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GI Medications Flashcards

(46 cards)

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1
Q

What is late PONV defined as?

A

6-24hr post emergence

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2
Q

What are patient risk factors for PONV?

A

female, non-smoker, hx of motion sickness, previous PONV

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3
Q

What are surgical risk factors for PONV?

A

Length of procedure, laparotomies, gynecologic surgery, laparoscopic, ENT, breast, and orthopedic surgeries.

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4
Q

What are anesthesia risk factors for PONV?

A

Inhaled agents, Nitrous Oxide, Neostigmine, Narcotics, Etomidate

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5
Q

Where is the vomiting center located?

A

Medulla Oblongata

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6
Q

What are the 4 areas involved with nausea and vomiting?

A

CTZ, Vestibular apparatus, thalamus/cerebral cortex (CNS), and GI tract

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7
Q

Which neurotransmitters work in the vestibular apparatus and what is the receptor?

A

Acetylcholine (M1 receptor), Histamine (H1 receptor)

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8
Q

Which neurotransmitters work in the CTZ and what is the receptor

A

Dopamine (D? receptors), Serotonin (5HT3), Substance P (NK), Acetylcholine (M1), Histamine (H1)

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9
Q

Which neurotransmitters work in the GI tract and what is the receptor

A

Acetylcholine (M1), Histamine (H1), Serotonin (5HT3), Substance P (NK), and mechanoreceptors

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10
Q

What ending do anticholinergics have and what is an example?

A

“ine”

ex: Scopolamine, Atropine

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11
Q

What ending do benzamides have and what is an example?

A

“ide”

Ex: Metaclopramide

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12
Q

What ending do benzodiazepines have and what is an example?

A

“azolam”

Ex midazolam

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13
Q

What ending do butrophenones have and what is an example?

A

“peridol”

Ex. Haloperidol, Droperidol

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14
Q

What ending do 5HT3 have and what is an example?

A

“tron”

Ex: Ondansetron

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15
Q

What ending do NK1 anatgonists have and what is an example?

A

“itant”

Ex. Aprepitant

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16
Q

What ending do phenothiazines have and what is an example?

A

“azine”

Ex: Promethazine

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17
Q

What is an example of a glucocorticoid?

A

Dexamethasone

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18
Q

What is an example of a Cannabinoid?

A

Dronabinol

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19
Q

What is the following for Scopolamine:

MOA:
Dose:
Uses:
Side Effect(s)

Study These Flashcards
A

MOA: blocks transmission from the vestibular apparatus to the medulla
Dose: 5mcg/hr x 72 hrs (give 4 hrs before for best results)
Uses: motion sickness, middle ear surgery, N/V with PCA or morphine
Side effects: visual disturbances

20
Q

What is the following for metoclopramide:

MOA:
Caution with:

Study These Flashcards
A

MOA: stimulates the GI tract via cholinergic mechanism and anti-dopaminergic effect
Use with caution in pts with Parkinsons and restless leg

21
Q

What is the MOA and use with Midazolam?

Study These Flashcards
A

Decreases the synthesis and release of dopamine within the CTZ. Use at the end of case for nausea

22
Q

What is the following for Droperidol:

Class name:
MOA:
Dose:
Cautions:

Study These Flashcards
A

Class: Butyrophenomes
MOA: Competitive dopamine antagonist. Receptor is D2 and ligands are dopamine and GABA
Dose: 0.625-1.25mg
Cautions: Parkinsons, restless leg syndrome, black box for high dose d/t long QTc

23
Q

What is the following for Dexamethasone:

Class name:
MOA:
Dose:
Cautions:

Study These Flashcards
A

Class: Corticosteroid
Dose: 4mg
Cautions: obese, diabetes (hyperglycemia)

24
Q

What is the dose, onset, and side effects of zofran?

Study These Flashcards
A

dose: 4mg
onset: 30-60 min
s/e: headache, diarrhea, QTc prolongation

25
What is tropisetron used for?
To treat carcinoid syndrome
26
What is the dose for Granisetron?
0.1mg per 24 hrs
27
What is the name of the 5HT3 antagonist that has an active metabolite?
Dolasetron
28
Where is substance P produced?
CNS and gut
29
What is a side effect or NK Antagonists?
can inhibit steroidal contraceptives for about 7 days
30
What are NK Antagonists commonly used for?
Chemo induced NV
31
How do NK Antagonists work?
Competitive antagonist at the NK1 receptor and prevents substance P from binding
32
What is the following for Phenothiazines? MOA: Receptors: Use: Examples:
MOA: antagonizes H1 and M1 receptors Receptors: histamine, acetylcholine Use: vestibular apparatus Ex: promethazine
33
What are examples of h1 receptor antagonists?
Benadryl, meclizine, phenergan
34
What is the following for benadryl? Use: Dose: Onset: Duration:
Use: prophylaxis and treatment of allergic reactions Dose: 25-50mg IV Onset: 3 min Duration: 1-7 hrs
35
What is the MOA and use of Dramamine (dimenhydrinate)?
MOA: H1 and M1 antagonist Use: motion sickness and sleep aid
36
What are the 4 H2 receptor antagonist drugs?
Cimetidine/Tagamet Ranitidine/Zantac Famotidine/Pepcid Nizatidine/Axid
37
Are H2 receptor antagonists selective or nonselective?
Selective
38
What side effects are seen with H2 antagonist toxicity?
CNS: slurred speech, delirium, confusion in elderly | Liver toxicity
39
Which H2 antagonist is most likely to cause CNS side effects and liver toxicity?
Cimetidine
40
T or F: H2 receptor antagonist cross the placenta and are secreted into breastmilk
True
41
Is cimetidine a P450 inducer or inhibitor?
inhibitor
42
Name 6 drugs cimetidine has an interaction with. What does it cause?
``` Reduced blood flow and inhibits P450 system. Dilantin Propranolol metoprolol labetalol diazepam calcium channel blockers ```
43
What syndrome is Omeprazole good for?
Zollinger-Ellison Syndrome
44
What is the following for Reglan: MOA: Dose Cautions:
MOA: Cholinergic stimulation and dopamine antagonism. Causes contraction of lower esophageal sphinctor and stomach (prevents reflux), increases gastric and small intestine mobility. Crosses BBB and can be used as an antiemetic. Dose: 10-30mg IV over 3-5 min Cautions: Parkinsons, RLS, patients on MAOI's, tricyclic antidepressants, GI surgery
45
Which GI medication does not change gastric pH?
Reglan
46
What are s/e of Reglan?
Abdominal cramping if given too fast, Extrapyramidal symptoms (crosses BBB), Prolongs Succ (inhibits plasma cholinesterase)

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