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Antiemetics
Pharm Test 3
| Question | Answer |
|---|---|
| Incidence of PONV is _______% in the immediate post-op period. | 10% |
| Incidence of PONV is ______% in the first 24 hrs post-op. | 30% |
| Incidence of PONV is ______% for high-risk surgeries. | 70-90% |
| What are the 3 top reasons for unplanned admissions in outpt procedures? | 1)PONV, 2)pain, 3)bleeding |
| What are some complications of PONV? | surgical wound dehiscence, esophageal damage, aspiration, dehydration, alkalosis, hypokalemia, intraocular hemorrhage, increased ICP, myocardial ischemia, delayed d/c, inc. bleeding |
| What are some factors that can inc. PONV? | female, h/o PONV or motion sickness, nonsmoker, young age, general anesthesia, volatiles/N2O, post-op opioids, longer anesthesia, cholecystectomy/laparoscopic/GYN surgery |
| What 4 risk factors are used to calculate the risk score of PONV? | female, non-smoker, history of PONV, post-op opioids |
| A pt w/ a PONV risk score of 1 has a ______% chance of PONV. | 20% |
| A pt w/ a PONV risk score of 2 has a ______% chance of PONV. | 40% |
| A pt w/ a PONV risk score of 3 has a _____% chance of PONV? | 60% |
| A pt w/ a PONV risk score of 4 has a _____% chance of PONV. | 80% |
| Children age 3-puberty have a ______% risk of PONV. How does this compare to adult incidence? | 40%; 2X adult incidence |
| Childhood risk of PONV (increases or decreases?) as children age, until puberty. | increases |
| True or False: There is no difference in PONV risk in male and female children until puberty. | True |
| What are some ways to reduce a pt's baseline risk for PONV? | avoid general anesthesia, use propofol (antiemetic), avoid N2O/volatiles, minimize opioid use, adequate hydration |
| True or False: A small dose of propofol can be used as a "rescue" drug if pt becomes nauseous. | True |
| Which 2 antiemetics should not be readministered after 1st dose? | dexamethasone and scopolamine |
| Which antiemetic has a black box for QT prolongation? | droperidol |
| Which receptors are located in the brainstem vomiting center in the lateral medullar reticular formation? | muscarinic, histamine1, serotonin (5-HT3), neurokinin1 |
| Where is the chemoreceptor trigger zone located? | 4th ventricle |
| Which receptors are located in the chemoreceptor trigger zone? | dopamine, 5HT3, opioid receptors |
| Which system deals w/ motion sickness? | vestibular system |
| Which receptors are located in the vestibular system? | muscarinic and H1 receptors |
| What causes the gag and retch reflex? | irritation of the pharynx (vagus nerve) |
| True or False: Mucosa of the GI tract can sense air or food in the stomach and release serotonin that activates the 5HT3 receptors to stimulate vagal input to the CTZ and vomiting center. | True |
| What causes the physical act of vomiting? | Efferent output from the emetic center travels via the phrenic and spinal nerves of the abdominal wall musculature during the act of vomiting |
| How can the CNS cause vomiting? | stress and anticipatory vomiting |
| How do benzo's decrease PONV? | dec. dopamine input at the CTZ as well as anxiolysis. Also dec. adenosine reuptake leading to dec. synthesis, release, and postsynaptic action of dopamine at the CTZ |
| Which receptors do antihistamines block? | muscarinic, H1 |
| What are some examples of antihistamines that dec. PONV? | Benadryl, meclizine (bonine), Dramamine (dimenhydrinate), phenothiazines (compazine/promethazine; rescue), scopolamine |
| What are some limitations of admin. of antihistamines for reduction of PONV? | sedation, dizziness, confusion, dry mouth, urinary retention |
| Which type of antihistamine is used as a "rescue drug"? Examples? | phenothiazines (prochlorperazine/Compazine), (promethazine/Phenergan) |
| What are some limitations specific to phenothiazines? | sedation, extrapyramidal side effects, lowers seizure threshold, hypotension (alpha blockade) |
| What receptors do phenothizines block? | dopamine and muscarinic (histamine???) |
| What receptors does scopolamine block? | muscarinic (antagonizes histamine and serotonin) |
| How is scopolamine administered? | transdermal patch |
| Does scopolamine cross the BBB? | yes |
| When should you apply the scopolamine patch? How long does it last? | 60min before induction; lasts 48-72 hrs |
| A 1.5mg patch of scopolamine releases a _____mg dose. | 1mg |
| What are some limitations of scopolamine? | ocular effects (glaucoma), restlessness, delirium, sedation, dry mouth, tachycardia |
| What is an example of a butrophenone drug? | droperidol/inapsine |
| What receptors are blocked by droperidol? | dopamine, alpha |
| What are some limitations for droperidol? | sedation, dissociative state, dec. in BP (vasodilation), prolonged QT, extrapyramidal effects |
| What is a therapeutic dose of droperidol? | 0.625-1.25 mg IV |
| What is the max dose of droperidol? | 2.5mg |
| What is an example of a gastrokinetic drug? | metoclopramide/reglan |
| What receptors does metoclopramide block? | dopamine |
| What is a therapeutic dose of metoclopramide? | 10-20mg IV |
| What can occur if metoclopramide/reglan is given w/ phenothiazines or droperidol? | increased incidence of extrapyramidal effects |
| Which pts should not be given metoclopramide? | intestinal obstruction, appendicitis, parkinson's |
| True or False: Serotonin is a cerebral stimulant. | True |
| 90% of serotonin is stored in ______________ cells. | enterochromaffin cells of the GI tract |
| Activation of 5-HT1 receptors causes: | cerebral vasoconstriction (blockade causes migraines) |
| Activation of 5-HT2 receptors causes: | coronary artery and pulmonary vessel vasoconstriction |
| Activation of 5-HT3 receptors in the PNS causes: | visceral pain |
| Activation of 5-HT3 receptors in the CNS causes: | emesis, appetite, addiction, pain, anxiety |
| Activation of 5-HT4 receptors causes: | gastrokinesis (blockade causes constipation and IBS) |
| What are the 2 most common complaints of 5-HT blockers? | headache, constipation |
| True or False: 5-HT3 antagonists are effective in treating chemo-induced N/V. | True |
| True or False: 5-HT3 antagonists are effective in treating motion sickness. | False |
| Can 5-HT3 antagonists be given to pts with Parkinson's? | Yes (no effect on dopamine receptors) |
| What are some examples of 5-HT3 antagonists? | Ondansetron/Zofran, Dolasetron/Anzemet, Granisetron/Kytril, Palonosetron/Aloxi |
| What is a therapeutic dose of ondansetron/Zofran? | 4-8mg IV |
| What is a therapeutic dose of dolasetron/anzemet? | 12.5 mg IV |
| What is a therapeutic dose of granisetron/kytril? | 1mg IV |
| What is a therapeutic dose of palonosetron/aloxi? | 0.075mg IV |
| What are some side effects of 5-HT3 antagonists? | headache, constipation, cardiac arrhythmias (Anzemet), QT prolongation |
| True or False: The PONV incidence when using volatiles + Zofran is equal to that of a TIVA. | True |
| What is an example of a corticosteroid used for PONV? | dexamethasone/decadron |
| What is a therapeutic dose of dexamethasone/decadron? | 0.5mg/kg |
| How does decadron prevent PONV? | enhances effectiveness of 5-HT3 antagonists |
| What are some limitations for decadron? | interference w/ healing, immune suppression, avascular necrosis |
| At what point in the case should you give decadron? | prior to induction |
| According to the protocol, what is the best prevention method for a pt w/ a low PONV risk score? | none (wait and see) |
| According to the protocol, what is the best 1st intervention for a pt w/ a low PONV risk score? | ondansetron |
| According to the protocol, what is the best 2nd intervention for a pt w/ a low PONV risk score? | droperidol |
| According to the protocol, what is the best prevention method for a pt w/ a medium PONV risk score? | Dexamethasone + Ondansetron or TIVA |
| According to the protocol, what is the best 1st intervention for a pt w/ a medium PONV risk score? | droperidol |
| According to the protocol, what is the best 2nd intervention for a pt w/ a medium PONV risk score? | dimenhydrinate |
| According to the protocol, what is the best prevention method for a pt w/ a high PONV risk score? | dexamethasone + ondansetron + TIVA |
| According to the protocol, what is the best 1st intervention for a pt w/ a high PONV risk score? | droperidol |
| According to the protocol, what is the best 2nd intervention for a pt w/ a high PONV risk score? | dimenhydrinate |
| If it is w/in ______hrs of your first 5-HT3 blocker dose, don't redose. | 6hrs |
| General anesthesia had an _______X increased risk for PONV than regional anesthesia. | 11X |
| What is the new research drug approved by FDA for PONV prophylaxis? | aprepitant/emend |
| What receptor does aprepitant/emend block? | neurokinin1 |
| What is the endogenous ligand for neurokinin 1 receptors? | Substance P |
| What is a therapeutic dose of aprepitant/emend? When do you give it? | 40mg PO 1hr pre-op |
| What is 1 limitation for aprepitant/emend? | interactions w/ seldane, Hismanal, Coumadin, calcium channel blockers, anticoagulants |
| Anatomically, where would you apply P6 pressure to prevent PONV? | between flexor tendons, 3 finger-widths below the hand-wrist crease |
| What dose of propofol can be used to treat PONV? | 0.5mg/kg |
| What dose of ephedrine can be used to treat PONV? | 0.5mg/kg IM |
| True or False: IM ephedrine= droperidol IV. | True |
Created by:
lindseymontgomery
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