Anti-emetic Medications Flashcards
1
Q
What is nausea? Hint: 3
A
1) The conscious recognition of the imminent need to vomit
2) May or may not result in vomiting
3) Mediated by ANS
2
Q
What is retching/ dry heaves? Hint: 2
A
1) Rhythmic & spasmodic movement involving diaphragm & abdominal muscles
2) Controlled by the respiratory center in the brainstem
3
Q
What is vomiting?
A
Forceful expulsion of gastric contents through the mouth
4
Q
List 16 causes of N/V
A
1) Surgery
2) Infection
3) Constipation
4) Malnutrition
5) Cancer
6) Immunosuppression
7) MI
8) Motion sickness
9) Depression
10) Pregnancy
11) Radiation therapy
12) Bowel obstruction
13) Concomitant meds
14) Fluid & electrolyte imbalances
15) Liver failure
16) Certain meds
5
Q
List 4 medications that can cause N/V
A
1) Chemotherapy
2) Abx
3) Oral hypoglycemics
4) Oral contraceptives
6
Q
What does the medulla in the brain contain?
A
Contains vomiting center (VC), activated by CTZ, cerebral cortex, afferent vagal & visceral nerves, & vestibulocellular apparatus
7
Q
List 9 neuroreceptors found in the chemoreceptor trigger zone, VC, vestibular centers, & GI tract
A
1) Corticosteroid
2) Dopamine-2
3) Neurokinin-1
4) Acetylcholine
5) Histamine
6) Opioid
7) Muscarinic
8) Cannabinoid
9) Serotonin (5-HT3)
8
Q
List 5 steps of the vomiting reflex
A
1) Relaxation of lower esophageal sphincter
2) Contraction of diaphragm & abd muscles
3) Autonomic changes
4) Epiglottis closes
5) Expulsion of food
9
Q
List 12 consequences of un- or undertreated N/V
A
1) Decreased quality of life
2) Non-compliance/ refusal to complete Tx plan
3) Dehydration
4) Electrolyte imbalances
5) Decreased self care
6) Decreased function
7) Nutritional deficits
8) Taste changes
9) Decrease performance status
10) Esophageal tears
11) Weight loss
12) Anorexia
10
Q
Explain acute chemo-induced N/V (CINV) Hint: 2
A
1) Occurs within min to hrs after chemo admin
2) Depends upon type, dose, route, & schedule
11
Q
List 5 risk factors of acute CINV
A
1) Gender
2) Age
3) Stage of disease
4) Alcohol use
5) Co-morbidities
12
Q
Explain anticipatory CINV
A
Pt thinks they will get it, so they do
13
Q
Explain delayed CINV Hint: 2
A
1) Occurs at least 24 hrs following chemo admin
2) Acute N/V increases risk
14
Q
List 3 other risk factors of delayed CINV
A
1) High dose chemo
2) Certain agents
3) Poorly controlled N/V
15
Q
Explain breakthrough CINV Hint: 2
A
1) Occurs despite standard Tx
2) Requires further intervention
16
Q
Explain refractory CINV
A
Unrelieved N/V despite standard & breakthrough Tx
17
Q
List 6 types of Anti-emetics
A
1) Anticholinergics
2) Antihistamines
3) Neurolytics
4) Prokinetics
5) 5 HT3
6) Adjunct meds
18
Q
List 7 routes of administration for anti-emetics
A
1) Oral
2) Sublingual
3) Rectal
4) IV
5) IM
6) SQ
7) Transdermal
19
Q
How do anticholinergics work?
A
Block acetylcholine at the muscarinic receptors
20
Q
What else can anticholinergics help treat?
A
Motion sickness
21
Q
List 5 side effects of anticholinergics
A
1) Dry mouth
2) Urinary retention
3) Blurred vision
4) Exacerbation of narrow-angle glaucoma
5) Skin irritation
22
Q
List 2 types of anticholinergics
A
1) Scopolamine (Transderm scop)
2) Dicyclomine (Bentyl)
23
Q
When should anticholinergic patch be removed?
A
Before an MRI
24
Q
Where are serotonin receptors (5-HT3 type) located?
A
Present both peripherally & centrally
25
List 3 Indications for giving 5-HT3 antagonists
1) Chemotherapy
2) Radiation therapy
3) Post-op N/V
26
Where are 5-HT3 (serotonin) antagonists metabolized & excreted?
In the liver & excreted in urine
27
Suffix for 5-HT3 (serotonin) antagonists
"setron"
28
List 4 medications considered 5-HT3 (serotonin) antagonists
1) Odansetron (zofran)
2) Granisetron (kytril)
3) Dolasetron (anzemet)
4) Palonosetron (aloxi)
29
List 5 side effects of 5-HT3 (serotonin) antagonists
1) H/A
2) Diarrhea
3) Fever
4) Hypotension
5) QT prolongation
30
Where does ondansetron (zofran) block serotonin?
Chemoreceptor trigger zone (CTZ)
31
List 4 routes of admin for Ondansetron
1) PO
2) Sublingual
3) IV
4) IM
32
Ondansetron dosing
4 mg or 8 mg
33
What pregnancy category is Ondansetron?
Cetgory B
34
Ondansetron is contraindicated in pts taking _____
Anticonvulsants
35
Ondansetron should be used with caution in what pts?
Those with hepatic & renal impairment (lowest dose)
36
List 4 side effects of Ondansetron
1) H/A
2) Diarrhea
3) Constipation
4) Fatigue
37
List 3 subtypes of dopamine 2 antagonists
1) Piperaze phenothiazine/ antipsychotics (prochlorperazine)
2) Metoclopramide (Reglan)
3) Butyrophenone derivative/ antipsychotic (Droperidol & haloperidol (Haldol)
38
List 3 indications for giving dopamine 2 antagonists
1) Motion sickness
2) Chemo induced N/V (CINV)
3) Post-op N/V
39
What 2 other properties do dopamine 2 antagonists have?
1) Antihistamine
2) Anticholinergic
40
What line therapy are dopamine 2 antagonists
Second-line
41
List 2 other drugs considered dopamine 2 antagonists
1) Promethazine (Phenergan)
2) Trimethobenazamide (Tigan)
42
Dopamine 2 antagonist Metoclopramide can also be considered a ________
NOn-Phenothiazine
43
List 3 indications for giving Metoclopramide
1) GERD
2) Diabetic gastroparesis
3) N/V
44
List 3 routes of admin for metocloprmaide
1) Oral
2) IV
3) IM
45
Black box warning for Metoclopramide
May cause tardive dyskinesia
46
What pregnancy category is Metoclopramide
Category B
47
List 4 contraindications of Metoclopramide
1) Bowel obstruction
2) GI bleeding
3) Pheochromocytoma
4) Epileptics
48
List 5 side effects of Metoclopramide
1) Restlessness
2) Drowsiness
3) Extrapyramidal Sx (EPS)
4) Neuroleptic malignant syndrome (NMS)
5) Suicide ideations
49
What medication is a Butyrophenone derivative?
Haloperidol (Haldol)
50
List 3 indications for giving Haloperidol
1) Schizophrenia
2) Control of tics & vocal utterances of tourette's disorder
3) N/V
51
List 3 routes of admin for Haloperidol
1) Oral
2) IV
3) IM
52
Black box warning of Haloperidol
Elderly pts with dementia related psychosis
53
What pregnancy category is Haloperidol?
Category C
54
List 4 contraindications to giving Haloperidol
1) Pts w severe toxic CNS depression or comatose states from any cause
2) Hypersensitivity to drug
3) Parkinsons
4) Dementia
55
List 6 side effects of Haloperidol
1) Sedations
2) EPS
3) Tardive dyskinesia
4) Dystonia
5) Dizziness
6) QT prolongation
56
What Anti-emetic meds are centrally acting?
Phenotiazines
57
Phenothiazines are used for N/V related to what 3 things
1) Anesthesia
2) Severe vomiting
3) Intractable hiccoughs
58
List 4 routes of admin for phenothiazines
1) Oral
2) Suppositories
3) IM
4) IV
59
List 4 contraindications of giving Phenothiazines
1) Pts in comas or severe CNS suppression
2) Severe hypo/ HTN
3) Liver dysfunction
4) Severe renal impairment
60
List 4 drugs considered phenothiazines
1) **Prochlorperazine (Compazine)**
2) Chlorpromazine (thorazine)
3) Perphenazine (Trilafon)
4) Thiethylperazine maleate (Torecan: IM; Norazine; PO/ PR)
61
List 7 adverse effects of phenothiazines
1) Decreased CNS stimulation
2) Hypotension
3) Cardiac arrhythmias
4) Autonomic effects
5) Urine may become pink to red-brown
6) Endocrine effects
7) Photosensitivity
62
Prochlorperazine (Compazine)
Piperaze Phenothiazine
63
List 4 indications for giving Prochlorperazine
1) N/V
2) Schizophrenia
3) Non-psychotic anxiety
4) Morning sickness
64
List 4 routes of admin for Prochlorperazine
1) Oral
2) IV
3) IM
4) Rectal
65
How is Prochlorperazine metabolized & excreted?
Metabolized in liver & excreted via urine
66
List 8 side effects of Prochlorperazine
1) Drowsiness
2) Hypotension
3) Extrapyramidal Sx
4) TArdive dyskinesia
5) Neuroleptic malignant syndrome
6) Dystonia
7) Phototobia
8) Blurred vision
67
List 2 contraindications of giving Prochlorperazine
1) Pts taking antipsychotic drugs
2) Children
68
H1 receptor antagonists aka ____
Anti-histamines
69
List 3 indications for giving H1 receptor antagonists
1) Motion sickness
2) Morning sickness
3) Allergies
70
What other properties do H1 receptor antagonists have?
Anticholinergic properties
71
What do H1 receptor antagonists block?
Muscarinic receptors
72
List 4 medications considered H1 receptor antagonists
1) Diphenhydramine
2) Meclizine
3) Promethazine
4) Doxylamine succinate
73
List 5 side effects of H1 receptor antagonists
1) Drowsiness
2) Blurred vision
3) Dry mouth
4) Hypo/ HTN
5) Urinary retention
74
Indication for giving corticosteroids
Used as adjunct to Tx CINV
75
How do corticosteroids work?
Suppresses prostaglandin release from hypothalamus, which may inhibit the subsequent process of N/V
76
What type of properties do corticosteroids have?
Anti-inflammatory properties
77
List 2 drugs considered corticosteroids
1) Dexamethasone (Decadron)
2) Prednisone (Deltasone)
78
How should corticosteroids be administered?
Slowly
79
List 4 side effects of corticosteroids
1) Insomnia
2) Anxiety
3) Acne
4) Hyperactivity
80
List 2 types of cannabinoids
1) CB-1 receptors: GI tract
2) CB-2 receptors: inflammatory & epithelial cells
81
Efficacy of cannabinoids is equal to what other anti-emetic?
Ondansteron
82
List 2 drugs considered cannabinoids
1) Drobabinol (Marinol)
2) Nabilone (Cesamet)
83
List 6 side effects of cannabinoids
1) Sedation
2) Vertigo
3) Euphoria
4) Dry mouth
5) Tachycardia
6) Paranoid reactions
84
List 3 indications for giving Dronabinol (Marinol)
1) Anorexia
2) CINV that has failed standard Tx
3) Appetite stimulant
85
Route of admin for Dronabinol
Oral
86
Dosing for Dronabinol
2.5, 5. or 10 mg
87
What Cannabinoid medication is highly protein bound & considered pregnancy category C?
Dronabinol (Marinol)
88
List 3 types of pts Dronabinol should be used with caution in
1) Elderly pts due to increased risk of neuro-psychoactive effects
2) Pts w HX of alcohol, &/or substance abuse
3) Pts w underlying psychiatric disorders (i.e. mania, depression, schizophrenia)
89
List 5 side effects of Dronabinol
1) Mood changes
2) Euphoria
3) Depression
4) Insomnia
5) Psychosis (in extreme cases)
90
What is Olanzapine (Zyprexa) considered?
**Thienobenzodiazepine**
Also an antipsychotic
91
List 4 indications for giving Olanzapine
1) Depressive episodes r/t to bipolar I
2) Tx resistant depression
3) Acute agitation r/t schizophrenia & bipolar I mania
4) N/V
92
List 2 routes of admin for Olanzapine
1) Oral
2) IM
93
Black box warning for Olanzapine
Elderly pts w dementia-related psychosis
94
List 3 contraindications for giving Olanzapine
1) elderly pts w dementia related psychosis
2) Fluoxetine in combo
3) In combo w lithium or valproate
95
List 3 labs to monitor for pt taking Olanzapine
1) CBC
2) Glucose
3) Lipid profile
96
What pregnancy category is Olanzapine considered?
Category C
97
List 5 side effects of Olanzapine
1) Hypotension
2) Weight gain
3) Suicide ideations
4) Neuroleptic malignant syndrome
5) Sedation
98
What neurotransmitters do anxiolytics/ benzodiazepines affect?
GABA neurotransmitters
99
List 2 indications for giving anxiolytics/ benzos
1) Typically used as adjunct agent for acute/ delayed N/V
2) Anticipatory N/V
100
What are anxiolytics/ benzos considered?
CNS depressants, interfere w afferent nerves
101
LISt 2 drugs considered anxiolytics/ benzos
1) Alprazolam (xanax)
2) Lorazepam (ativan)
102
Dose & route of Alprazolam (xanax)
0.5 to 2 mg PO
103
Dose & route of Lorazepam (ativan)
0.5 to 2 mg PO, sublingual, or IV
104
List 6 side effects of anxiolytics/ benzos
1) Drowsiness
2) Sedation
3) Confusion
4) Agitation
5) Dependence & withdrawal Sx
6) Hallucinations
105
Neurokinin-1 antagonists (NK-1) also inhibit what?
Substance P
106
Indication to give NK-1s
Prevent & Tx acute & delayed nausea associated w highly emetogenic chemo
107
LISt 2 routes of admin for NK-1s
1) Oral
2) IV
108
True or False:
NK-1s can be given in combo with other anti-emetics
TRUE
109
NK-1s are inducer of what?
CYP 450 system
110
LISt 3 drugs considered NK-1s
1) **Aprepitant (emend)**
2) Fosaprepitant dimeglumine (emend)
3) Rolapitant (Varubi)
111
List 6 side effects of NK-1s
1) Diarrhea
2) Constipation
3) Gastritis
4) Anorexia
5) H/A
6) Fatigue
112
Route & dose of Aprepitant (emend)
Route: IV
Dose: 150 mg
113
What anti-emetic crosses BBB?
Aprepitant (Emend)
114
Where is Aprepitant metabolized & excreted?
Metabolized in liver & excreted via urine & feces
115
List 4 drug interactions of Aprepitant
1) Pimozide
2) Warfarin
3) Oral contraceptives
4) Corticosteroids
116
List 4 side effects of Aprepitant
1) Liver enzyme elevation
2) Dehydration
3) Hiccups
4) Steven-johnson
117
Miscellaneous meds:
Other drugs used to control N/V
Scopolamine (Anticholinergic)
118
Miscellaneous meds:
Herbal & vitamin supps
1) Ginger
2) Pyridoxine (Vit. B6)
119
Miscellaneous meds:
Meds used to augment anti-emetics **Hint: 3**
1) Diphenhydramine (Benadryl)
2) Lorazepam
3) Megestrol acetate (Megace)
120
Anti-emetics used across the life span:
Pediatrics **Hint: 2**
1) Should be used w caution
2) Increase risk for adverse effects
121
Anti-emetics used across the life span:
Adults **Hint: 2**
1) Frequently used for surgery & chemo
2) Pregnancy & lactation has not be studied; & many can enter breast milk
122
Anti-emetics used across the life span:
Older adults **Hint: 2**
1) More likely to experience an adverse effect from drugs
2) Issue of hepatic &/or renal impairment
123
List 2 things to monitor for pts taking anti-emetics
1) Weight
2) Hydration status
124
List 4 labs to monitor for pts taking anti-emetics
1) Serum electrolytes
2) Creatinine
3) LFTs
4) I & O
125
Extrapyramidal symptoms (EPS) are primarily manifested as
Acute dystonic reactions
126
Dsytonic reactions may include **Hint: 4**
1) Sudden onset of muscular spasms (head & neck) or opisthotonos
2) Other EPS include: laryngospasm, dysphagia, oculogyric crisis
3) Involuntary spasms of tongue & mouth may lead to diff speaking & swallowing
4) May also include: akathisia, restlessness, akinesia, other Parkinson-like Sx (i.e. tremors)
127
List 3 Tx options for extrapyramidal Sx
1) Depends on severity of Sx
2) Reduce or discontinue drug
3) Anticholinergic drugs can be used to Tx acute dystonic reactions
128
When may emetics be given?
Cases of overdosing or poisoning
129
How do emetics work?
Induce vomiting
130
List an example of emetic
Ipecac
131
What should nurses assess/ identify for when giving anti-emetics?
Factors contributing to Sx of N/V
132
Nursing focused assessment when giving anti-emetics should include **Hint: 5**
1) Skin
2) Cardiac
3) I & O
4) Lab studies
5) Signs/ Sx of dehydration
133
What should nurses monitor for in pts receiving anticholinergics?
Side effects
134
List 3 pt educations points for anti-emetic use
1) Drink plenty of fluids
2) Small frequent meals
3) Avoid strong smells
135
Evaluation of effectiveness of anti-emetics **Hint: 3**
1) Did Sx improve
2) Good urine output
3) Able to tolerate food
136
Question 1:
When planning administration of antiemetic medications to a client, the nurse is aware that combination therapy is preferred because of which drug effect?
A) It is easier to achieve the desired level of sedation
B) There are faster drug absorption & distribution
C) Different vomiting pathways are blocked
D) The risk of constipation is decreased
C) Different vomiting pathways are blocked
**Rationale:**
Combining antiemetic drugs from various categories allows the blocking of the vomiting center and chemoreceptor trigger zone (CTZ) through different pathways, thus enhancing the antiemetic effect
137
Question 2:
A patient is receiving an anticholinergic drug to treat their nausea and vomiting. The nurse should Instruct to patient to expect which adverse effect?
A) Lacrimation
B) Dry mouth
C) Diarrhea
D) Bradycardia
B) Dry mouth
**Rationale:**
Anticholinergic drugs block the PNS, which causes the body to "rest and digest." Blocking of these effects leads to constipation, urinary retention, and decreased secretions (dry mouth).
138
Question 3:
Which drug works by blocking serotonin receptors in the GI tract, vomiting center, and CTZ?
A) Meclizine (Antivert)
B) Metoclopramide (Reglan)
C) Ondansetron (Zofran)
D) Droperidol (Inapsine)
C) Ondansetron (Zofran)
**Rationale:**
Ondansetron is a serotonin blocker. Metoclopramide is a prokinetic drug. Meclizine is an antihistamine. Droperidol is an antidopaminergic drug.
