Therapeutics - N/V 2
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What are the DA antagonists?
What is the MOA of DA antagonsist?
Block DA in the CTZ
Which DA antagonists can cause QT prolongation?
Haloperidol and Droperidol (BBW)
What is the dose for Prochlorperazine?
10 mg IV/PO Q6H or PRN
What is the dose for Promethazine?
12.5-25 mg Q4-6 H or PRN
What is the dose for Haloperidol?
1-3 mg IV/PO Q2-4H PRN
What is the dose for Metoclopramide?
- 10-40 mg IV/PO Q6H
- Might add Diphenhydramine 25-50mg to prevent EPS
What is the BBW for Metoclopramide?
Irreversible tardive dyskinesias
What is the BBW for promethazine?
What is the DOC for Anticipatory N/V?
- Lorazepam 1-2 mg IV/PO/SL Q4-6H or 1 dose before chemo
What place in therapy does Dronabinol have?
- Mild-Moderate CINV
- Caution in elderly due to hallucinogenic, confusion and sedative effects
- May be equivalent or superior to prochlorpromazine or metoclopramide
What antipsychotic can be used for CINV?
What drugs would be given to prevent CINV for a highly emetogenic regimen?
- Option A: NK1 antagonist + 5-HT3 + Dexamethasone
- Option B: Akynzeo + steroid
- Option C: Olanzapine + palonsetron + steroid
- All options: +/- lorazepam
What drugs would be given to prevent CINV for a moderately emetogenic regimen?
- Dexamethasone +/- areprepitant
- +/- lorazepam
What drugs would be given to prevent CINV for a lw emetogenic regimen?
- Dexamethasone, Prochlorperazine, Metoclopramide or 5-HT3 anatagonist
- +/- lorazepam
What drugs would be given to prevent CINV for a minimally emetogenic regimen?
Every day that chemo is given a ________________ should be given, unless you choose to use ___________________ or if the chemo drugs pose low to minimal risk of emetogenicity.
- 5-HT3 antagonist
What factors create a higher risk of Postoperative surgery?
- Surgery type: Abdomen, eye, ear, nose, throat, OB-gyn
- females 3x incidence than males
- NO >>>> isoflurane
How should you treat Low risk PONV?
No prophylaxis, 5-HT3 for rescue
How should you treat High risk PONV?
- 5-HT3 prior to cessation of anesthesia or pre-surgery
- Aprepitant 40mg - Can get outpatient and take before surgery
- Droperidol, propofol, dexamethasone, promethazine, metoclopramide all helpful
There is limited use of ___________________ and promethazine due to excessive sedation after surgery.
What antiemetics are used for pregnancy NV?
- Histamine antagonists
- 5-HT3 antagonists – limited data on fetal outcome
- Diclegis (Pyridoxine 10 mg + Doxylamine 10 mg)
- Vitamin B6 10-25 mg QID –start with this
General NV in adults should not be treated with?
General NV in adults should be treated with?
- DA agents:
When can 5-HT3 antagonists be used for general NV?
What would you like to do?
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