Summer 25 - PONV

Question 1

What is the definition of nausea?

Answer 1

A subjective, unpleasant sensation in the epigastrium and throat that creates an urge to vomit.

Question 2

Define vomiting.

Answer 2

The forceful expulsion of upper GI contents via the mouth, caused by sustained abdominal muscle contraction.

Question 3

What is retching?

Answer 3

Rhythmic contractions of respiratory, abdominal, and diaphragmatic muscles without expulsion of gastric contents.

Question 4

Where is the Chemoreceptor Trigger Zone (CTZ) located?

Answer 4

In the area postrema.

Question 5

What is the role of the Emetic Center?

Answer 5

Coordinates vomiting response.

Question 6

What nerve conveys signals from the GI tract to the emetic center?

Answer 6

Vagus nerve.

Question 7

Which cranial nerve is implicated in motion sickness?

Answer 7

CN VIII (Vestibular system).

Question 8

List the neurotransmitter systems and receptors involved in emesis.

Answer 8

• 5-HT₃ (Serotonin)
• D₂ (Dopamine)
• H₁ (Histamine)
• Muscarinic (M₁) (Acetylcholine)

Question 9

Name some common stimuli triggering emesis.

Answer 9

• Drugs (Cisplatin, nitrogen mustard, digoxin, opioids)
• Motion/Vestibular input
• GI tract distension and irritation
• Pharynx gag reflex stimulation
• Higher centers (vision, taste, emotion)
• N₂O

Question 10

What factors increase the risk of PONV related to patient-specific factors?

Answer 10

• Female sex
• Young age
• Non-smoker
• Obesity
• History of motion sickness or PONV

Question 11

What surgical-related factors contribute to PONV?

Answer 11

• Type and duration of surgery
• Intra-abdominal procedures

Question 12

What anesthetic-related factors increase the risk of PONV?

Answer 12

• Use of volatile agents
• Nitrous oxide
• Opioid use
• Prolonged anesthesia duration

Question 13

What are the primary patient-related risk factors for PONV?

Answer 13

• Age
• Sex
• Obesity
• Nonsmoking status
• History of PONV or motion sickness
• Anxiety
• Delayed gastric emptying

Question 14

Which surgical categories promote PONV?

Answer 14

• Gonadal/Reproductive
• Abdominal
• Oculo-gyric
• Pharyngeal

Question 15

What is the effect of benzodiazepines on PONV risk?

Answer 15

They reduce PONV risk.

Question 16

True or False: General anesthesia has a higher PONV risk than major regional anesthesia.

Answer 16

True.

Question 17

What is the incidence of PONV with general anesthesia?

Answer 17

25–30%.

Question 18

What are the consequences of PONV?

Answer 18

• Patient discomfort
• Functional impairment
• Increased healthcare cost
• Wound complications
• Pulmonary risk
• Physiologic derangements

Question 19

What is the total risk score that indicates prophylactic antiemetics should be used?

Answer 19

≥ 3 points.

Question 20

Fill in the blank: The drug Aprepitant is an approved _______ antagonist.

Answer 20

NK-1

Question 21

What is the mechanism of 5-HT₃ receptor antagonists?

Answer 21

They are the only serotonin receptor that is a ligand-gated cation channel.

Question 22

What is the risk associated with high doses of 5-HT₃ receptor antagonists?

Answer 22

QT Prolongation.

Question 23

What is the clinical implication of CYP2D6 ultrarapid metabolizers?

Answer 23

Higher risk of PONV despite standard dosing.

Question 24

What is Scuderi’s Multimodal Therapy?

Answer 24

A comprehensive strategy targeting multiple emetogenic pathways.

Question 25

What is the adverse effect associated with Droperidol?

Answer 25

Proarrhythmic effects leading to QT interval prolongation.

Question 26

What is the pharmacokinetic property of Metoclopramide?

Answer 26

Rapid and complete absorption orally; ~75% bioavailability.

Question 27

List some common side effects of 5-HT₃ receptor antagonists.

Answer 27

* Headache * Dizziness * Constipation