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Post-Opp N/V Flashcards

1
Q

What is the 1st line treatment of N/V with unknown cause?

A

Proclorperazine COMPAZINE

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2
Q

What are SEs with Proclorparazine?

A

hypotension
EPS

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3
Q

What is the 2nd line treatment of N/V with unknown cause?

A

Metoclopramide

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4
Q

What is the 3rd line treatment of N/V with unknown cause?

A

Ondansetron

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5
Q

What are patient-specific risk factors for PONV?

A

female
non-smoker
hx of PONV
motion sickness

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6
Q

What are medication-associated risk factors for PONV?

A

volatile anesthetics
nitrous oxide
opioids

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7
Q

How do we minimize modifiable risk factors to prevent PONV?

A
  1. avoid general anesthesia
  2. avoid volatile anesthetics and nitrous oxide
  3. minimize intra- and post-operative opioids
  4. adequate hydration
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8
Q

How do we minimize post-operative opioids?

A
  1. IV ketorolac (NSAID)
  2. Acetaminophen IV/PO
  3. Ketamine
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9
Q

How much NS is given to maintain hydration?

A

10-30 ml/kg/hr

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10
Q

What reasons is D5 1/2 NS given instead of NS for hydration?

A

diabetes
prolonged procedure

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10
Q

How many agents are given to a medium-risk patient for PONV prophylaxis?

A

1-2, usually 2

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11
Q

How many agents are given to a high-risk patient for PONV prophylaxis?

A

> 2 with different MOAs

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12
Q

What are SEs with 5HT-3 antagonists?

A

Headache
Constipation
QTc prolongation

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13
Q

What 5HT-3 antagonists are more associated with QTc prolongation?

A

Ondansetron
Granisetron

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14
Q

When should Ondansetron and Granisetron be given because of fast onset and short duration?

A

at the end of surgery

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15
Q

When should Palonosetron be given because of its slow onset and long duration?

A

start of surgery

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16
Q

When is Aprepitant EMEND used to prevent PONV?

A

not recommended 1st line should be used in severe cases

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17
Q

When is Aprepitant administered to prevent PONV?

A

w/in 3 hours of the start of surgery

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18
Q

What are SEs with Aprepitant?

A

headache
fatigue
hiccups

19
Q

When are corticosteroids used to prevent PONV?

A

1st line in combination therapy

20
Q

What patients should corticosteroids be avoided in?

A

labile diabetes

21
Q

What corticosteroids are used to prevent PONV?

A

Dexamethasone
Methylprednisolone

22
Q

What is a SE with corticosteroids?

A

severe hyperglycemia 6-12 h post-operative

23
Q

What is the MOA of Butyrophenones?

A

blocks dopamine

24
What are SEs with Droperidol?
BBW: QTc
25
What are SEs with Haloperidol?
QTc Sedation-dose dependent
26
What form of Haloperidol is not FDA approved for PONV?
IV
27
What patients cannot get Haloperidol?
children
28
When should Droperidol be administered?
at the end of surgery
29
What role does Droperidol have in PONV?
2nd line
30
What antihistamines are recommended in combination in PONV?
Dimenhydramine DRAMAMINE Meclizine Hydroxyzine
31
What are SEs with antihistamines?
sedation headache drowsiness dizziness
32
When should Scopolamine patch be placed for PONV?
24h prior to surgery
33
What are SEs with Scopolamine?
anticholinergic effects: dry mouth visual disturbances constipation
34
What dose of Metoclopramide is needed in PONV?
50mg
35
What are SEs with Metoclopramide?
tardive dyskinesia QTc prolongation sedation
36
What is a serious ADE with IV Proclorparazine and Promethazine?
extravasation
37
What are SEs with Proclorparazine and Promethazine?
sedation hypotension dizziness
38
What are NOT effective antiemetic therapies?
music therapy PPIs intra-operative gastric decompensation ginger root cannabinoids
39
What is usually given to low-risk patients?
5HT3- usually Ondansetron
40
What is 1st line therapy in moderate to high risk PONV?
5HT3 antagonist + Dexamethasone
41
What therapy should be used in moderate to high risk PONV if Dexamethasone is CI?
5HT3 antagonist + Droperidol
42
What therapy should be used in moderate to high risk PONV if 5HT3 antagonist is CI?
Droperidol + dexamethasone
43
What should be given to patients with refractory NV?
1. choose med with different MOA 2. repeat initial therapy if >6h since last dose
44
What should be given to patients with refractory NV in the PACU?
Propofol 20mg IV prn

GI (23 decks)

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