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Nutritional and Dietary Supplementation during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
For severe cases of hyperemesis gravidarum in which other agents are largely ineffective, ondansetron (Zofran) 32 mg intravenously as a single dose may be effective. Ondansetron is also available in an oral form (8 mg b.i.d.). However, this route is much less likely to be effective in treatment of hyperemesis gravidarum because almost everything taken orally is vomited.
Gastrointestinal diseases and pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Murtaza Arif, Anjana Sathyamurthy, Jessica Winn, Jamal A. Ibdah
Antiemetics are commonly used for the management of nausea and vomiting during pregnancy, but there are little data regarding their safety and efficacy in HG (Table 5). Anti-histamines and phenothiazines are considered the most effective antiemetic medications. In general, antihistamines are considered to have the lowest teratogenic risk. A meta-analysis showed no evidence of teratogenicity or other serious maternal or fetal adverse outcomes associated with the use of antihistamines for nausea and vomiting during pregnancy (56). Phenothiazines include prochlorperazine and chlorpromazine. Isolated case reports have reported cleft palate, skeletal, limb, and cardiac abnormalities in association with the use of phenothiazines; however, there is no evidence of adverse fetal effects in clinical studies (57). No adverse fetal outcomes have been found with the use of metoclopramide in animals or humans (57). Recently 5HT3 antagonists (ondansetron) have been shown to have efficacy for nausea and vomiting during pregnancy, and their use seems to be increasing (58). No adverse effects in animal studies and no reported increase in birth defects have been found with the use of ondansetron during pregnancy (58).
Practice exam 2: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
The mainstay of management is adequate and appropriate fluid and electrolyte replacement (1). Normal saline [sodium chloride 0.9%; 150 mmol/l Na+] or Hartmann’s solution [sodium chloride 0.6%; 131 mmol/l Na+] is recommended, and potassium chloride can be added to the infusion bag as required (1). [5% dextrose saline solution and 10% dextrose solutions are dangerous, as there is a risk of the patient developing Wernicke’s encephalopathy with the use of these infusions. Double-strength saline is also contra-indicated, as this may correct the hyponatraemia too rapidly and cause central pontine myelinolysis.] Initially, daily urea and electrolyte measurements should be performed, permitting appropriate adaptation and titration of fluid and electrolyte regimes (1). Antiemetics should be prescribed and given regularly, rather than on ‘as required’ basis, until vomiting and nausea are under control. Suitable agents include cyclizine [50 mg t.d.s., orally, intramuscularly or intravenously], metoclopramide [10 mg t.d.s., orally, intramuscularly or intravenously] or prochlorperazine [5 mg orally t.d.s.; 12.5 mg t.d.s., intramuscularly or intravenously] (1). Should these agents fail to control the vomiting, ondansetron [8 mg b.d. orally or 4–8 mg b.d. slowly intravenously], a highly selective 5-HT3 antagonist, may safely be used (although it is not licensed in pregnancy) (1).
Treatment strategies for serotonin reuptake inhibitor-resistant obsessive-compulsive disorder: A network meta-analysis of randomised controlled trials
Published in The World Journal of Biological Psychiatry, 2023
Satish Suhas, Palash Kumar Malo, Vijay Kumar, Thomas Gregor Issac, Nellai K. Chithra, Binukumar Bhaskarapillai, Y. C. Janardhan Reddy, Naren P. Rao
Treating SRI-resistant OCD is challenging. A clinician has to choose amongst the diverse interventions available. Our NMA suggests that deep TMS, ondansetron, topiramate, CBT[TA], and aripiprazole are better than other interventions. Based on the findings of the NMA and the sensitivity analysis wherever available, deep TMS should be offered to patients with resistant OCD. A trial of CBT[TA] may be a pragmatic alternative to first-line augmentation, especially if it has not been tried before. Among the pharmacological options, one can consider treatment with ondansetron or topiramate or aripiprazole. Any of the other evidence-based interventions may be considered subsequently based on treatment guidelines. These conclusions are limited because they are drawn from different studies with different samples and therefore large multicentric randomised controlled trials with a larger cohort of patients are needed to confirm these findings.
Current understanding of the etiology of cyclic vomiting syndrome and therapeutic strategies in its management
Published in Expert Review of Clinical Pharmacology, 2022
Rosita Frazier, Thangam Venkatesan
5HT3 antagonists are highly effective in treating acute, delayed, and anticipatory chemotherapy-induced nausea and vomiting [84]. However, there are no clinical trials in CVS, although they are frequently used in these patients. It would likely not be logistically feasible to conduct such studies in CVS given its proven efficacy as an anti-emetic and its widespread use. The 2019 guideline on the management of CVS in adults recommends ondansetron as a first-line agent in aborting an episode of CVS. The recommended dose of ondansetron is 8 mg every 8 hours either as a sublingual tablet or intravenously. Adding a benzodiazepine and/or a phenothiazine for sedation is also recommended [56]. Ondansetron is well tolerated, and side effects include headache, dizziness, drowsiness, diarrhea, or constipation [85].
The Comparison of Postoperative Analgesic Efficacy of Ultrasound-Guided Paravertebral Block and Mid-Point Transverse Process Pleura Block in Mastectomy Surgeries: A Randomized Study
Published in Journal of Investigative Surgery, 2022
Agâh Abdullah Kahramanlar, Mehmet Aksoy, Ilker Ince, Aysenur Dostbıl, Erdem Karadenız
Routine general anesthesia protocol was performed using 2–3 mg/kg IV propofol, 0.6 mg/kg IV rocuronium, and 2 µg/kg IV fentanyl. Anesthesia was maintained with desflurane, a fresh gas flow of 3 L/min, and a nitrous oxide mixed with oxygen in a 2:1 ratio. During surgery, the patient’s systolic, diastolic and average artery blood pressures and oxygen saturation values were recorded in the 5th, 10th, 15th, 20th, 35th, and 50th minutes, and postoperative 1st and 2nd hours. At the end of the operation, neuromuscular block antagonization was performed using sugammadex (4 mg/kg). All patients were extubated and taken to the postanesthetic care unit (PACU). Patients with a modified Aldrete score ≥9 were transferred to the clinic. Intravenous 1 g of paracetamol was administered to all patients postoperatively and the same dose was repeated every 6 hours. Intravenous 8 mg of ondansetron was administered to all patients, for the prevention of nausea and vomiting. Intravenous 6 mg of ephedrine was used to treat hypotension (a 20% decrease in systolic blood pressure compared to baseline values) and IV 1 mg of atropine was given in case of bradycardia (the heart rate < 45 beats/minute) during the operation. Nausea and vomiting were treated with an IV of 10 mg of metoclopramide.