QuestionPrescription
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Ondensatron can be given IV or IM in this circumstance? 
17234
QuestionComment
yeah BNF says slow IV or IM so idk why theyre saying IM is wrong?
17272
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DNA Tachycardia
QuestionComment
if there's a cannula in situ, it's better to do IV route over IM
19969
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Chronic Metabolism
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Hematoma Transplant
QuestionComment
why is domperidone wrong?
39233
QuestionComment
don't give domperidone in someone with parkinsons 
40205
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Serpiginous Metabolism
QuestionComment
This is wrong domperidone is gold standard for GI side effects in Parkinson's but that's when nausea and vomiting is associated with opiates, so you would give ondansetron for this patient as the treatment is for post-op nausea and vomiting 
40437
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Chronic Liver
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Lymph Tyrosine
QuestionComment
Re. Cyclizine —> in practice it works better for patients who have nausea from ear related problems eg motion sickness, vestibular neuritis etc…
Ondansetron is typically a good choice for treatment or prophylaxis of post-surgical nausea :) 
40248
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also: cyclizine = CI: heart failure
61789
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Pseudopseudopseudopseudohypoparathyroidism
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Izzy
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Why not haloperidol as the QT interval is not prolonged in this patient? Unless there are other contraindications
60834
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Parkinson's would be a CI as it's a dopamine receptor antagonist
61161
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DJnR
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Serotonin Fracture
Concept
Chapter
Assess cause:

- Infection
- Hypovolaemia
- Pain
- Paralytic ileus
- Drugs

Management:

- Non-pharmacological

  - Minimise patient movement
  - Analagesia
  - IV fluids if dehydrated

- Pharmacological
  - 5HT3 receptor antagonist e.g. Ondansetron - first line. Risk of QT prolongation and constipation
  - Histamine (H1) receptor antagonist e.g. Cyclizine. Avoid in severe heart failure
  - Dopamine (D2) receptor antagonist e.g. Prochlorperazine. Risk of extrapyramidal side effects (dystonic reactions)

Other anti-emetics such as corticosteroids or Metoclopramide reserved for specific cases of post-operative nausea and vomiting.

# External links 

- [NHS Greater Glasgow & Clyde: Adult Therapeutics Handbook: Management of Postoperative Nausea and Vomiting](https://handbook.ggcmedicines.org.uk/guidelines/pain-post-operative-nausea-and-vomiting-and-palliative-care-symptoms/management-of-postoperative-nausea-and-vomiting-ponv/)
- [Up To Date: Postoperative Nausea and Vomiting](https://www.uptodate.com/contents/postoperative-nausea-and-vomiting)
- [Norfolk and Norwich University Hospitals: Clinical Guideline for the management of post-operative nausea and vomiting in adults and children](http://www.nnuh.nhs.uk/publication/download/management-of-post-operative-nausea-and-vomiting-in-adults-and-children-clinical-guideline-v1-1/)

1107
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Post-operative nausea and vomiting
Topic
13
Neurosurgery
# Drug choice feedback

This patient requires an anti-emetic. Ondansetron is the most appropriate. Cyclizine is contra-indicated in light of her severe heart failure, whilst prochlorperazine is contra-indicated due to her mild Parkinson's disease, as it can result in extra-pyramidal side effects. Metoclopramide is contra-indicated as it is a pro-kinetic in the context of thias patient's gastrectomy

# Dose/Route/Frequency/Duration feedback

The dose of IV ondansetron in post-operative nausea and vomiting is 4mg. Whilst it can be given IM, this patient already has a cannula in situ, hence the IV route is preferred.
6759
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PrescribeAnswerData
1 mg
PrescribeAnswerData
granisetron 1 mg/mL injection
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
intravenous (IV)
PrescriptionAnswer
PrescribeAnswerData
4 mg
PrescribeAnswerData
ondansetron 2 mg/mL injection
PrescribeAnswerData
Once-off
PrescribeAnswerData
once only (STAT)
PrescribeAnswerData
intravenous (IV)
Case Presentation: A 73-year-old woman admitted to the general ward for observation after a gastrectomy 12 hours ago complains of nausea and has vomited three times. She has been given adequate analgesia.


## PH

Stomach cancer, severe heart failure, Type 2 Diabetes Mellitus, Obesity, Hyperlipidaemia, Mild Parkinson's Disease

## DH

Ramipril 5mg OD PO, Bisoprolol 2.5mg PO, Spironolactone 50mg PO OD, Metformin 1g BD PO, Empaglifozin 10mg PO OD, Atorvastatin 40mg PO OD (NKDA)

## On examination

Appears unwell, not oriented to time and place. Peripheries warm, CRT 2s. Cannula in situ.

Temperature 36.6°C, HR 97, RR 23, BP 113/80, O2 96% RA, GCS 14, Weight 95kg

## Investigations

FBC: Hb 144, WCC 7.3, Plts 324

U&Es: Na<sup>+</sup> 136, K<sup>+</sup> 4.2, Cl<sup>-</sup> 105, Ur 6.8, Cr 98, eGFR 51mL/min/1.73m<sup>2</sup>

ECG: Normal sinus rhythm, QTc 430ms (<460ms)

# Prescribing Request

Write a prescription for one medication that is most appropriate for treating her post-operative nausea and vomiting.