Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Mar: Sem 4 - Principles II > Exam 3: PONV > Flashcards

Exam 3: PONV Flashcards

1
Q

When does nausea peak in patients post-operatively?
How long does nausea/vomiting typically last post operatively?

A

Peak: 6 hours
Persists for 24 - 48 hours

S3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the most common pt complaint?

A

Nausea or vomiting

overall incidence 20-30% with intractable vomiting being 0.1%

S3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the four major inherent (patient-specific) risk factors for PONV?

A
  • Female
  • Non-smoker
  • PONV history
  • History of motion sickness

Opioid use not an inherent risk factor.

S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are two additional risk factors for PONV that are based on the pt?

A
  • delayed gastric emptying (in states such as DM, GLP-1, gastroporesis etc)
  • Peroperative anxiety

S4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What factor is the greatest cause of PONV from anesthesia?

A

Intraoperative and postoperative opioids.

S5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the full list of anesthetic-technique risk factors for PONV?

A
  • Volatile’s
  • Nitrous > 50%
  • Opioids
  • Neostigmine
  • Gastric distention
  • Anesthesia duration
  • Forced PO fluids prior to discharge

Very Nice Opairs Need Gassy Ant’s Feurosemide

S5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What surgeries place a patient at higher risk for development of PONV in adults?

A
  • Longer duration of surgery (relates to long Anesthesia)
  • High risk surgeries
  • ENT surgeries
  • Neuro surgeries
  • Belly surgeries
  • Breast, plastic, strabismus surgery (girly sx’s)
  • Laparoscopy (bc of insufflation)
  • Laparotomy

BEGAN (Belly including laps, ENT, Girly, Anesthesia long, Neuro)

S6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pediatric PONV incidence increases with age until ____.

A

puberty

S7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which pediatric procedures are noted to have a higher incidence of PONV?

A
  • Adenotonsillectomy
  • Strabismus repair
  • Hernia repair
  • Orchiopexy
  • Penile surgeries

Also Males and Females experience PONV equally while peds have 2x risk of PONV as adults

OPAHS

S7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Will increased O₂ concentrations increase or decrease PONV occurrence?

A

decrease

S8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Will adequate hydration increase or decrease PONV occurrence?

A

decrease (dehydration induces nausea)

S8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Will nitrous use increase or decrease PONV occurrence?

A

increase

(N2O greater than 50% creates PONV)

S8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Will neuromuscular blockade reversal with acetylcholinesterase inhibitors increase or decrease PONV occurrence?

A

Increase

↑ neostigmine = ↑ PONV

S8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Will minimized motion/ambulation increase or decrease PONV occurrence?

A

decrease (CN VIII)

Let patient guide movement based on how they feel.

S8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Will Propofol increase or decrease PONV?

A

Decrease

Might consider running a very light sedation drip on top of the volatile for super long cases so you don’t run all out of prop

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Where is the emetic center of the brain located?

A

Lateral reticular formation of the brainstem

S10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which substances act directly on receptors of the lateral reticular formation of the brainstem?

A

Trick Question. No substances act directly on the emetic center.

S10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Where does afferent input arrive from to the emetic center?

A
  • Pharynx
  • GI tract
  • Mediastinum
  • Afferent nerves

Perfect Giraffes Manhandle Astronauts

S10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where does CNS afferent input to the emetic zone come from?

A
  • Chemotactic Zone (CTZ) of the area postrema
  • Vestibular portion of Vestibulocochlear nerve (CN VIII)

S10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The CTZ of the area postrema does not have the ____.
What are the implications of this?

A

Blood brain barrier (BBB)

No BBB means chemicals and drugs in the blood or CSF can trigger N/V.

S11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What receptors are located in the Chemoreceptor Trigger Zone?

A
  • Dopamine
  • Serotonin 5-HT3
  • Opioid
  • Histamine
  • Muscarinic
  • Neurokinin-1
  • Cannabinoid

Dale (Dr. T!) Consumed 5 Olives. His Magnificent Nutrition…

S11

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What drug is the gold standard for PONV prophylaxis and treatment?

A

Trick question. No single drug is gold standard.

S13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Patients (should / should not) receive the same drug for prophylaxis and treatment of PONV.

A

Should not.

Ex. If ondansetron is used for prophylaxis, use promethazine for treatment

s13

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When it comes to anti-emetics more is ____ (better, or worse.)

A

Better

S14

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Opioid premedication in Preop will ____ risk of PONV. Benzodiazepine premedication in Preop may ____ risk of PONV.
Increase Decrease | S15
26
What induction drug(s) increase risk of PONV?
- Volatiles's - Etomidate - Ketamine | S15
27
What induction drug(s) decrease risk of PONV?
Propofol | S15
28
What volatile agent is associated with PONV (especially in concentrations greater than 50%)?
Nitrous Oxide | S15
29
One single dose of an opioid is not enough to cause PONV. T/F?
False. A single dose can cause PONV. | S16
30
Greater than ____mg of Neostigmine is associated with increased PONV risk.
> 2.5mg **Dose dependent: ↑ neostigmine = ↑ PONV**. | S16
31
What drug could reduce the PONV associated with neostigmine?
Atropine *can use glyco for HR, but glyco doesn't decrease PONV* **Atropine dose is 7-10 mcg/kg just in case Corn gets crazy with "you learned it 1000 years ago, you need to know it"** | S16
32
What is the mechanism of action of PONV induced by neostigmine?
Thought to be muscarinic actions on the GI tract | Lecture
33
At how many risk factors is PONV prophylaxis indicated?
| S17
34
# PONV algorithm Low risk and low risk of medical sequela
No prophylaxis but reduce baseline risk - rescue using 5HT3 | S18
35
# PONV Algorithm Low risk and high risk of medical sequela
- Prophylaxis: 5HT3 - rescue with different classes: Phenothiazine, antihistamine or metoclopramide | S18
36
# PONV Algorithm Moderate risk with any risk of medical sequela
- Prophylaxis: 5HT3 + steriod - Rescue with different classes: Phenothiazine, antihistamine, or metoclopramide | S18
37
# PONV Algorithm High risk with any risk of medical sequela
- Prophylaxis: 5HT3 + steroid + propofol TIVA + scop patch - Rescue using different classes: Phenothiazine, antihistamine or metaclopramide | S18
38
What is P-6 stimulation?
Radial compression from acupuncture and acupressure | S20
39
How is P-6 manipulation thought to treat PONV?
P-6 compression → Hypophyseal secretion of β-endorphins → inhibition of CTZ. Also decreases acid secreation | S20
40
Is P-6 manipulation good at treating nausea and vomiting?
No really, better at inhibition. *might be effective early in Preop* | S20
41
What are the subtypes of anti-dopaminergics that are used to treat PONV?
- Butyrophenones - Phenothiazines | S21
42
What are the side effects of dopamine receptor antagonists?
- Drowsiness/sedation - Extrapyramidal s/s *These are also antipsychotic and neuroleptic agents too* | S21
43
What drugs are butyrophenones?
Haloperidol Droperidol | S22
44
What black box warning exists for Droperidol?
Torsades de Pointes and sudden death. | S22
45
More than ____ mg of droperidol should never be given.
0.625mg *Dr. M says the people that DO give it start with a 0.3mg dose* | S22 ## Footnote Give SLOW
46
Droperidol is as effective as ___________ for treatment of PONV.
Ondansetron 4mg | S22
47
Droperidol also has effects as a ____ thus resulting in hypotension.
weak α blocker | S22
48
What drugs are phenothiazines?
Prochlorperazine Chlorpromazine **Promethazine** | S23 ## Footnote PPCP (Like PCP, but you studder at first)
49
What black box warnings are there for promethazine?
- Tissue damage - Resp arrest for < 2yo's *Must be diluted and pushed very slowly* | S23
50
What receptors does promethazine act on?
- Anti-dopamine - Anti-histamine - α adrenergic - muscarinic/cholinergic MAAA! | S23
51
What are known side effects of promethazine?
- Sedation - Hypotension - EPS | S23
52
Dose of Promethazine
12.5-25 mg | S23 ## Footnote Just like benadryl dosing - we learned in anesthesia pharm that benadryl dose was 25-50mg tho - you right
53
How do 5HT3 Antagonists work in the treatment of nausea/vomiting?
Antagonize serotonin receptors on the vagal nerve and CTZ | S24
54
Chronic use of 5HT3 antagonists can result in mild elevation of what?
Liver enzymes | S24
55
When should ondansetron be given?
4mg within 15 - 20 min of surgery end. *Data unclear of 4mg vs 8mg* | S24
56
What anticholinergic is given for PONV prophylaxis? What dose and route is utilized?
Scopolamine 1.5mg transdermal patch and left in place for 48-72 hours | S25
57
What is the PONV rescue dose of dexamethasone?
Trick question. Dexamethasone should be used for prophylaxis only. | S26
58
When is dexamethasone given and what dosage is utilized?
Given during or immediately after induction. 4mg (just as effective as 8mg) | S26
59
How does metoclopramide combat PONV? dose?
Increases LES tone and GI motility. Not very efficacious. 10 - 20mg IV | S27
60
What NK-1 antagonist is given for PONV? How does it work?
Aprepitant (Emend): - antagonizes substance P in the emetic center. - Depresses Neucleus tractus soltarius (NTS) activity (*this is the area where the NK-1 receptors are which are activated by Sub P*) - Blocks afferent messages from enterochromaffin cells Nurses Embalmed Peas | S28
61
What is the aprepitant dose?
40mg or 125mg - given 2-3 hours prior to induction which is difficult to time, so give it as early as possible in preop *This has better effects on vomiting over nausea* | S28
62
How does propofol prevent/treat PONV?
Blocks serotonin release in subhypnotic doses. *May also inhibit CTR*. | S29
63
What is the subhypnotic dose of propofol?
16.7 mcg/kg/min | S29
64
What drug needs to be given alongside propofol?
Glycopyrrolate (to counteract bradycardia) **Glyco dose: 7-15 mcg/kg (1mg max)** | S29
65
____ has been associated with a 50% reduction in nausea.
Isopropyl alcohol | S30
66
What is the dose for prehydration to decrease nausea?
10-30 mL/kg
67
What other non-pharmachologic choices could decrease PONV?
- accupuncutre/accupressure - Adequate pre-hydration (10-30 ml/kg) - Carbohydrate loading (theory - but stabalize BG can potentially help) - Aromatherapy - Peppermint: not effective - Isopropyl alcohol: 50% reduction in nausea - Ginger (No significant reduction) - Chewing gum (Potential improvement in nausea; stimulates GI motility) | S30

Mar: Sem 4 - Principles II (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions