer 58

smooth muscle contraction in GI tract

Question 59

compared to ondansetron- what is the benefit of tropisetron

Answer 59

tropisetron has the benefit of a longer elimination half time- 7.3hr vs. 3.5hr

Question 60

what disease process is tropisetron effective in treating symptoms of

Answer 60

carcinoid syndrome

Question 61

what additional properties does tropisetron treat

Answer 61

gastrokinetic properties

Question 62

compared to ondansetron: tell me about granisetron

Answer 62

it is more selective than ondansetron

Question 63

what can be administered with granisetron to siginificantly improve the acute antiemetic efficacy

Answer 63

dexamethasone

Question 64

name the 5ht3 antagonist that increases appetite

Answer 64

dolasetron

Question 65

which 5ht3 antagonist medication is highly potent

Answer 65

dolasetron

Question 66

explain the antiemetic effect of dolasetron

Answer 66

dolasetron is rapidly metabolized to hydrodolasetron- which is responsible for the antiemetic effect