PONV Flashcards

Question

the type of opioid depends on PONV risk T/F

Answer 1

FALSE- dose is greater predictor rather than type of opioid

Answer 2

iv tylenol / NSAID subhypnotic dose of propofol (background) 10-25 mcg/kg/min

Answer 3

insufflation of stomach duodenal distention can drop OGT to deflate stomach

Answer 4

## Footnote GLP1s

Answer 5

lady hx of ponv nonsmoker use op post op opioids | more scores = more risk

Answer 6

* The most commonly cited procedures and their possible mechanisms are: * Tympanoplasty: vestibular stimulation * ENT and oral surgery: swallowed blood * Breast surgery: anxiety and emotional load * Laparoscopy: peritoneal irritation * Abdominal and hysterectomy: GI and vagal stimulation * Strabismus surgery

Answer 7

Changes in middle ear pressure Bowel distension due to diffusion into closed cavities Also responsible for more adverse effects: wound infections, pulmonary complications, fever

Answer 8

They increase GI motility and gastric secretions

Answer 9

Surgical compression and manipulation  tissue ischemia and the release of serotonin from GI tissues High inspired-oxygen concentrations may counter the tissue hypoxia resulting from surgical manipulation, thereby preventing serotonin

Answer 10

big abdomen lady surgeries strabismus sx

Answer 11

TIVA 1-2L IVF allow pts to drink clears for as long as possible pre-op

Answer 12

Simplified risk score for postoperative vomiting in children Surgical time ≥ 30 minutes, ≥ 3 years old, strabismus surgery, and history of POV or PONV in immediate relatives POV incidence of 9% (0), 10% (1), 30% (2), 55% (3), and 70% (4)

Answer 13

Dopamine antagonist high doses for chemo 200 mg/8hrs = EPS <20 mg not clinicall effective

Answer 14

10 mg 1-3 min 1-2 hrs

Answer 15

D2 antagonist .625- 1.25 mg 3-10 min onset 2-4 hrs

Answer 16

increased sedation torsades and death? LONG QTS- need EKG <.0625 = no arrhythmic s/e | for >2.5 mg

Answer 17

Dopamine Antagonist only IM admin- IV off label Dose- 1 mgIV / .5mg IM Onset: 3-10 IV Duration 2-4 hrs

Answer 18

Promethazine (Phenergan) dopamine antagonist Dosing: 12.5 to 25 mg 12.5 to 50 mg IM Onset: IV: 5 minutes IM: 20 minutes Duration: 4-12 hours

Answer 19

WARNING! The drug is also a known vesicant that is highly caustic to the intima of blood vessels and surrounding tissue Limit the concentration Limit the dose Dilute the drug Use large patent veins Administer slowly (10-15 minutes) don't use in asthma patients- increases secretions

Answer 20

Prochlorperazine (Compazine) Antiemetic effect through a depressant action of the CRTZ D2 ANTAGONIST Dosing: 6.25 to 12.5 mg IV or IM Onset: 10-20 minutes following IM induction Duration: 3-4 hours following IM

Answer 21

akathisia parkinson's disease Tardive dyskinesia

Answer 22

A selective dopamine-2 (D2) and dopamine-3 (D3) receptor antagonist Available preparation: 2.5mg/mL (2-mL or 4-mL, single-dose vial) Dosing: 5 mg or 10 mg as a single intravenous (IV) dose infused over 1 to 2 minutes Onset: 15 minutes Duration: 4 to 5 hours QT Prolongation Barhemsys causes dose- and concentration-dependent prolongation of the QT interval

Answer 23

barhemsys 5mg at induction 10 mg when n/v post op if they haven't gotten preop dont give to renal pts

Answer 24

it's not really just decreases opioid use

Answer 25

Antihistamine’s efficacy is presumably due to the high concentration of histamine (H1) and muscarinic cholinergic receptors within the vestibular system Antagonizes the effects of histamine at H1-receptor sites These agents are considered drugs of choice for surgeries related to the **middle ear** Used in the prevention of **motion sickness**

Answer 26

H1-receptor antagonist Effective against motion sickness and weak anticholinergic activity Dose: PO, IV, IM- 25-50 mg Onset: IV-rapid IM-20-30 minutes Duration: 3-6 hours

Answer 27

Antihistamine and anticholinergic properties Contraindicated in patients with glaucoma and prostate hypertrophy due to anticholinergic effects

Answer 28

anticholinergic- crosses BBB Conflicting data on its effectiveness against PONV Crosses the blood-brain barrier Short half-life

Answer 29

Centrally acting **anticholinergic** Scopolamine blocks muscarinic receptors in the vestibular system, thereby halting the signaling to the central nervous system and central vomiting center Short half-life Transdermal patch-slow administration over 72 hours Useful in treating motion-induced nausea and vomiting

Answer 30

Can be applied the night before or morning of surgery Can cause pupil dilation- wear gloves Use with caution in neurosurgical cases where postop pupil checks are needed Onset is 2-4 hours Side effects: inhibits the secretion of saliva and sweat, decreased GI secretions and motility, drowsiness, increased heart rate, depresses motor function

Answer 31

Narrow-angle glaucoma -the angle where aqueous fluid drainage occurs is narrow, and therefore may drain slowly or may be at risk of becoming closed. Closed-angle glaucoma Restriction in aqueous flow creates excessive pressure in the posterior chamber peripheral iris bows forward and closes the angle Any drug that causes pupillary dilation also may precipitate angle closure due to the pulling of the peripheral iris into the anterior chamber angle **acute medical injury- needs surgery asap

Answer 32

severe dementia alzheimers older friends

Answer 33

Most effective antiemetic for PONV No sedation or extrapyramidal symptoms Similar efficacy of ondansetron 4 mg, dexamethasone 4 mg, and droperidol 1.25 mg Plasma half-life of 4 hours Should be given at the end of procedure Dosing: 4 mg over 2-5 minutes IV/IM Onset: 30 minutes Duration: IV: 4-8 hours

Answer 34

Dolasetron mesylate (Anzemet) Highly specific 5-HT3 antagonist Half-life is twice that of ondansetron 12.5 mg is FDA approved dose for PONV Granisetron (Sancuso, Kytril) Highly specific 5-HT3 antagonist Half-life is twice that of ondansetron 1 mg is FDA approved dose for PONV

Answer 35

2nd-generation serotonin antagonist Half-life of 40 hours Allosteric binding to 5-HT3 receptors  receptor internalization Does not appear to affect QT interval and may be safer for patients with a history of or at risk for cardiac arrhythmias

Answer 36

Glucocorticoid-Thought to centrally inhibit the nucleus tractus solitarii, not the area postrema May act centrally to either modulate the release of endorphins or inhibit prostaglandin synthesis Slow onset of action-Most effective when given at the beginning of procedure after induction As effective in treating PONV as ondansetron and droperidol Dosing: 4 mg over 2-5 minutes Onset: 30 minutes Duration: 4-8 hours higher doses for cervical procdures and if you anticipate swelling in yonder throat

Answer 37

Substance P -> regulatory peptide that binds to NK1 receptors -> found in the vagal afferents in the GI tract; also found in areas of the CNS thought to be involved in the vomiting center NK1 antagonists- Very effective in animal studies to treat emetic stimuli

Answer 38

First NK1 approved by the FDA Studies showed better at treating postop vomiting 40 mg is approved dose for PONV by the FDA Rarely used for PONV because of expense Dosing: IV: 150 mg IV PO: 40 mg within 3 hours prior to induction of anesthesia

Answer 39

prevent! use multimodal agents to hit all receptors

Answer 40

ginger IVF P6 acupuncture- by radial art essential oils (BS)

Answer 41

Zofran even tho it doesn't work Serotonin Antagonists- good cause they don't make you sleepy blocks all receptors so you can't use more than once (ineffective) try something else after- dexamethasone, phenergen ex

Answer 42

Two preventative measures are usually appropriate Antiemetic drugs TIVA Peripheral nerve block NSAIDs Lidocaine Low-dose ketamine

Answer 43

Avoid GA, if possible Avoid perioperative opioids, if possible Consider peripheral nerve block or spinal TIVA

Answer 44

Entry of material from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract Secretions Blood Bacteria Liquids Food particles retrograde mvmt of gastric contents into lungs can cause direct injury to lungs with gastric acid

Answer 45

Full stomach Symptomatic GERD Hiatal hernia Presence of NG tube Diabetic gastroparesis Morbid obesity, pregnancy

Answer 46

arterial hypoxemia earliest and MOST reliable sign

Answer 47

Aspiration pneumonitis in anesthetic patients results from the intersection of 3 components: Gastric contents escapes from the stomach into the pharynx Those contents enter the lungs The caustic nature of those contents injure the lungs | CHEMICAL INJURY -

Answer 48

Mendelson Syndrom 1946: He was the first to describe aspiration pneumonitis in pregnant women undergoing general anesthesia At risk if: Residual gastric volume > 25 ml pH < 2.5 The harmful effects correlate with the degree of acidity of the aspirated material

Answer 49

Clinical picture can appear 2-5 hours after the aspiration Dyspnea Cyanosis Tachycardia Fever Shock Chest may be clear on exam, but CXR looks like pulmonary edema Bronchospasm Simulates pulmonary edema Pulmonary wheeze Crackles Rhonchi

Answer 50

large dose corticosterioids for several days 02 bronchoscopy may be contraiindicated

Answer 51

Confirm NPO times Rapid Sequence Induction Sellick’s maneuver (cricoid pressure) Do not insufflate the stomach with mask ventilation (easy for them to say) ETT with inflated cuff Suction the stomach

Answer 52

Histamine 2 receptor antagonists (H2) Proton Pump Inhibitors Prokinetic agents Metoclopromide Shortens gastric emptying time Increases LES tone Antiemetic properties Antacids Bicitra Immediately effective to raise gastric pH 15-30 mL Onset: 5-10 minutes Duration: 30-60 minutes Histamine Receptor Antagonists Class of drugs that are competitive antagonists at the H2 receptor Inhibit further gastric fluid production Pepcid (famotidine) Tagamet (cimetidine)

Answer 53

Histamine Receptor Antagonist Dose: IV: 20 mg Onset: 1-2 hours Duration: 10-12 hours

Answer 54

histamine receptor antagonist Dose: IV: 300 mg over 15-20 minutes Onset: 1-2 hours Duration:4-8 hours

Answer 55

Mechanism of action Inhibits H⁺/K⁺ ATPase (proton pump), the final step in the acid secretory pathway; this irreversible inhibition has an effect which is greater, and longer than compared to H₂ antagonists can affect acid secretion for 2-3 days Effective in decreasing gastric acid production by more than 95% Prevacid (Lansoprazole), Prilosec (Omeprazole), Zegerid (Omeprazole & sodium bicarbonate

Answer 56

(Nexium) PPI Dose: 40 mg IV over 3 minutes Onset: 3 hours Duration: up to 24 hours

Answer 57

(Protonix)- pantoprazole sodium PPI Dose: 40 mg IV over 15 minutes Onset: 2 hours Duration: up to 24 hours

Answer 58

increased risk of C-Diff Plavix resistance

PONV Flashcards

(87 cards)