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Top Drawer > Antiemetics/Aspiration Prophylaxis > Flashcards

Antiemetics/Aspiration Prophylaxis Flashcards

1
Q

PONV definition

A

nausea or vomiting within 24 hrs of surgery

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2
Q

2 leading causes of unanticipated hospital admission after outpatient surgery

A

pain & PONV

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3
Q

what % of patients without prophylaxis have nausea after general anesthesia

A

40%

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4
Q

what % of high-risk patients have PONV without prophylaxis

A

80%

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5
Q

risk factors for PONV

A

female= strongest indicator

nonsmoker

hx of PONV and/or motion sickness

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6
Q

surgical factors for PONV

A

longer procedures

certain procedures (GYN, laparoscopy, ENT, breast/plastics)

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7
Q

anesthetic factors for PONV

A

inhalational agents

nitrous

neostigmine

opioids

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8
Q

what is the greatest association of PONV for children

A

surgical procedure

hernia, tonsila, male genitalia

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9
Q

when does adult PONV risk decrease

A

may ↓ with age

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10
Q

PONV is associated with

A

dehydration, electrolyte abnormalities, wound dehiscence, bleeding, airway compromise and UNPLANNED ADMISSIONS and PATIENT DISCOMFORT

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11
Q

scopolamine can prevent

A

motion-induced nausea and PONV

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12
Q

motion sickness is caused by

A

stimulation of the vestibular apparatus

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13
Q

what can increase vestibular sensitivity to motion

A

opioids and morphine

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14
Q

transdermal absorption of scopolamine is beneficial because

A

patients may have less sedation, cycloplegia, and drying of secretions

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15
Q

zofran mechanism of action

A

Selective 5-HT3 receptor antagonist in GI tract and Chemoreceptor Trigger Zone

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16
Q

zofran uses

A

preventative and rescue treatment for N/V

used in chemo

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17
Q

zofran side effects

A

headaches
diarrhea

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18
Q

zofran should be used carefully in

A

patients with prolonged QT interval → can lead to torsades

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19
Q

zofran questionable use

A

obstetrics

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20
Q

zofran dose

A

4mg IV

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21
Q

zofran duration

A

4-6 hours

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22
Q

zofran metabolism

A

extensive hepatic metabolism

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23
Q

Dexamethasone uses

A

N&V prevention

ENT

traumatic intubations

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24
Q

Dexamethasone mechanism of action

A

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

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25
Q

Dexamethasone side effects

A

genital itching and burning

26
Q

which drug should absolutely be given after the patient is asleep

A

Dexamethasone

27
Q

Dexamethasone caution

A

diabetics, patients with wound healing issues

28
Q

Dexamethasone dose

A

4-12 mg IV

29
Q

Dexamethasone duration

A

about 24 hours

30
Q

promethazine/ phenergan

A

IV phenergan no longer on US formulaty

31
Q

promethazine mechanism of action

A

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

32
Q

Promethazine is considered

A

Considered a First-generation H1 receptor antagonist due to sedation potential

33
Q

promethazine uses

A

N/V and anxiety

34
Q

promethazine side effects

A

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

35
Q

promethazine dose

A

12.5-25 mg IV diluted and given slowly

36
Q

promethazine onset

A

3-5 min

37
Q

promethazine duration

A

4-6 hrs

38
Q

factors associated with complications of aspiration

A

volume of gastric contents

acidity of the aspirated gastric contents

39
Q

metoclopramide

A

Gastrointestinal prokinetic, increases LES tone, enhances response to AcH in upper GI tract to enhance gastric motility and accelerate gastric emptying/reducing gastric volume

40
Q

metoclopramide antiemetic action is probably due to

A

antagonism dopamine-agonist effects in the chemoreceptor trigger zone

41
Q

metoclopramide inhibits ________ receptors within the CNS

A

dopamine

42
Q

does metoclopramide cross the blood-brain barrier

A

yes

43
Q

metoclopramide side effects

A

sedation, restlessness, extrapyramidal symptoms

44
Q

metoclopramide contraindications

A

bowel obstructions and Parkinson’s, restless leg syndrome, or movement disorders related to dopamine inhibition or depletion

45
Q

metoclopramide can be used to treat

A

diabetic gastroparesis, GERD, OB

46
Q

what med is usually given in preop for aspiration prophylaxis

A

metoclopramide

47
Q

does metoclopramide alter gastric fluid pH

A

no

48
Q

metoclopramide dose

A

5-10 mg IV in preop

49
Q

metoclopramide duration

A

1-2 hours

50
Q

metoclopramide onset

A

1-3 min

51
Q

rescue drug in PACU

A

metoclopramide

52
Q

what med has the potential for neuroleptic malignant syndrome

A

metoclopramide

53
Q

hyperthermic toxidromes

A

may present with overlapping features (hyperthermia, rhabdo, altered mental status/seizures)

54
Q

famotidine mechanism of action

A

H2 receptor antagonist

inhibits gastric acid secretion/ fluid volume and raises gastric pH

55
Q

what drug is given in preop to decrease the risk of pulmonary aspiration in at risk patients

A

famotidine (pepcid)

56
Q

famotidine dose

A

20 mg IV

57
Q

famotidine onset

A

30 min - 1 hour

58
Q

hydroxyzine mechanism of action

A

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

59
Q

hydroxyzine uses

A

N/V
pruritus (pregnancy)
anti anxiety

60
Q

hydroxyzine side effects

A

sedation
pain on injection

61
Q

hydroxyzine dose

A

25 mg mixed with ephedrine

25 mg IM 20 min before the end of surgery

62
Q

hydroxyzine caution

A

in HTN patients and outpatients

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