Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Nurs 575 Anesthesia Pharmacology > Week 6 Antiemetics/Prokinetics/Antihistamines/serotonins > Flashcards

Week 6 Antiemetics/Prokinetics/Antihistamines/serotonins Flashcards

(66 cards)

Start Studying
1
Q

Without prophylaxis, nausea occurs in up to ________ of patients who undergo general anesthesia, but can be as high as ________ in high risk patients

A
  • 40%
  • 80%

Stoelting’s, pg. 692

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

PONV can be further classified as early or late - what time frames align with each classification?

A
  • Early: within 6 hours of emergence
  • Late: 6-24 hours after

Stoelting’s, pg. 692

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PONV can be associated with increased morbidity due to:

A
  • dehydration
  • electrolyte abnormalities
  • wound dehiscence
  • bleeding
  • esophageal rupture
  • airway compromise

Stoelting’s, pg. 692

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

__________ is the muscular contractions within the ileum and jejunum that moves luminal contents back towards the stomach

A
  • antiperistalsis

Stoelting’s, pg. 692

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

The sequence of events that occur during emesis are controlled by the so-called vomiting “center”, which lies in the ______________

A
  • medulla oblongata

Stoelting’s, pg. 692

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Name several of the neurotransmitters that modulate the activity of the vomiting center

A

Dopamine
Serotonin

Substance P
Ach
y-aminobutyric acid
cannabinoids

Stoelting’s, pg. 692 - Fig 34-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Slightly cephalad to the vomiting center is the _____________, which detects noxious stimuli in the bloodstream

A
  • Chemoreceptor trigger zone

Stoelting’s, pg. 693

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What other anatomic sites (besides the CTZ) can activate the vomiting center?

A
  • vestibular apparatus
  • thalamus
  • cerebral cortex
  • neurons within the GI tract itself

Stoelting’s, pg. 693

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Upon activation, the vomiting center sends efferent signals via which cranial nerve(s)?

A
  • 5 - trigeminal
  • 7 - facial
  • 9 - glossopharyngeal
  • 10 - vagus
  • 12 - hypoglossal

Stoelting’s, pg. 693

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What patient factors are associated with an increased risk of PONV?

A
  • female gender (effects of progesterone/estrogen on CTZ/vomiting center)
  • nonsmoker
  • history of motion sickness or PONV

Stoelting’s, pg. 693

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Among adults, the risk for PONV is ___________ with aging

A
  • reduced

Stoelting’s, pg. 693

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What surgical factors are associated with increased risk for PONV?

A

Longer procedures

Type of procedure

  • laparotomy & laparoscopic
  • gynecologic
  • ENT
  • breast
  • ortho

Stoelting’s, pg. 693

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What anesthetic factors are associated with an increased risk for PONV?

A

The use of:
Inhaled anesthetics
* nitrous oxide
* neostigmine
* opioids

Stoelting’s, pg. 693

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

_____________ is a transdermal anticholinergic that can be used for the prevention of PONV

A
  • scopolamine

Stoelting’s, pg. 693

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Due to it’s onset of action, scopolamine is most effective when administered _________ before noxious stimuli

A
  • 4 hours

Stoelting’s, pg. 694
Nagelhout, pg. 211

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long can a scopolamine patch remain in place?

A
  • 24-72 hours

Stoelting’s, pg. 694

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

True or false:

Transdermal scopolamine provides sustained therapeutic plasma concentrations, usually WITHOUT producing the prohibitive side effects such as sedation, cycloplegia (mydriasis/visual disturbances), or drying of secretions

A
  • True

Stoelting’s, pg. 694

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Transdermal scopolamine exerts significant antiemetic effects in patients being treated with ____________ or ____________ for postoperative pain

A
  • PCA
  • epidural morphine

appears most effective for these indications

Stoelting’s, pg. 694
Nagelhout, pg. 211

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Which two anticholinergics may decrease barrier pressure and increases the reflux of acidic fluid into the esophagus?

A
  • atropine (0.6 mg IV)
  • glycopyrrolate (0.2-0.3 mg IV)

Stoelting’s, pg. 695

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

__________ and __________ may enter the CNS and can produce symptoms of central anticholinergic syndrome

A
  • scopolamine
  • atropine

Stoelting’s, pg. 694

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the symptoms of central anticholinergic syndrome?

A

Symptoms may range from:

  • restlessness & hallucinations
    to
  • somnolence & unconsciousness

Stoelting’s, pg. 694

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Central anticholinergic syndrome is often mistaken for _____________ as ventilation may be depressed

A
  • delayed recovery from anesthesia

Stoelting’s, pg. 694

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

______________ is a lipid-soluble anticholinesterase that can be administered as a treatment for central anticholergic syndrome or anticholinergic overdose

A
  • Physostigmine (15-60 mcg/kg)

Stoelting’s, pg. 694-695

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Symptoms of anticholinergic overdose may include:

A
  • dry mouth
  • difficulty swallowing or talking
  • blurred vision/photophobia
  • tachycardia
  • dry/flushed skin
  • increased body temperature (inhibition of sweating)

Stoelting’s, pg. 694-695

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
This benzamide is a **weak antiemetic** that also stimulates the GI tract via cholinergic mechanisms (increased gastric/small intenstine motility)
* Metoclopramide ## Footnote Stoelting's, pg. 695
26
In addition to it's peripheral effect in the GI tract, metoclopramide readily crosses the blood-brain barrier and may act directly on the CTZ via its __________ effects - this makes it contraindicated in patients with ____________ disease
* anti-dopaminergic * Parkinson's (or any disease related to dopamine inhibition or depletion) ## Footnote Stoelting's, pg. 695
27
Akathisia is a feeling of unease or restlessness in the lower extremities that may occur following the IV administration of _____________
* Metoclopramide | may be so severe that it results in cancellation of the surgery ## Footnote Stoelting's, pg. 695
28
What is the mechanism by which metoclopramide exerts its prokinetic effect? Antiemetic?
* enhances cholinergic activity on GI smooth muscle * antagonism of dopamine at the CTZ ## Footnote Stoelting's, pg. 711
29
Administration of metoclopramide __________ mg IV may be useful to speed gastric emptying before the induction of anesthesia
* 10-20 mg
30
How and when should Metoclopramide be given?
* Pre-op, About 15-30 min before * 10-20mg over 3-5 min
31
More rapid IV administration of metoclopramide may produce _____________
* abdominal cramping ## Footnote Stoelting's, pg. 711
32
The activity of the benzodiazepines, such as midazolam, may decrease the synthesis and release of _____________ within the CTZ as well as reducing the release of serotonin
* dopamine *midazolam may be administered near the end of surgery for patients at risk of PONV who have not already received one as part of the anesthetic plan* ## Footnote Stoelting's, pg. 695 Nagelhout, pg. 211
33
The black box warning for droperidol is due to its association with _______________
* prolonged QT syndromes ## Footnote Stoelting's, pg. 695
34
The black box warning for droperidol was associated with doses much higher than necessary for the treatment of PONV - what dose is effective for the prevention and treatment of PONV?
* 0.625-1.25 mg IV near the end of surgery ## Footnote Stoelting's, pg. 696 Nagelhout, pg. 211
35
Because it's mechanism of action is _____________, droperidol should be used with caution, if at all, in patients with ______________
* anti-dopaminergic * Parkinson's (or any disease related to dopamine inhibition or depletion) ## Footnote Stoelting's, pg. 696
36
This corticosteroid has efficacy similar to ondansetron and droperidol
* Dexamethasone ## Footnote Stoelting's, pg. 696
37
# True or false: Dexamethasone has a minimal side effect profile with one-time use and decreases the risk for perioperative hyperglycemia for obese and diabetic patients
* False - it does have a minimal side effect profile, but INCREASES the risk for hyperglycemia in these patients | avg increase of 40 mg/dL 6-12 hrs postop, no effects on wound healing ## Footnote Stoelting's, pg. 696 Nagelhout, pg. 209
38
A ________ mg dose of dexamethasone is popular for the prevention of PONV - It is best given prior to or after the induction of general anesthesia (as opposed to at the end of surgery) because it's onset of action is __________
* 4-8 mg * 1 hour ## Footnote Nagelhout, pg. 209
39
What is the mechanism of action for drugs like ondansetron and granisteron?
* 5-HT3 receptor antagonism * serotonin acts on 5-HT3 receptors on enteric neurons in the GI tract and brain to stimulate vagal afferents and the vomiting reflex ## Footnote Stoelting's, pg. 696
40
# True or false: The serotonin receptor antagonists are not effective at treating motion-induced or vestibular PONV and they do not cause the same CNS effects as droperidol and metoclopramide
* True - no 5-HT3 receptors in the vestibular apparatus; no action on dopamine, histamine, or cholinergic receptors ## Footnote Stoelting's, pg. 696
41
What is the typical dosing strategy for ondansetron in the prevention/treatment of PONV
* 4-8 mg IV over 2-5 minutes before induction or prior to the end of surgery * also listed as effective when administered orally | consider it's duration of action (4-6 hrs) when timing dose ## Footnote Stoelting's, pg. 697
42
What side effects are associated with the use of 5-HT3 receptor antagonists?
* headache * diarrhea * QTc prolongation * serotonin syndrome ## Footnote Stoelting's, pg. 696-697
43
Granisetron is _________ selective 5-HT3 receptor antagonist than ondansetron, with a ___________ duration of action
* more * longer | may be efective for 24 hours ## Footnote Stoelting's, pg. 697
44
Non-specific antihistamines such as __________, likely act on H__ receptors
* diphenhydramine, dimenhydrinate, promethazine * 1 ## Footnote Stoelting's, pg. 697
45
What is the mechanism of action of antihistamines in the prevention of nausea and vomiting
Prevents GI smooth muscle contraction Prevents secretion of acid in the stomach Prevents release of neurotransmitters in the CNS ## Footnote Stoelting's, pg. 697, 700
46
Dimenhydrinate is a ____________ used for PONV in adults - standard dose is __________
* Non-specific antihistamine * 20 mg IV ## Footnote Stoelting's, pg. 697
47
Which generation of H1 antagonists is more likely to cause CNS side effects such as somnolence?
* 1st generation (diphenhydramine, dimenhydrinate) ## Footnote Stoelting's, pg. 701
48
# True or false: 1st generation histamine type 1 receptor antagonsits have a cross-reactivity with muscarinic receptors and thus exert anticholinergic effects such as dry mouth, blurred vision and urinary retention
* True ## Footnote Stoelting's, pg. 703
49
What cardiovascular side effect is common with 1st generation antihistamines?
* tachycardia ## Footnote Stoelting's, pg. 703
50
In children, a _________ dose of IV dimenhydrinate significantly reduces vomiting after strabismus surgery
* 0.5 mg/kg ## Footnote Stoelting's, pg. 697
51
# True or false: Antihistamines exert their effects by preventing the release of histamine
* False - they are histamine receptor antagonists ## Footnote Stoelting's, pg. 701
52
Factors associated with pulmonary complications of aspiration include the ___________ and __________ of the aspirated gastric contents
* volume * acidity ## Footnote Stoelting's, pg. 699
53
Antacids act by either ____________ hydrogen ions or ____________ of hydrogen chloride into the stomach
* neutralizing * decrease the secretion ## Footnote Stoelting's, pg. 699
54
___________ antacids are less likely to cause foreign body reactions if aspirated
* Nonparticulate ## Footnote Stoelting's, pg. 700
55
_________ mL of sodium citrate can be given ________ minutes before induction to decrease gastric fluid pH
* 15-30 * 15-30 ## Footnote Stoelting's, pg. 700
56
What are the possible complications of antacid therapy?
* bacterial overgrowth of duodenum * UTI * acid rebound ## Footnote Stoelting's, pg. 700 Dr. C's powerpoint
57
List 2 drugs that are histamine type 2 receptor antagonists
* Cimetidine * Famotidine ## Footnote Stoelting's, pg. 703
58
Describe the mechanism of action of cimetidine/famotidine
* They are both H2 receptor antagonists * Blockade of H2 receptors reduces the secretion of H+ ions in the stomach by parietal cells | there is also some reduction of gastric fluid volume ## Footnote Stoelting's, pg. 703-704
59
Increasing age must be considered when determining the dose of H2-receptor antagonists - cimetidine clearance may decrease by ___________% in patients between the ages of 20 and 70 years
* **75%** | bolded on Dr. C's slides ## Footnote Stoelting's, pg. 705
60
# True or false: The ASA has recommended that all patients routinely receive H2RA to decrease the risks associated with pulmonary aspiration
* False - routine use in patients who have no apparent increased risk for pulmonary aspiration is **not recommended** ## Footnote Stoelting's, pg. 705
61
What are the most common adverse side effects associated with H2RAs?
* diarrhea * headache * fatigue * skeletal muscle pain | see also table 35-3 ## Footnote Stoelting's, pg. 706
62
____________ are the most effective drugs available for controlling **gastric acidity *and* volume**
* **proton pump inhibitors** | bolded on Dr. C's slides ## Footnote Stoelting's, pg. 709
63
How long before surgery should omeprazole be administered to ensure adequate chemoprophylaxis/increase in gastric pH?
* > 3 hours | onset of antisecretory effect ~2-6 hours ## Footnote Stoelting's, pg. 710
64
Name several side effects related to the PPIs
* headache * abdominal pain * agitation/confusion ## Footnote Stoelting's, pg. 710
65
What class of medication is aprepitant (Emend)? Describe its mechanism of action
* substance P/Neurokinin 1 (NK-1) receptor antagonist * NK-1 receptors, located in the nucleus of the solitary tract (NST), are involved in central regulation of GI tract * GI vagal afferents and other input converge in the NST to initiate emesis | NST located within the medulla ## Footnote Nagelhout, pg. 211
66
What kind of patient will you **not** give Metoclopramide?
* Suspected or known mechanical bowel obstruction * After GI surgery or intestinal anastomosis

Nurs 575 Anesthesia Pharmacology (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions