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Anes. Pharm I Test 3
Antiemetics
| Question | Answer |
|---|---|
| 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
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