Anti-emetic Flashcards
Chemotherapy-Induced Nausea and Vomiting (CINV)
Acute:
Occurs within minutes to hours after chemotherapy administration
Depends upon type, dose, route, and schedule
Risk factors: gender, age, stage of disease, alcohol use, co-morbidities
Anticipatory-Think they will get, so they do
Delayed:
Occurs at least 24 hours following chemotherapy administration
Acute n/v increase risk
Other risk factors include: high-dose chemo, certain agents, and poorly controlled N/V
Breakthrough:
Occurs despite standard treatment, Requires further intervention
Refractory
Unrelieved n/v despite standard and breakthrough treatment
Types of Anti-emetics
Anticholinergics – Scopolamine, Dicyclomine (Bentyl)
Antihistamines -
Neurolytics – Chlropromazine, Haldol
Prokinetics –Metoclopramide, Cisaprine
5HT3 - Ondansetron
Adjunct Medications – Corticosteroids, Benzodiazepines, Cannabinoids
Can be Administered: Oral, sublingual, Rectal, IV, IM, SQ, and transdermal
5-HT3 (Serotonin) Antagonist
Serotonin receptors (5-HT3 type) are present both peripherally and centrally
Given for Chemotherapy, radiation therapy, or post-op N/V
Metabolized in the liver and excreted in the urine
Drugs end in “Setron”:
Ondansetron (Zofran)
Granisetron (Kytril)
Dolasetron (Anzemet)
Palonosetron (Aloxi)
Side effects:
Headache
Diarrhea
Fever
Hypotension
Qt prolongation
Ondansetron (Zofran)
Block Serotonin in the CTZ
Routes: PO, sublingual, IV, IM
Pregnancy Category B
Contraindications
Patients taking anticonvulsants
Use lowest dose in hepatic and renal impairment
Side effects
Headache
Diarrhea
Constipation
fatigue
Dopamine 2 Antagonist
3 subtypes:
Piperaze phenothiazine/ Antipsychotics
Prochloperazine
Metoclopramide (Reglan)
Butyrophenone derivative/Antipsychotic
Droperidol and Haloperidol (Haldol)
Indications:
Motion sickness
Chemotherapy-induces nausea/vomiting (CINV)
Post-op N/V
Also have antihistamine and anti-cholinergic properties
Considered second-line therapy
Other Drugs in class:
Promethazine (Phenergan)
Trimethobenazamide (Tigan)
Metoclopramide (Reglan)
Dopamine 2 receptor antagonist
Also classified as a non-phenothiazine
Indications:
GERD, Diabetic Gastroparesis
Nausea and Vomiting
Routes: Oral, IV, IM
Black Box warning:
May cause tardive dyskinesia
Pregnancy Category B
Contraindications
bowel obstruction
GI bleeding
pheochromocytoma
Epileptics
Side effects
Restlessness
Drowsiness
Extrapyramidal symptoms (EPS)
Neuroleptic Malignant Syndrome (NMS)
Suicide ideations
Haloperidol (Haldol)
Butyophenone derivative
Indications:
Schizophrenia
control of tics and vocal utterances of Tourette’s Disorder.
Nausea and vomiting
Routes: PO, IV, im
Black Box warning:
Elderly Patients with Dementia-Related Psychosis
Pregnancy Category C
Contraindications
Patients with severe toxic central nervous system depression or comatose states from any cause.
Hypersensitivity to drug
Parkinson’s disease
Dementia
Side effects
Sedation
EPS
Tardive dyskinesia
Dystonia
Dizziness
Qt prolongation
Phenothiazines
Are centrally acting
Used for N/v related to:
Anesthesia
Severe vomiting
Intractable hiccoughs
Routes: Oral, Suppositories, IM, IV
Contraindications
Patients in comas or severe cns suppression
Severe Hypo/hypertension
Liver dysfunction
Severe renal impairment
Drugs
Prochlorperazine (Compazine)
Chlorpromazine (Thorazine)
Perphenazine (Trilafon)
Thiethylperazine maleate
Torecan (IM) or Norazine (PO or PR)
Adverse effects include:
Decreased CNS stimulation
Hypotension
Cardiac arrhythmias
Autonomic effects
Urine may become pink to red-brown in color
Endocrine effects
photosensitivity
Prochlorperazine (Compazine)
Piperaze phenothiazine
Indications: nausea and vomiting, schizophrenia, and non-psychotic anxiety
Routes: Oral, IV, IM, Rectal
Metabolized by the liver, excreted via urine
Side effects
Drowsiness
Hypotension
Extrapyramidal symptoms
Tardive dyskensia
Neuroleptic malignant syndrome
dystonia
Photophobia
Blurred vision
Contraindications:
Patients taking antipsychotic drugs
Children
H1 receptor antagonist
AKA: Anti-Histamines
Used for motion sickness, morning sickness; also allergies
Also have anticholinergic properties
Block muscarinic receptors
Drugs in Class:
Diphenhydramine
Meclizine
Promethazine
Doxylamine Succinate
Side effects:
drowsiness
Blurred vision
Dry mouth
Hypo/hypertension
Urinary retention
Corticosteroids
Cochrane report: Low-degree of evidence for treatment of N/V
Indication:
Used as an adjunct to treat CINV
Suppresses prostaglandin release from hypothalamus, which may then inhibit the subsequent process of nausea and vomiting
Anti-inflammatory
Drugs:
Dexamethasone (Decadron)
Prednisone (Deltasone)
Administer slowly
Side effects:
Insomnia
Anxiety
Acne
Hyperactivity
Cannabinoids
Have been used for centuries for a wide variety of ailments
Types:
CB-11receptors: GI tract
Cb-2 receptors: inflammatory and epithelial cells
Equal in efficacy to ondansetron
Drugs:
Drobabinol (Marinol)
Nabilone (Cesamet)
Side effects:
Sedation
Vertigo
Euphoria
Dry mouth
Tachycardia
Paranoid reactions
Dronabinol (Marinol)
Cannabnoids drug
Indications:
anorexia
CINV that has failed standard treatment
Appetite stimulant
Route: Oral
highly protein bound
Pregnancy Category C
caution:
elderly pts due to an increased risk of neuro-psychoactive effects
patients with a history of alcohol and/or substance abuse.
patients with underlying psychiatric disorders (i.e. mania, depression, or schizophrenia)
side effects:
mood changes
Euphoria
Depression
Insomnia
Psychosis (in extreme cases).
Olanzapine (Zprexa
Thienobenzodiazepine
Also an Antipsychotics
Indications:
Depressive Episodes related to Bipolar I
Treatment Resistant Depression
Acute agitation related to Schizophrenia and Bipolar I Mania
Nausea and vomiting
Routes: Po, im
Black box Warning:
Elderly Patients with Dementia-Related Psychosis
Contraindications:
Elderly patients with dementia-related psychosis
fluoxetine in combination
in combination with lithium or valproate
Labs: CBC, lipid profile
Pregnancy Category C
Side effects:
Hypotension
Weight gain
Suicide ideations
Neuroleptic Malignant syndrome
Sedation
Anxiolytics/benzodiazepines
Effects GABA neurotransmitter
Indication:
Typically used as an adjunct agent for acute or delayed N/V
Anticipatory N/V
CNS depressant, interferes with afferent nerves
Drugs:
Alprazolam (Xanax)
Dose/Route: 0.5 to 2 mg PO
Lorazepam (Ativan)
Dose/Routes: 0.5 to 2 mg PO, Sublingual, or IV
Side effects:
Drowsiness
Sedation
Confusion
Agitation
Dependence and withdrawal symptoms
Hallucinations
