PONV Jeopardy

Apfel & PONV Risk Stratification

100

What is the purpose of the Apfel scoring system?

To predict a patient's risk of developing PONV within 24 hrs of surgery

200

Name 2 things that earn a patient a "point" in the Apfel score.

Female gender, nonsmoker, Hx of PONV, postop opioids

300

Name a type of anesthetic that would help reduce the risk of PONV.

Regional, opioid-free, TIVA

400

Name a surgery type that puts a patient at an increased risk of PONV.

Laparoscopic, gynecologic, cholecystectomy, ENT, trauma

500

When scoring a patient using the Apfel score, what % PONV risk is a patient at if they have 3 risk factors?

60% risk of PONV

Reference:

0 risk factors = 10% PONV risk

1 = 20%

2 = 40%

3 = 60%

4 = 80%

Antiemetic Contraindications/Side effects

100

Name a side effect of Ondansetron administration.

QT prolongation, serotonin syndrome (when combined with SSRIs or other serotonergic meds)

Note: caution w/ liver dz d/t metab via CYP pathway

200

Name a contraindication for using a Scopolamine patch for a patient.

Elderly, Narrow-angle glaucoma, impaired mental status

300

Important side effect to educate female patients about when administering Aprepitant?

It makes hormonal birth control ineffective for 4 weeks.

400

Name an antiemetic medication that you cannot give to a patient with Parkinsons disease.

Metoclopramide, Droperidol, Haldol

(all are dopamine receptor blockers)

500

Why was Droperidol given a black box warning?

QT prolongation (and possible Torsades)