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GI System Flashcards

1
Q

For surgical patients, is there ever a chance for zero PONV

A

No

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2
Q

Define retching

A

rhythmic action of respiratory muscles preceding vomiting

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3
Q

Define Nausea

A

SUBJECTIVE personal patient experience with or without associated vomiting

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4
Q

The Vomiting Center is located where

A

Lateral reticular formation within the medulla oblongata

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5
Q

What two regions located near the vomiting center, once stimulated will initiate vomiting

A

Nucleus solitarius

Chemoreceptor Trigger Zone (located in the areas postrema near the bottom of the 4th ventricle)

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6
Q

What factors stimulate the vomitng center

A

Peripheral stimulation (sensory afferents of vagal nerve to VC)

CNS (directly relay to CTZ, AP, and NTS)

Chemicals in the CNS/Blood (directly stimulate VC)

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7
Q

What are the five CNS areas that are located near the VC and what are the physiological reactions associated with N/V

A 
Balance center (motion sickness)
Vasomotor center (diaphoresis, pallor, tachycardia, cardiac dysrhythmias)
Salivation center
Respiratory center (tachypnea)
Bulbar controls (cerebellum, medulla, and pons)
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8
Q

True/False
Although the CTZ, AP, and NTS contain receptors for vomiting, the vomiting reflex is INITIATED from within the vomiting center

A

True

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9
Q

What receptor population live withing the CTZ

A

Dopamine (D2)
Opioid
Enkephalin

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10
Q

What receptor population live within the AP

A

Dopamine
Opioid
Serotonin (5-HT)

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11
Q

What receptro population live within the NTS

A

Histamine
Enkephalin
Muscarinic

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12
Q

What physiologic state is a potent emetic stimulus

A

Blood in the stomach

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13
Q

Between 2-14, incidence of PONV increases or decreases

A

increases

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14
Q

After 14 yoa, incidence of PONV increases or decreases

A

decreases

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15
Q

What anesthetic agents increase PONV

A 
Neostigmine
Etomidate
Methohexital
Opioids
Ketamine
NITROUS OXIDE
All HALOGENATD AGENTS
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16
Q

What scoring system is used when a patient is at increased risk for PONV

A

Apfel scoring system

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17
Q

What four risk factors does the apfel scoring system assess

A

PONV
Use of Postop opioids
Female gender
Nonsmoker

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18
Q

If a patient has zero factors on apfel, what is the incidence of PONV

A

10%

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19
Q

If a patient has all four factors on apfel, what is the incidence of PONV

A

79%

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20
Q

If a paitent has 2 factors on apfel, what is the incidence of PONV

A

39%

*up/down by 20% from here

21
Q
  • What receptors can I stimulate to decrease PONV
A

Muscarinic (M3, M5)
Dopaminergic (D2)
Histamine (H1)
Serotonin (5-HT)

22
Q

What antimuscarinic drug does not cross the bbb and therefore, cannot be used to treat vomiting

A

Glycopyrollate

23
Q

Sucralfate is classified as an

A

anti-ulcer agent

24
Q

“prazoles” are

A

proton pump inhibitors

25
Inhibition of acid production continues how long after administration of prazoles
up to 72 hours *may not need to give to patient if taken within this time period prior to surgery
26
Misoprostol is used in OB to
induce labor
27
Misoprostal is contraindicated
during pregnancy
28
What is the MOA of metaclopramide
increases LES spincter tone increases gastric emptying decreases gastric volume *centrally acts as a dopaminergic antagonist resulting in antiemetic properties
29
What are the precautions associated with metaclopramide
Contraindicated in intestinal obstruction or pheochromocytoma Avoid in patient's with parkinson's May cause tardive dyskinesia
30
Cisapride is a
prokinetic
31
What are the two anti-emetics discussed in lecture
``` Metoclopramide Droperidol (potent) ```
32
True/false | Droperidol is a neuroleptic tranquilizer
true
33
Peripherally, droperidol acts as a
alpha-adrenergic blocker | *decreases ABP
34
Droperidol has what effect on patient's with pheochromocytoma
stimulate the release of catecholamines from the adrenal medulla precipitating a HTN crisis
35
What effect does Droperidol have on cerebral blood flow/ICP
decreases *Does not decrease CMRO2, problem for pts with CVS disease
36
Droperidol has antidopaminergic activity and therefore can precipitate
extrapyramidal reactions *dont use in patient's with parkinsons
37
What drugs is countered by droperidol
dopamine | central a-adrenergic agonists
38
What is the "Black Box" warning on droperidol
may cause QT prolongation/torsades de points leading to potentially fatal rhthyms * use only patients refractory to other anti-emetics. Must monitor EKG
39
Ondansetron works on what receptor type
selective 5-HT3 *does not effect alpha, dopamine, or histamine receptors
40
The phenothiazine hydroxyzine should ONLY be given
IM *never IV
41
Phenothizaines examples include promethazine, prochlorperazine, and hydroxyzine and involve many reactions including:
``` sedative-tranquilizer antiemetic antihistamine/antipuritic adrenolytic anticholinergic extrapyramidal activity Potentiator of anesthetics ```
42
Phenothiazines may cause what syndrome
Neuroleptic Malignant Syndrome *Fever, muscle ridgidity, AMS, autonomic dysfunction, leukocytosis, elevated CPK
43
Excess Fe is stored as
Ferritin
44
What is the ONLY clinical indication for the use of iron
Treating iron deficiency anemia
45
Iron sodium gluconate complex is given
ONLY IV
46
What is the Gold standard treatment for acute iron toxicity
Deferoxamine *activated charcoal DOES NOT work
47
What is the central atom in vitamin b12
COBALT
48
Without vitamin b12, what two ESSENTIAL enzymatic rxn couldn't occur
methyltetrahydrofolate to tetrahydrofolate (folate) methylmalonyl-CoA to succinyl-CoA

Pharmacology (27 decks)

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