management of N/V scott

Question 1

what other sx are associated with nausea and vomiting?

Answer 1

pallor
tachycardia
diaphoresis

Question 2

etiology of nausea and vomiting

Answer 2

influenza***
intestinal pathogen
ulcers; gerd
pancreatitis
cholecystitis
obstruction
tumors
DM gastroparesis

Question 3

more etiology of N/V

Answer 3

CNS disorders like anxiety, tumors, HA
Pain
excessive intake of just about anything
pregnancy

Question 4

tx-induced causes of n/v

Answer 4

cancer chemotherapy
radiation therapy
anesthesia
NV associated with procedures

Question 5

drug induced causes of n/v

Answer 5

anti-neoplastic agents
opioids
asprin, nsaids, etc.
iron
some antibitoics (tetracycline, erythomycin)
estrogens
anti-parkinson meds
SSRIs

Question 6

complications of NV

Answer 6

patient discomfort
dehydration
malnutrition
aspiration penumonia
anxiety; anticipatory nv
compromise therapy
decrease QOL

Question 7

assessment of NV

Answer 7

number of episodes
onset
duration of symptoms
evidence of dehydration
severity of nausea

Question 8

questions to ask patients:

Answer 8

how long have you had NV
what color is your vomit
how often do you vomit
is NV associated with any other sx
is vomiting related to eating

Question 9

pathophysiology of n/v

Answer 9

cortex- anxiety
CTZ- drugs, metabolic
vestibular- motion sickness
GI- serotonin release from mucosal enterochromaffin cells

Question 10

Gi tract

Answer 10

mechanoreceptors
chemoreceptors
5-HT3 receptors

Question 11

CNS

Answer 11

cortex
thalamus
hypothalamus
meninges

Question 12

vestibular system

Answer 12

h1 receptor
m1 receptor

Question 13

chemorecetor trigger zone

Answer 13

chemoreceptors
d2 receptor
NK receptor
5-ht2 receptor

Question 14

vomiting center

Answer 14

h receptor
m receptor
nk receptor
5ht receptor

Question 15

most common receptors

Answer 15

dopamine [d2]
histamine receptor [h1 and h2]
muscarinic cholingeric [m1]
serotonin [5-ht3]
neurokinin [nk-1]

Question 16

non- pharm management of n/v

Answer 16

1. determine the cause ahnd put the gut to rest
   clear liquid diet and iv hydration
2. dietary
   avoid fatty, fried, sweet, and spicy foods
   eat food that is cold or at room temp

Question 17

physical non-pharm treatment

Answer 17

avoid unpleasant sights, sounds, and odors that may aggrevate NV
fresh air
avoid sudden movements
dim lights

Question 18

Relief band

Answer 18

physical non-pharm tx
accupressure
3 fingers above the wrist
helps the stomach return to normal rhythm of 3 cycles/min
pregnancy
chemotherapy

Question 19

antimuscarinics and antihistamines

Answer 19

meclizine
dramamine
scopolamine

Question 20

phenothiazines

Answer 20

promethaZINE
prochloperaZINE
chlorpromaZINE

Question 21

serotonin antagonists

Answer 21

ondansetron***
gransistreon
dolasetron
palonosetron

Question 22

nuerokinin-1 antagonists

Answer 22

aprepitant
fosaprepitant
rolapitant

Question 23

butyrophenones

Answer 23

droperidol
haloperidol

Question 24

prokinetic agent

Answer 24

metoclopramide

Question 25

corticosteroids

Answer 25

dedxamethasone

Question 26

cannabinoids

Answer 26

dronabinol nabilone

Question 27

benzodiazepene

Answer 27

lorazepam midazolam

Question 28

route of admin

Answer 28

po tablet odt tablet pr iv im

Question 29

treatment of CINV

Answer 29

very common with selected agents a combo of 2-4 agents usually used to prevent acute CINV; agents with different MOAs

Question 30

motion sickness

Answer 30

very common 1/3 of population very susceptible 1/3 susceptible with rough conditions 1/3 susceptible only with extreme conditions prevention is key!!!! peak age 12-21 y/o

Question 31

scopolamine (transderm scop)

Answer 31

motion sickness tx apply patch before needed duration 72 hours

Question 32

dimenhydrinate 50 mg

Answer 32

dramamine oral (30-60 min before needed)

Question 33

meclizine 25 mg

Answer 33

bonine oral 30-60 minutes before needed

Question 34

tx of nv secondary to gastroenteritis or pain

Answer 34

very common treat sx while treating the CAUSE

Question 35

ondansetron

Answer 35

4-8 mg IV/ODT/PO q 8-12 h prn

Question 36

promethazine

Answer 36

12.5-25 mg IV/IM/PO q 4-6 h prn

Question 37

post operative n/v

Answer 37

very common with older inhaled agents pts with multiple risk factors are at highest risk for PONV

Question 38

patient specific factors pf PONV

Answer 38

f>m non-smokig status hx of PONV hx of motion sickness

Question 39

anesthetic risk factors

Answer 39

intra-operative use of volatile anesthetics use of nitrous oxide type of surgery: laparoscopy, crainiotomy, ENT

Question 40

Low risk tx of PONV

Answer 40

no tx necessary

Question 41

moderate-high risk tx of PONV

Answer 41

tx with 1 or 2 agents only 1 agent if propofol is used 5-ht3 antagonists are DOC all classes can be used ***DRUGS ADMINISTERED AT END OF PROCEDURE***

Question 42

highest risk tx of PONV

Answer 42

ALWAYS USE TWO agents 5-TH3 + metoclopramide or aprepitant

Question 43

BREAKTHROUGH risk tx for PONV

Answer 43

use an agent from a different class if within 6 hours of original dose AMISULPRIDE 5-10 mg IV infused over 1-2 minutes

Question 44

Aprepitant (Emend)

Answer 44

40 mg orally 1-3 hours prior to induction of anesthesia May be superior to ondonsetron 4 mg at both 24 and 48 hours post-op Data in trials was not statistically significant

Question 45

monitoring antiemetic therapy: efficacy

Answer 45

frequency and duration nausea rating ability to eat PRN doses of anti-emetic agents QOL ratings

Question 46

monitoring antiemetic therapy: toxicity

Answer 46

sedation/drowsiness dizziness diarrhea headache anticholinergic SE EPS

Question 47

D2 dopamine receptor antagonist

Answer 47

Prochlorperazine