Therapeutics - N/V 2

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Author:
kyleannkelsey
ID:
301900
Filename:
Therapeutics - N/V 2
Updated:
2015-05-01 11:05:03
Tags:
Therapeutics
Folders:
Therapeutics - N/V
Description:
Therapeutics - N/V
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  1. What are the DA antagonists?
    • Trimethobenzamide
    • Prochlorperazine
    • Promethazine
    • Haloperidol
    • Droperidol
    • Metoclopramide
  2. What is the MOA of DA antagonsist?
    Block DA in the CTZ
  3. Which DA antagonists can cause QT prolongation?
    Haloperidol and Droperidol (BBW)
  4. What is the dose for Prochlorperazine?
    10 mg IV/PO Q6H or PRN
  5. What is the dose for Promethazine?
    12.5-25 mg Q4-6 H or PRN
  6. What is the dose for Haloperidol?
    1-3 mg IV/PO Q2-4H PRN
  7. What is the dose for Metoclopramide?
    • 10-40 mg IV/PO Q6H
    • Might add Diphenhydramine 25-50mg to prevent EPS
  8. What is the BBW for Metoclopramide?
    Irreversible tardive dyskinesias
  9. What is the BBW for promethazine?
    Severe extravasation
  10. What is the DOC for Anticipatory N/V?
    • Benzodiazapines
    • Lorazepam 1-2 mg IV/PO/SL Q4-6H or 1 dose before chemo
  11. 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
  12. What antipsychotic can be used for CINV?
    Olanzapine
  13. 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
  14. What drugs would be given to prevent CINV for a moderately emetogenic regimen?
    • 5-HT3
    • Dexamethasone +/- areprepitant
    • +/- lorazepam
  15. What drugs would be given to prevent CINV for a lw emetogenic regimen?
    • Dexamethasone, Prochlorperazine, Metoclopramide or 5-HT3 anatagonist
    • +/- lorazepam
  16. What drugs would be given to prevent CINV for a minimally emetogenic regimen?
    • Nothing
    • +/- lorazepam
  17. 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
    • Palonostron
  18. What factors create a higher risk of Postoperative surgery?
    • Surgery type: Abdomen, eye, ear, nose, throat, OB-gyn
    • Children
    • females 3x incidence than males
    • nonsmokers
    • NO >>>> isoflurane
  19. How should you treat Low risk PONV?
    No prophylaxis, 5-HT3 for rescue
  20. 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
  21. There is limited use of ___________________ and promethazine due to excessive sedation after surgery.
    Prochlorperazine
  22. What antiemetics are used for pregnancy NV?
    • Histamine antagonists
    • Phenothiazines
    • 5-HT3 antagonists – limited data on fetal outcome
    • Diclegis (Pyridoxine 10 mg + Doxylamine 10 mg)
    • Vitamin B6 10-25 mg QID –start with this
    • Scupuncture
  23. General NV in adults should not be treated with?
    5-HT3 antagonists
  24. General NV in adults should be treated with?
    • DA agents:
    • Trimethobenzamide
    • Prochlorperazine
    • Promethazine
    • Haloperidol
    • Droperidol
    • Metoclopramide
  25. When can 5-HT3 antagonists be used for general NV?
    Pediatric gastroenteritis

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