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Pharmacology > PONV > Flashcards

PONV Flashcards

1
Q

1st guideline

A

1 identify Patients risk for PONV

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2
Q

risks for PONV

A

female
<50
hx PONV/motion sick
post op opiod use
GA > regional
volatiles + NO
>30m sx
lap, chole, gyn

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3
Q

2nd PONV guideline

A

2 Reduce Baseline Risk

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4
Q

how to reduce baseline risk

A

use TIVA
use regional
minimize opiods
hydrate
suggamadex

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5
Q

3rd PONC guideline

A

Prophylaxis with 2 interventions

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6
Q

1-2 risk factors use

A

2+ antiemetics

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7
Q

> 2 risk factors

A

3-4 antiemetics

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8
Q

4th PONC guideline

A

treat children prohyphalctially

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9
Q

decadon dose in children

A

150 mcg/kg up to 5 mg

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10
Q

SE decadon in children

A

TLS with leukemia

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11
Q

Dose Zofran in children

A

50-100mcg/kg max 4mg

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12
Q

SE zofran in children

A

Diarrhea
headache

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13
Q

5th PONV guideline

A

use antiemetics in failed prophylaxis or failure to treat

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14
Q

which meds are 1x use

A

scopalamine
decadon

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15
Q

if no PONV prophylaxis given

A

use zofran 1 mg
dexamethasone 2-4 mg

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16
Q

6th PONV guideline

A

ensure multimodal timely rescue

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17
Q

Pacu Prop dose

A

10-20 mg or 1-2 ml

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18
Q

CN that cause activation of vomiting center through efferent signals

A

5 + 7 = 12, 10, 9

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19
Q

Vagal parasympathetic fibers and sympathetic chain and to skeletal muscle through α motor neurons

A

5 + 7 = 12, 10, 9

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20
Q

medulla regions associated with vomiting vente

A

NTS The nucleus of the solitary tract
Reticular formation

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21
Q

Vomiting center receptor

A

muscarinic

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22
Q

CRTZ receptors

A

dopamine
5-HT3 (serotonin)

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23
Q

Where are 5HT3 located

A
  • on neurons in GI tract and brain

Serotonin stimulates CN 10 afferent through 5-HT3 receptors, initiating the vomiting reflex

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24
Q

Vestibular apparatus receptors

A

H1 and muscarinic

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25
Q

emesis pressure

A

Increased intrabdominal
Decreased thoracic

26
Q

Does the diaphragm/abdominal muscles contract or relax

A

contract

27
Q

when do you give zofran to prevent PONV

A

end of surgery

28
Q

most common side effects of zofran

A

headache
diarrhea

29
Q

gold standard for PONV

A

Zofran

30
Q

what is Dolasetron (Anzemet) metabolized ton

A

hydrodolestron 100x more potent → this is the antiemetic effect

31
Q

side effects of dolasetron (Anzemet)

A

HEADACHE
dizzy
increase appetite

32
Q

NK-1 receptor antagonist

A

emend (Aprepitant)

33
Q

half life of emend

A

40 hours

34
Q

Dexamethasone dose

A

4-10mg IV after induction

35
Q

coriticosteroid not widely used for PONv

A

methylpred Solu-Medrol

36
Q

Butyrophenones MOA and caution

A

dopamine antagonist
Caution in Parkinson’s and RLS

droperidol
halidol

37
Q

droperidol Dose

A

0.625 to 1.25 mg IV

38
Q

Black box restictin of droperidol

A

QT prolongation

39
Q

when to give droperidol

A

end of sx

40
Q

Haloperidol dose

A

0.5-2mg IV

41
Q

Scopolamine

A

Transdermal 1.5mg

42
Q

when should scopolamine be places

A

2-4 hours before stim

43
Q

reverse anticholinergic syndrome

A

physiostigmine

43
Q

prokinetic, dopamine antagonist

A

reglan

44
Q

Effects of Reglan on. body

A

relaxes lower esophageal sphincter
increases motility
decreases muscle activity in the pylorus and duodenum

45
Q

3 Meds to avoid in Parkinsons

A

haidol
droperidol
reglan

46
Q

How do antihistamines work

A

DO NOT inhibit the release of histamine

DO attach to receptors and prevent responses mediated by histamine

47
Q

H1 first generation

A

sedating (benedryl)

48
Q

SE benedry

A

dry mouth, blurred vision, somnolence, tachycardia, long QT

49
Q

H1 2nd generation

A

Non sedating; loratadine

50
Q

H2 Blocker Meds

A

Cimetidine

Famotidine

Ranitidine

51
Q

4 SE of H2 blockers (FCR)

A

diarrhea
headache
fatigue
skeletal muscle pain

52
Q

Background propofol infusion for nauea

A

20 mcg/kg/min + Zofran + decadron

53
Q

not recommended at end of sx due to the possibility of sedation-related adverse events and delayed awakening

A

midazolam

54
Q

promethazine IM

A

gangene

55
Q

gabapentin

A

1-2 hr before sx

56
Q

p6 median nerve stim

A

tetanic

57
Q

Ineffective against PONV

A

music therapy
isopropyl alcohol inhalation
gastric decompression
nicotine patch 7 mg to nonsmokers
supplemental O2

58
Q

sx risk factors of PONV

A

Breast
Cholecystectomy
ENT
Gyno
Length of surgery
Laparotomies
Laparoscopic
Orthopedic
Plastic

59
Q

sx risk factors in children

A

Surgery > 30m
Age >3 years
Strabismus surgery
Hx PONV or family history

60
Q

peds sx risk factors

A

hernia
TNA
stabismus
male gentials

61
Q

factors in post d/c n/v

A

female
Age <50
PONV hx
Opioid use
Nausea in recovery room

Pharmacology (10 decks)

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