Quick Reference
MOA / Classes
| Class | Drugs | Dopamine | Acetylcholine | Histamine (H1) | Serotonin | Side Effects |
|---|---|---|---|---|---|---|
| Phenothiazine | Compazine Phenergan | +++ | +++ | +++ | - | |
| Anticholinergic | Scopolamine | + | ++++ | + | - | Can’t see/pee/spit/shit |
| Antihistamine | Diphenhydramine Dimenhydrinate Meclizine | + | ++ | ++++ | - | |
| 5HT-3 Antagonist | Ondansetron Palonosetron Granisetron | - | - | - | ++++ | |
| Benzamides D2 | Metoclopramide | ++++ | - | - | - | EPS (high) Sedation/CNS depression Anticholinergic (moderate) PRL elevation |
PONV
Guidelines:
Fourth Consensus Guidelines for the Management of Postoperative Nausea and Vomiting
- Assess Risk
- Apfel Score
- Reduce Risk
- Multimodal Analgesia
- Gastrectomy: IV APAP
- NSAIDs/COX-2/Ketamine (intraoperative) have morphine sparing effect
- Perioperative Demedetomidine
- Multimodal Analgesia
- Administer PONV Prophylaxis Using 2 Interventions in Adults at Risk for PONV
Level A1 combos:- Ondansetron plus dexamethasone
Level A2 Evidence combos: - Palonosetron plus dexamethasone
- Ramosetron plus dexamethasone
- Ondansetron plus aprepitant
- Ondansetron plus betahistine
- Aprepitant plus dexamethasone
- Haloperidol plus midazolam
- Dexamethasone plus haloperidol
- Ondansetron plus dexamethasone
Rescue therapy:
Sniffing isopropyl alcohol wipe!!!