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Anes. Pharm I Test 3

Antiemetics

QuestionAnswer
What are the top 3 reasons for unplanned admissions in outpatient procedures? PONV, pain, bleeding
What is the post-op incidence of nausea? Vomiting? nausea - 67-96%; vomiting 48-80%
What is the incidence of PDNV and how long can it last? 35 - 50% and may persist up to 5 days after surgery!
According to the National Center for Health Statistics what was the incidence of PONV/PDNV post discharge only? What can account for this? 25.9% - car ride home
What are the risk factors for PONV in adults? female, history of PONV or motion sickness, nonsmoking, younger age, general anesthesia, volatile anesthetic and nitrous oxide use, post-op opioids, longer anesthesia; cholecystectomy, laparascopric, or gynecological surgery
With no risk factors, what is the % of PONV risk? 10%
With 2 risk factors, what is the % of PONV risk? 40%
The brainstem vomiting center is located where? in the lateral medullary reticular formation
What are the receptors for the lateral medullary reticular formation? muscarinic, histamine H1, Serotonin 5HT3, Neurokinin 1
Where is the chemoreceptor trigger zone located? in the 4th ventricle
What are the receptors types for the chemoreceptor trigger zone? dopamine, serotonin 5HT3, opioid receptors
What are the receptors for the vestibular system? muscarinic and histamine H1
The gag and retch response related to irritation of the pharynx is related to which cranial nerve? vagus nerve
Serotonin released by mucosa of the GI tract actives 5HT3 receptors which then stimulate vagal input to the ___________ and vomiting center CTZ
Efferent output from the emetic center travels via which nerves during the act of vomiting? the phrenic and spinal nerves of the abdominal wall musculature
What is the rationale for giving benzodiazepines as prophylaxis for PONV? decreases dopamine input at the CTZ and reduces anxiety (anticipatory vomiting)
Which drug class provides anticholinergic effects and histamine receptor blockade (H1)? antihistamines
Benadryl ,meclizine, and dramamine are typically used as prophylaxis and treatment for NV secondary to what? motion sickness - weak effect except for combating motion sickness
Which drug class inhibits dopamine and muscarinic receptors? What are some examples of these drugs? phenothiazines; prochlorperazine (compazine) and promethazine (phenergan)
Why are phenothiazines a poor choice for patients with seizure disorders? because they lower the seizure threshold
Why are phenothiazines a poor choice for patients with Parkinson's? because they antagonize dopamine, making Parkinson's symptoms worse
Scopolamine is an antimuscarinic, so it targets the vestibular system. It antagonizes which two substances? histamine and serotonin
What is the dose for a Scopolamine patch? 1.5 mg patch releases 1 mg dose and can provide adequate drug levels for 48 - 72 hours
The Butyrophenones class of drugs (droperidol, inapsine) are considered to be _______ blockers. dopamine (alpha blockade)
What is the mechanism of action of metoclopramide (reglan)? dopamine blockade in the CTZ
If metoclopramide is used in conduction with phenothiazines or droperidol, what is the result? increased incidence of extrapyramidal effects
Metoclopramide is predominantly used for this reason rather than PONV prevention. aspiration prophylaxis - because it is a gastrokinetic
5HT1 receptors cause what effect? cerebral vasoconstriction
5HT2 receptors cause what effect? coronary artery and pulmonary vessel vasoconstriction
5HT3 receptors cause what effect? visceral pain, emesis, appetite, addiction, pain and anxiety
5HT4 receptors cause what effect? gastrokinesis
5HT3 receptor antagonists are or are not effective on motion sickness? are NOT!!!
5HT3 blockers have NO effect on what 4 types of receptors? dopamine, histamine, adrenergic, muscarinic
Zofran has minimal side effects, but what are the 2 biggest complaints with chronic use? constipation and migraines
What are the two biggest limitations with 5HT3 antagonists? cost and prolonged QT interval
Decadon in 6 = 10 mg doses is known to increase the effectiveness of which drugs? 5HT3 antagonists
General anesthesia has an _____ increased risk for PONV when compared with regional anesthesia. 11 fold
What is Aprepitant (Emend)? an antagonist drug for the NK1 receptor that was recently approved by the FDA for PONV prophylaxis
What is the dosage of Aprepitant (Emend)? 40 mg PO one hour pre-op
What drugs could cause an interaction with Aprepitant (Emend)? Seldane, hismanal, coumadin, calcium channel blockers, and anticoagulants
What dose of propofol can be used as an alternative treatment for PONV? 0.5 mg/kg IV
What dose of ephedrine can be used as an alternative treatment for PONV? 0.5 mg/kg IM (IM ephedrine = IV droperidol)
Acupressure and/or acupuncture is effective in what percentage of adults for combating PONV? 20-25%; not effective in pediatric patients
Created by: Mary Beth