-
Emetic Reflex Locations
- Chemoreceptor Trigger Zone: Area Postrema
- Higher cortical centers
- Vomiting center: brainstem/medulla
-
Chemoreceptor Trigger Zone Receptors
- Dopamine: blood
- Serotonin(5-HT): blood, CSF, and GI
- Opioids and anesthetics
-
Common Nausea and vomiting
- Cancer chemo
- Postoperative period
- headache syndrome
- Opioid use
-
Risk Factors for PONV
- Increasing age
- Premenopausal women
- Obesity
- Previous history of PONV
- Anxiety
- Gastropareiesis
- Type of surgery: laparoscopy, strabismus, middle ear
- Length of Surgery
-
Treatments for PONV
- Ondansetron/granisetron
- Droperidol/Haloperidol
- Dexamethasone
- Metoclopramide
- Promethazine
- Propofol
-
Antidopaminergic Drugs
- Butyrophenones: haloperidol
- Phenothiazines
- Domperidone
- Metoclopramide (Reglan)
- SA: Do not use with RLS, Parkinsons,or another disorder for dopaminergic drugs are used to treat
-
H1-Receptor Agonists
- Diphenhydramine
- Promethazine (Phenergan): black box warning for chemical irritation and tissue damage
- SA: sedation, dizziness, headache, hypotension, urinary retetion.
-
Muscarinic Antagonists
- Scopolamine
- SA: transdermal is less likely to cause effects of dry mouth, drowsiness, and blurred vision
-
5HT3-Receptor Antagonists
- Ondansetron: Zofran
- Dolasetron
- Granisetron
- SA: headache, constipation, prolonged QT
-
Steroids
- Dexamethasone: inhibits multiple inflammatory cytokines in the CNS and PNS.
- SAs: hyperglycemia, appetite changes, insomnia, mood swings, anxiety, headache. flossing, edema
-
NK1 antagonists
Aprepitant: Substance P antagonists
-
Propofol
Due to D2 antagonism, 5HT3 antagonism, or a cannabinoid agonis,
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