Busy. Please wait.
or

show password
Forgot Password?

Don't have an account?  Sign up 
or

Username is available taken
show password

why


Make sure to remember your password. If you forget it there is no way for StudyStack to send you a reset link. You would need to create a new account.
We do not share your email address with others. It is only used to allow you to reset your password. For details read our Privacy Policy and Terms of Service.


Already a StudyStack user? Log In

Reset Password
Enter the associated with your account, and we'll email you a link to reset your password.

Remove ads
Don't know
Know
remaining cards
Save
0:01
To flip the current card, click it or press the Spacebar key.  To move the current card to one of the three colored boxes, click on the box.  You may also press the UP ARROW key to move the card to the "Know" box, the DOWN ARROW key to move the card to the "Don't know" box, or the RIGHT ARROW key to move the card to the Remaining box.  You may also click on the card displayed in any of the three boxes to bring that card back to the center.

Pass complete!

"Know" box contains:
Time elapsed:
Retries:
restart all cards




share
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.

  Normal Size     Small Size show me how

Antiemetics

Pharm Test 3

QuestionAnswer
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