Antiemetics

Question 1

PONV defined as N/V within _______ hours of surgery

Answer 1

24`

Question 2

Along with pain,____ is the highest complaint and leading cause of unanticipated hospital admission after outpatient surgery

Answer 2

PONV

Question 3

__% of patients without prophylaxis have nausea who have general anesthesia

Answer 3

40

Question 4

___% of high risk patients without prophylaxis experience PONMV

Answer 4

80

Question 5

Risk Factors for PONV

Answer 5

patient factors: female, nonsmoker, hx PONV/motion sickness

surgical factors: long sx, certain procedures( GYN, laparoscopy, ENT, breast/plastics)

anesthetic factors: IA, N2O, neostigmine, opioids

Question 6

Risk Factors for PONV in kids

Answer 6

weak association with age, greatest association is the surgical procedure :
- hernia,
- tonsils/adenoids/
- strabismus surgery,
- male genitalia

Question 7

T or F: risk for PONV decreases with age

Answer 7

F - increases

Question 8

PONV is associated with: (6)

Answer 8

• dehydration
• electrolyte abnormalities
• wound dehiscence, bleeding
• airway compromise
• unplanned admissions
• pt discomfort

Question 9

Motion sickness is caused by stimulation of the

Answer 9

Vestibular apparatus

Question 10

T or F: Opioids and morphine increase vestibular sensitivity to motion

Answer 10

T`

Question 11

pt admionistered scopalamine may have visual disturbances due to

Answer 11

anisocoria (unequal pupil size)

Question 12

indication scopalamine

Answer 12

• motion induced nausea and PONV
• trauma pt

Question 13

Zofran acts on ___________ in GI tract and _________

Answer 13

Selective 5-HT3 receptor antagonist

Chemoreceptor Trigger Zone

Question 14

S/E of Zofran

Answer 14

HA and diarrhea

Question 15

cautious using zofran in what patients

Answer 15

prolonged QT interval: can lead to torsades

Question 16

T or F: zofran safe in OB

Answer 16

F- questionable

Question 17

Indications for Zofran

Answer 17

Preventative and rescue treatment for N/V,
used in chemo

Question 18

Zofran

dose
DOA
metabolism

Answer 18

Dose: 4 mg IV
duration: 4-6 hours
extensive hepatic metabolism

Question 19

Zofran (______)

Answer 19

Ondansetron

Question 20

Decadron (________)

Answer 20

Dexamethasone

Question 21

indicatios for decadron

Answer 21

Nausea and Vomiting prevention, ENT, traumatic intubations…..

Question 22

MOA of decadron as antiemetic

Answer 22

Mechanism is unclear, proposed to centrally inhibit prostaglandin synthesis and control endorphin release

Question 23

S/E of decadron

Answer 23

genital itching/burning (give after patient asleep), hyperglycemia

Question 24

cautious using decadron in which patients

Answer 24

Careful in diabetics, wound healing issues

Question 25

dose and DOA of decadron for N/V/ PONV

Answer 25

Dose: 4-12 mg IV on induction duration: about **24 hours**

Question 26

Phenergan (________)

Answer 26

Promethazine

Question 27

MOA of phenergan

Answer 27

- Phenothiazine, - H1 receptor antagonist (antihistamine), - Anticholinergic action (motion sickness), - D2 antagonist in CTZ

Question 28

why is phenergan considered a First-generation H1 receptor antagonist

Answer 28

due to sedation potential

Question 29

phenergan indications

Answer 29

N/v anxiety

Question 30

S/E of Phenergan

Answer 30

- Causes sedation - potentiates sedative effects of benzos and opioids (Cesarean delivery) - **hypotension** - extrapyramidal symptoms (**Akathisia**)

Question 31

phenergan dose onset DOA

Answer 31

Dose: 12.5-25 mg IV **(diluted and given slowly in good IV);** onset: 3-5 min duration: 4-6 hours

Question 32

Factors associated with pulmonary complications of aspiration: (2)

Answer 32

1. Volume of gastric contents 2. Acidity of the aspirated gastric contents

Question 33

REGLAN (______)

Answer 33

METOCLOPRAMIDE

Question 34

MOA of reglan and effetcs

Answer 34

MOA: - Antiemetic action probably due **antagonism dopamine-agonist** effects in the chemoreceptor trigger zone - **Inhibition of dopamine receptors** within the CNS….. Crosses the BBB Effects: - Gastrointestinal **prokinetic**, - increases **LES tone**, - enhances response to AcH in upper GI tract to enhance **gastric motility** and accelerate **gastric emptying/reducing gastric volume**

Question 35

S/E of reglan

Answer 35

Can cause sedation, restlessness, extrapyramidal symptoms (tardive dyskinesia)

Question 36

C/I of Reglan

Answer 36

Bowel obstructions and Parkinson's, Restless leg syndrome, or Movement disorders **related to dopamine** inhibition or depletion

Question 37

indications for reglan

Answer 37

- Treatment of diabetic gastroparesis - OB - GERD - Usually given in preop for aspiration prophylaxis

Question 38

t or f: reglan alters gastric fluid pH

Answer 38

F -- Does not alter gastric fluid pH

Question 39

reglan: dose onset DOA

Answer 39

Dose: 5-10 mg IV in preop onset: 1-3 minutes, can be used as a **rescue drug in PACU** duration: 1-2 hours

Question 40

what **adverse** reaction can reglan cause

Answer 40

Potential for Neuroleptic Malignant Syndrome

Question 41

Pepcid (_________)

Answer 41

Famotidine

Question 42

MOA of pepcid

Answer 42

- **H2** - receptor antagonist, - inhibits gastric acid secretion/fluid volume and - raises gastric pH

Question 43

why is pepcid given in pre-op?

Answer 43

Given in preop to decrease **risk of pulmonary aspiration** in at risk patients

Question 44

dose and onset of pepcid

Answer 44

Dose: 20 mg IV Onset: 30 min – 1 hour

Question 45

Vistaril (______)

Answer 45

Hydroxyzine

Question 46

MOA of Hydroxyzine

Answer 46

Blocks Ach in the **vestibular apparatus**, blocks H1 receptors in the **solitary tract**, antihistamine

Question 47

uses for vistaril

Answer 47

N/V, pruritus (pregnancy), antianxiety

Question 48

S/E of vistaril

Answer 48

sedation, pain on injection

Question 49

Vistaril dose:

Answer 49

25 mg mixed with Ephedrine 25 mg IM 20 minutes before the end of surgery (careful in **HTN patients/outpatients**)