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16. 701 Exam 4 PONV

Terms in this set (29)

what are is a patient more at risk for the longer the patient is under anesthesia?
PONV
every 30 min of surgery increases risk by 60%
what are the risk factors for PONV?
female
non-smoker
hx of PONV/motion sickness
school aged children
opioids
volatile anesthetics
nitrous oxide
what are some drugs that we can give to alleviate/prevent PONV?
Propofol
5-HT3 antagonists
steroids
butyrophenones
neurokinin-1 antagonists
antihistamines
scopalamine
if a patient has breast cancer with axillary node dissection, what is their risk for PONV?
60-80%
What are the 5HT3 antagonists?
Ondansetron (zofran)
Dolasetron (anzemet)
what is the MOA of 5-HT3 antagonists
blocks serotonin receptors without effecting dopamine receptors on the central and peripheral receptors
what are the uses for 5-HT3 antagonists?
PONV prophylaxis at the end of surgery or rescue in PACU
what is the dosing for 5-HT3 antagonists?
4 mg prior to induction or at the end of surgery
Q 4-8 hours
what are the side effects of 5-HT3 antagonists?
HA, prolonged QT
if a patient has significant history of PONV, when should you give zofran?
at induction and then at the end of the case
when would you avoid giving zofran?
if a patient has major migraine history
what medications are butyropherones?
Droperidol (anapsine)
What is the MOA of Butyrophenones?
Blocks dopaminergic stimulation of the CTZ (chemoreceptor trigger zone)
why do we not use butyrophenones anymore?
BBW of QT prolongation causing tordades (but this happens at ridiculously high doses)
what is the dosing for butyrophenones?
0.0625-0.125 mg IV at the end of surgery
in which patient population would you want to take caution in when administering butyrophenones?
Parkinson's and patients with extrapyramidal symptoms
what steroid do we give for PONV?
decadron (dexamethasone)
what is the MOA for steroids relieving PONV?
unknown
what is the dosing of decadron?
4-10 mg IV
when do you give decadron?
after induction and prior to incision
what kind of patients do you want to take precaution in when giving decadron?
DM
what medication is given with decadron that makes it most effective?
used in combination with zofran
what kind of patients do we give Emend and what kind of antiemetic is it?
used with chemotherapy NV, plastic surgery, mastectomy/tram flap
this is neurokinin-1 receptor antagonist
How do neurokinin-1 antagonists work?
inhibit substance P
what medication will enhance the effects of emend?
zofran
when do we use a scopalamine patch and how long does it last?
the night before a surgery and can be used for up to 72 hours
what do you wan to completely avoid in patients with severe PONV?
inhalational agents
what patient population do you want to take caution in with scopalamine?
elderly patients
patients with glaucoma-open angle, the mydriatic effect can increase IOP
when should you place a scopolamine patch on a pregnant patient getting a c section?
one hour prior to section to minimize exposure to the baby
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