Nausea and Vomiting

Question 1

….. is the preferred antiemetic in our protocols that can be found within the retitled Nausea/Vomiting Protocol and is also cited in various other locations in the protocols where nausea and vomiting are of concern.

Answer 1

Zofran

Question 2

Zofran is a rapid-acting ….. which essentially means it blocks the vomiting impulse from being sent to the brain and thus suppresses nausea and vomiting.

Answer 2

serotonin receptor antagonist

Question 3

n/v can lead to very serious illnesses or complications. Some of these may include dehydration and ….., aspiration, or other airway compromises.

Answer 3

electrolyte imbalances

Question 4

n/v can lead to very serious illnesses or complications. Some of these may include dehydration and electrolyte imbalances, aspiration, or other airway compromises. N/V can worsen a ….. or cause ….. that is controlled to start bleeding again.

Answer 4

hemorrhagic stroke

intracranial hemorrhage

Question 5

Zofran is provided and approved for administration by paramedics in the IV/IM form as a …..

Answer 5

4mg/2ml vial.

Question 6

Zofran

Adult dosing is….. initially that can be repeated in 10 minutes if needed, to a maximum dose of …..

Answer 6

4 mg

8 mg

Question 7

Zofran

Adult dosing is 4 mg initially that can be repeated in ….. if needed, to a maximum dose of 8 mg

Answer 7

10 minutes

Question 8

Zofran is provided and approved for administration by paramedics in the ….. form as a 4mg/2ml vial.

Answer 8

IV/IM

Question 9

Zofran
In the pediatric patient ….. old, the dosing of the IV/IM solution is 0.15 mg/kg that can be repeated in 10 minutes if needed, to a maximum dose of 4 mg.

Answer 9

> 1 year

Question 10

Zofran
In the pediatric patient >1 year old, the dosing of the IV/IM solution is ….. that can be repeated in 10 minutes if needed, to a maximum dose of 4 mg.

Answer 10

0.15 mg/kg

Question 11

Zofran
In the pediatric patient >1 year old, the dosing of the IV/IM solution is 0.15 mg/kg that can be repeated in ….. if needed, to a maximum dose of 4 mg.

Answer 11

10 minutes

Question 12

Zofran
In the pediatric patient >1 year old, the dosing of the IV/IM solution is 0.15 mg/kg that can be repeated in 10 minutes if needed, to a maximum dose of ……

Answer 12

4 mg

Question 13

Zofran
In the pediatric patient >1 year old, the dosing of the ….. solution is 0.15 mg/kg that can be repeated in 10 minutes if needed, to a maximum dose of 4 mg.

Answer 13

IV/IM

Question 14

The ODT (Oral Dissolving Tablet) form can only be used in the pediatric patient if they are over …..in weight and at least 12 years of age.

Answer 14

40 kg

Question 15

The ODT (Oral Dissolving Tablet) form can only be used in the pediatric patient if they are over 40 kg in weight and at least ….. of age.

Answer 15

12 years

Question 16

Zofran
In the pediatric patient >1 year old, the dosing of the IV/IM solution is 0.15 mg/kg that can be repeated in 10 minutes if needed, to a maximum dose of 4 mg. This solution can also be administered…… in a child >1 year of age by drawing up the medication, removing the needle, and using the syringe to “shoot” it past their tongue.

Answer 16

PO

Question 17

Zofran
In the pediatric patient >1 year old, the dosing of the IV/IM solution is 0.15 mg/kg that can be repeated in 10 minutes if needed, to a maximum dose of 4 mg. This solution can also be administered PO in a child >1 year of age by drawing up the medication, removing the needle, and using the syringe to ……

Answer 17

“shoot” it past their tongue

Question 18

Zofran
In the pediatric patient >1 year old, the dosing of the IV/IM solution is 0.15 mg/kg that can be repeated in 10 minutes if needed, to a maximum dose of 4 mg. This solution can also be administered PO in a child ….. of age by drawing up the medication, removing the needle, and using the syringe to “shoot” it past their tongue.

Answer 18

> 1 year

Question 19

Zofran

A slow IV push, over ….. minutes, will help reduce the risk of any unwanted side effects.

Answer 19

2

Question 20

Zofran Oral Dissolving Tablet
Place the tablet ….. the patient’s tongue. The tablet will rapidly dissolve, and the patient can then swallow their saliva. No water is needed.

Answer 20

on

Question 21

The list of contraindications for the use of Zofran has changed within the 2022 UH protocols. Other than a known allergy and ….., the presence of a prolonged QT interval of greater than 500 ms or 2.5 large boxes on the ECG is also listed as a contraindication

Answer 21

liver disease (the medication is metabolized in the liver)

Question 22

The list of contraindications for the use of Zofran has changed within the 2022 UH protocols. Other than a known allergy and liver disease (the medication is metabolized in the liver), the presence of a ….. of greater than 500 ms or 2.5 large boxes on the ECG is also listed as a contraindication.

Answer 22

prolonged QT interval

Question 23

The list of contraindications for the use of Zofran has changed within the 2022 UH protocols. Other than a known allergy and liver disease (the medication is metabolized in the liver), the presence of a prolonged QT interval of greater than ….. on the ECG is also listed as a contraindication.

Answer 23

500 ms or 2.5 large boxes

Question 24

Though a rare occurrence, serious cardiac arrhythmias including ….. can occur following the administration of Zofran. Thus, many sources recommend EKG monitoring before, during, and after the administration of Zofran.

Answer 24

Torsades de Pointes

Question 25

Other concerns listed within the protocol as precautions and side effects are also rare but include Zofran’s use in pregnancy (Zofran is a Category......); GI changes; headaches; and fatigue and general weakness.

Answer 25

B medication indicating no animal studies have shown fetal risk and no controlled studies in pregnant women have been completed

Question 26

Other concerns listed within the protocol as precautions and side effects are also rare but include Zofran’s use in pregnancy (Zofran is a Category B medication indicating no animal studies have shown fetal risk and no controlled studies in pregnant women have been completed); .....; headaches; and fatigue and general weakness.

Answer 26

GI changes

Question 27

Other concerns listed within the protocol as precautions and side effects are also rare but include Zofran’s use in pregnancy (Zofran is a Category B medication indicating no animal studies have shown fetal risk and no controlled studies in pregnant women have been completed); GI changes;.....; and fatigue and general weakness.

Answer 27

headaches

Question 28

Generic name for Zofran

Answer 28

Ondansetron

Question 29

Zofran Contraindications

Answer 29

Known hypersensitivity Severe liver disease QT interval greater than 500ms (2.5 large EKG boxes)

Question 30

zofran precautions

Answer 30

pregnancy may prolong QT interval when used with another QT prolonging agent

Question 31

Zofran Side Effects

Answer 31

Constipation, Diarrhea Increased liver enzymes headache fatigue and malaise

Question 32

Adult dose Zofran

Answer 32

4mg IM or IV | may repeat in 10 minutes - Max 8 Mg

Question 33

Zofran ODT dose

Answer 33

4mg ODT | may repeat in 10 minutes - Max 8 MG

Question 34

Peds Zofran Dose

Answer 34

0. 15 mg / kg IM or IV >1 year old 0. 15 mg / kg PO (injectable liquid NOT ODT) > 1 year old May repeat in 10 minutes - Max 4 mg

Question 35

Peds Zofran ODT dose

Answer 35

if > 40 kg AND > 12 years old | 4mg ODT

Question 36

In cases when Zofran is not available, the suggested alternative is now .......

Answer 36

Reglan.

Question 37

Reglan is an antiemetic (though a different class than Zofran, often used to treat ........

Answer 37

gastric reflux and nausea/vomiting (n/v)

Question 38

Reglan is an.......(though a different class than Zofran, often used to treat gastric reflux and nausea/vomiting (n/v).

Answer 38

antiemetic

Question 39

Reglan enhances the effects of the neurotransmitter acetylcholine (ACH) on the ..... which causes increased gastric motility and emptying of the stomach.

Answer 39

upper GI tract

Question 40

Reglan enhances the effects of the neurotransmitter ..... on the upper GI tract which causes increased gastric motility and emptying of the stomach.

Answer 40

acetylcholine (ACH)

Question 41

Reglan enhances the effects of the neurotransmitter acetylcholine (ACH) on the upper GI tract which causes increased gastric motility and emptying of the stomach. In addition, it is also a .......

Answer 41

dopamine antagonist (blocks dopamine receptors).

Question 42

Dopamine is one of the neurotransmitters released by ..... that can cause n/v, and blocking the receptor sites will reduce n/v.

Answer 42

GI irritation

Question 43

.....is one of the neurotransmitters released by GI irritation that can cause n/v, and blocking the receptor sites will reduce n/v.

Answer 43

Dopamine

Question 44

Dopamine also plays other roles in the brain, controlling ..... to name a few.

Answer 44

motor and cognitive function

Question 45

Reglan’s effect in blocking dopamine can also affect these other functions of dopamine causing altered levels of consciousness, impaired mental and physical abilities, and .....

Answer 45

extrapyramidal symptoms (EPS).

Question 46

Reglan’s effect in blocking dopamine can also affect these other functions of dopamine causing ....., and extrapyramidal symptoms (EPS).

Answer 46

altered levels of consciousness, impaired mental and physical abilities

Question 47

..... are involuntary muscle movements, often around the face.

Answer 47

EPS symptoms

Question 48

contraindications to Reglan’s use are

Answer 48

altered levels of consciousness, impaired mental and physical abilities, and extrapyramidal symptoms (EPS). when a patient is suspected of having a GI bleed, obstruction, or perforation. history of epilepsy due to Reglan’s effect on lowering the seizure threshold resulting in longer and more frequent seizures for the patient the presence of QT prolongation greater than 500 ms (2.5 large EKG boxes)

Question 49

Of all the side effects, the most concerning are the extrapyramidal reactions that are more likely to occur in diabetics, children, seniors, and those already taking anti-psychotic medications. In cases where EPS does occur, the provider is directed to administer ......

Answer 49

Benadryl

Question 50

The dosing of Reglan under the UH protocols is ..... given IV and should be given as a slow push, over 1-2 minutes.

Answer 50

10 mg

Question 51

The dosing of Reglan under the UH protocols is 10 mg given IV and should be given as a .....

Answer 51

slow push, over 1-2 minutes

Question 52

The dosing of Reglan under the UH protocols is 10 mg given... (Answer what route)... and should be given as a slow push, over 1-2 minutes

Answer 52

IV

Question 53

Reglan is a fast-acting medication with an onset of about..... via the IV route with a duration of 1-3 hours.

Answer 53

1-3 minutes

Question 54

Reglan is a fast-acting medication with an onset of about 1-3 minutes via the IV route with a duration of.....

Answer 54

1-3 hours.

Question 55

Repeat dose of Reglan is .....

Answer 55

There is no repeat dose recommended.

Question 56

Reglan is a medication only given by the paramedic provider and only to an ..... Pediatric dosing is not recommended in the pre-hospital setting.

Answer 56

adult patient.

Question 57

Reglan is a medication only given by the paramedic provider and only to an adult patient. Pediatric dosing is .....

Answer 57

not recommended in the pre-hospital setting.