nausea and vomiting Flashcards

Question

meclizine

Answer 1

25 mg PO taken 30-60 min before needed

Answer 2

``` dietary modifications herbal therapy -ginger root (1 gram in divided doses, efficacy similar to B6, onset is 3 days) -ginger gum -peppermint oil -best for mild cases B6 25 mg TID + doxylamine 12.5 TID metoclopramide 5-10 mg TID ondansetron 4-8 mg up to TID meclizine dimenhydrinate promethazine prochloperazine ```

Answer 3

metoclopramide and ondansetron SQ infusions | similar to using an insulin pump

Answer 4

very common w older inhaled anesthetic agents patients with multiple risk factors are at highest risk for PONV most common complication associated with ambulatory surgery prevention is more effective than treatment

Answer 5

female non-smoker Hx of PONV or motion sickness anesthetic: intra-operative use of volatile anesthetics (less w propofil), use of NO surgical: duration of surgery, type of surgery (laprascopic, craniotomy, ENT)

Answer 6

low risk: 0-1 factors, no prophylaxis, treat PRN mod-high: 2+ risk factors, prophylaxis with 1-2 antiemetics (1 if using propofol), 5HT3 is DOC, all classes can be used highest risk: always use 2 agents (5HT3 antagonist + metoclopramide or aprepitant) breakthrough: use an agent from a different class if within 6 hours

Answer 7

40 mg 1-3 hours prior to induction of anesthesia

Answer 8

begins within 1-2 hours after administration, symptoms reach maximum intensity after 5-6 hours and resolve within 12-24 hours

Answer 9

most difficult to treat follows acute emesis (post 24 hours) - less severe but more bothersome peak onset 48-72 hours after chemotherapy administration gradually diminishes over next 1-3 days may persist up to 1 week after chemotherapy treatment; - may worsen with repeated courses more common with high-doses of certain agents, especially cisplatin no clear MOA, but appears to differ somewhat from acute emesis

Answer 10

conditioned response to a conditioned stimuli usually develops after 4-5 cycles of cehmo more common in patients with history of severe uncontrolled emesis generally occurs before treatment begins

Answer 11

female age (decreased likelihood as age increases) EtOH intake (less chance in Hx of chronic intake) prior chemo (increases chance if emesis poorly controlled) predisposition to NV (motion sickness) personality (anxious) emetogenic potential of chemo (cisplatin, cyclophospamide + doxorubin) dose and dosage regimen (large doses, later in cycles, less with fractionated regimen) combination therapy

Answer 12

assess the individual situation assess the emetogenic potential of the agents and regimen always treat when risk is mod-high use PO therapy whenever possible

Answer 13

``` 5HT3 antagonist -ondansetron 16 mg PO or 8-16 mg IV -granisetron 2 mg PO or 1 mg IV -palonosetron 0.25 mg IV dexamethasone -12 mg IV/PO day 1, then 8 mg daily days 2-4 aprepitant -125 mg PO day 1 then 80 mg days 2-3 +/- lorazepam 0.5-2 mg IV or PO q46h PRN days 1-4 ``` netupitant: 300 mg PO on day 1 palonosetron: 0.5 mg PO on day 1 dexamethasone: 20 mg PO on day 1, then 8 mg BID on days 2-4 +/- lorazepam: 0.5-2 mg IV or PO q46h PRN days 1-4 olanzapine: 10 mg PO on days 1-4 dexamethasone: 20 mg IV on day 1, then 8 mg BID on days 2-4 palonosetron: 0,25 mg IV on day 1 +/- lorazepam: 0.5-2 mg IV or PO q46h PRN days 1-4

Answer 14

``` 5HT3 antagonist (palonosetron is preffered) dexamethasone: days 1-3 ```

Answer 15

``` any of the following: dexamethasone* 12 mg po/IV daily metoclopramide 10-40 mg PO/IV, then q6h prochlorperzine 10 mg PO/IV, then q6h ondansetron 16 mg PO daily granisetron 2 mg PO daily ``` minimal emetic risk: use agents PRN

Answer 16

difficult to control give agent from a different* drug class IV or PR administration often required ATC rather than PRN dosing

Answer 17

``` prochloperazine - 10 mg IV q46h PRN nabilone - 1-2 g PO q12h metoclopramide - 10-40 mg IV q46h prn + benadryl 50 mg IV haloperidol - 0.5-2 mg q46h PRN olanzapine - 10 mg PO daily ```

Answer 18

risk for acute CINV = risk for delayed CINV complete control may only be 50% clinicians often over-estimate efficacy of typical PRN regimens for delayed CINV

Answer 19

metoclopramide + dexamethasone ondansetron or granisetron + dexamethasone palonosetron +/- dexamethasone olanzapine + 5HT3 aprepitant add something the patient hasn't had carries over from acute treatment.... aprepitant 125 mg 1 hour prior to chemo and then 80 mg on days 2 and 3 plus dexamethsone 4-8 mg x 3-5 days starting on day 2

Answer 20

nabilone, dronabinol, medical marijuana | better in young patients

Answer 21

``` volume of vomit frequency and duration of vomiting nausea 0-10 ability to maintain food/liquid # of PRN doses of antiemetics QOL rating ```

Answer 22

``` sedation/drowsiness dizziness diarrhea headache anticholinergic SE EPS ```