Antiemetic Agents Flashcards
What is vomiting?
Complex reflex reaction to various stimuli. Sometimes vomiting is wanted such as in cases of food poisoning. However there are some cases where the reflex reaction of vomiting is not beneficial.
What are the most common complaints regarding a patient being uncomfortable.
Nausea and vomiting
Name an example where it is productive to vomit
Food poisoning.
When do we taken agents to prevent vomiting?
When the reflex rejection is not beneficial.
What does Emetics do?
Cause vomiting, however they are no longer recommended for at home poison control because the fluid could get into the lung and the vomiting could harm the trachea, esophagus and mucous membrane. May be used in rare emergency situations.
What does Antiemetics do?
Decrease or prevent nausea and vomiting.
Centrally or locally acting.
Varying degrees of effectiveness.
What should a parent do if they suspect that their child have ingested something that is toxic/poisonous?
Call their healthcare provider or poison control and wait for instructions which will depend on what the child ingested.
Are Antiemetic used in children?
Yes, but there should be heightened caution due to increased risk of CNS effects as well as fluid and electrolyte imbalances.
Emetics are rarely used anymore when suspected poisoning, instead syrup of ipecac may be used - we still want parents to call poison control of healthcare provider first!
What should we remember is Adults are taking Antiemetic agents?
They could have a CNS effect which makes safety a concern, and so performing daily activities may put them in risk of injury.
Safety has not been established in pregnancy and lactation so benefit have to outweigh risk when taken.
Have safety regarding Antiemetic Agents been established in pregnancy/lactation?
No, should only be used when benefit outweighs the risk.
what adverse effects are older people most likely to experience when taking antiemetic agents?
Confusion, dizziness, Fluid imbalance and cardiac effects. Safety measures are critical.
Patients with hepatic or renal impairment should start on a lower dose then adjust accordingly.
Is it recommended to give children syrup of ipecac to children?
Its advised to call the healthcare provider or poison control before giving the child anything.
What does Phenothiazines do?
This is an antipsychotic drug but it also depress various areas of the central nervous system so it can be taken for nausea and vomiting as well. It does this by decreasing the responsiveness of the chemoreceptor trigger sone in the medulla to stimuli.
What are the 3 drug classes we need to remember for the drug category Phenothiazines?
“-azine”
Prochlorperazine
Perphenazine
Chlorpromazine
Why would we give Prochlorperazine?
For Nausea and vomiting. Prochlorperazine is a Phenothiazine.
What are the contraindications when considering prescribing Phenothiazines to a patient?
CNS depression: coma, brain damage or injury - this drug may make these conditions worse.
Severe hypotension or hypertension
Severe liver dysfunction - alter metabolism of the drug
What should we be cautious of when prescribing Chlorpromazine to a patient?
Renal dysfunction
Moderate liver impairment
Active peptic ulcer
Chlorpromazine is a Phenothiazine.
What are the Drug-Drug interactions with Phenothiazines?
Other CNS depressants incl Alcohol.
What other drug class is Phenothiazines also a part of?
Antipsychotics
What type of antipsychotic is Phenothiazines?
1st generation antipsychotic
What are the most serious adverse effects of Chlorpromazine?
Side effects are higher the longer the drug is used.
Chlorpromazine is a Phenothiazines (1st generation antipsychotic) and have a lot of adverse effects. The most serious side effects are :
* Neuroleptic Malignant Syndrome : Muscle stiffness, high fever, tachycardia and diaphoresis. ( No treatment)
- Extrapyramidal symptoms/effects: Abnormal movement of the body - includes tardive dyskinesia
Abnormal movement of face and mouth.
What are the more common side effects of Prochlorperazine?
Prochlorperazine is a Phenothiazine and most common side effects are
CNS - Drowsiness, dizziness, weakness and dry mouth
Cardiac - Hypotension and Dysrhythmias
Endocrine - Menstrual disorders and Gynecomastia
Other - Photosensitivity (skin and eyes sensitive to the sun) and pink to reddish brown urine.
What is the drug we need to know for the drug category Nonphenothiazines?
Metoclopramide
What does Metoclopramide do?
Block dopamine receptors affecting the chemo trigger zone. Works on the parasympathetic system as well by increasing the movement of food through the GI system.
It is also a part of the drug category ‘GI stimulants’
Metoclopramide is a Nonphenothiazined
Why would we give Metoclopramide?
For nausea and vomiting associated with chemotherapy as well as post-operative nausea and vomiting.
What are two common side effects of Metoclopramide?
Fatigue and Weakness
What are the drug classes we need to know for the drug category 5-HT3 Receptor Blockers (Serotonin Receptor Blockers) and the suffixes.
“setron”
Granisetron
Palonosetron
Ondansetron - most common.
What does Ondansetron do?
Blocks specific receptor sites associated with nausea and vomiting, peripherally and in the CTZ (Chemoreceptor trigger zone in the medulla)
What are the adverse effects of Palonosetron?
Palonosetron is a 5-HT3 Receptor Blocker and the most common adverse effects are related to the CNS. Dizziness, Myalgia, Constipation and headaches.
What are the drug drug interactions with Granisetron?
Granisetron is a 5-HT3 Receptor Blocker and would interact with any other serotonin receptor blocker because this can increase the risk of serotonin syndrome/toxicity.
What drug classes and suffixes do we need to remember for the drug category Substance P/Neurokinin 1
Receptor Antagonists ?
“pitant”
Aprepitant
Rolapitant
Fosaprepitant
What does Aprepitant do?
Aprepitant is a Substance P/Neurokinin 1 Receptor Antagonists and act directly in the CNS to block receptors associated with nausea and vomiting.
Who do we give Rolapitant to ?
Rolapitant is a Substance P/Neurokinin 1 Receptor Antagonists and is given for nausea and vomiting to patients who are undergoing chemotherapy.
What are the drug-drug interactions to Fosaprepitant?
Fosaprepitant is a Substance P/Neurokinin 1 Receptor Antagonists and may have an adverse reaction when given with other medications such as Warfarin and Hormonal contraceptives.
It decreases warfarin levels and decreases effectiveness in the hormonal contraceptive.
What are the adverse effects of Aprepitant?
Aprepitant is a Substance P/Neurokinin 1 Receptor Antagonists
CNS - Headache and Fatigue
GI - Diarrhea or Constipation, Nausea and Anorexia
Blood - Neutropenia (decrease in neutrophil count) , Amenia (Decrease in red blood cell count), Leukopenia (Decrease in WBC count)
What are the Miscellaneous Agents that we need to know in the Antiemetic Agents category?
Cannabinoids
Antihistamines
Scopolamine
What do we need to know about Cannabinoids?
Drug classes : Dronabinol & Nabilone
Contain active ingredients of cannabis
Given for nausea and vomiting in chemotherapy and stimulate appetite for patients with AIDS
Miscellaneous Agent
What do we need to know about Antihistamines?
Drug classes: Hydroxyzine & Meclizine
Blocks histamine and muscarinic receptors.
Given for nausea, vomiting and motion sickness
Miscellaneous Agent
What do we need to know about Scopolamine
Drug class : Anticholinergic
Given for Nausea and vomiting due to motion sickness
Adverse effects include sedation and anticholinergic effects
Miscellaneous Agent
What would be the nursing assessment for all drug classes when looking at history?
Allergy, Pregnancy/lactation.
Impaired renal or hepatic function
Underlying neuro conditions (especially CNS conditions) or active peptic ulcer.
What physical nursing assessment would you do for all drug classes?
CNS: Baseline neuro exam assessing for orientation, affect and reflexes
Cardiac: baseline pulse and blood pressure
Abdominal: including bowel sounds and emesis ( note color, amount and frequency of vomiting episodes so that we can tell if there is an improvement after drugs are given)
Skin: any rashes or lesions
What Labs would you do for all drug classes?
Liver function and Kidney function
What would be the nursing conclusion for all drug classes?
Impaired comfort related to adverse effects
Injury risk related to the CNS effect
Altered cardiac output related to the cardiac effect
Knowledge deficit related to drug regimen
What implementations would you do for all drug classes?
Assure that the route of administration is appropriate for each patients to make sure they get the effectiveness that they need and to decrease adverse effects ex. if patient is vomiting they should take the drug orally.
Prevention vs treatment
Provide other measures to help the patient cope with the discomfort of nausea and vomiting and drug effects - make sure they’re close to the bathroom, have an emesis basin, giving them ice chips.
Patient teaching- avoid CNS depressant incl alcohol. When to notify provider or noticing side effects.
What is special about some of the pills in this category regarding how they’re designed for patients that are vomiting?
Some dissolve under the tongue to try to decrease the vomiting reflex.
What is a prophylactic administration?
When you foresee that the there might be a triggering effect happening in the patients body and you tailor the administration of the drug to that reaction. For example giving the drugs prior to chemotherapy.
Which drug is better for treating nausea and vomiting: ondansetron or prochlorperazine?
Ondansetron have fewer adverse reactions. Prochlorperazine have many adverse reactions due to being a 1st generation antipsychotic.
A nurse is teaching first aid to members of a community. Two participants state that they keep a supply of syrup of ipecac at home in case one of their children is accidentally poisoned. What instruction should the nurse provide?
Before using syrup of ipecac it is important to call poison control or your provider to ensure that this is the best way of action. Syrup of ipecac is rarely used anymore, however always check with poison control first.
What is Neuroleptic Malignant Syndrome and what drug may make this worse?
Neuroleptic malignant syndrome is a rare but life-threatening reaction that can occur in response to antipsychotic medications. Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fast heart rate. May be caused by Phenothiazine use.
Which antiemetic drug class may exacerbate or cause extrapyramidal symptoms?
Phenothiazines
Which other drug category does Metoclopramide belong to?
Gastrointestinal stimulants
Which drug is used to treat vomiting associated with chemotherapy?
Metoclopramide
A 57-year-old client is to receive metoclopramide for nausea. What statement by the client leads the nurse to believe that the client has understood the nurse’s teaching regarding the possible adverse reactions?
“I may experience fatigue and weakness as a side effect when taking this medication.”
Why do we need to be careful with taking Odansetron with other drug that affect serotonin levels?
It may lead to serotonin syndrome.
Which Antiemetic drug category has an effect on the blood?
Substance P/Neurokinin 1 Receptor Antagonists
Which two drug classes are used to increase the appetite for AIDS patients and which drug category do they fall under?
Dronabinol & Nabilone which are both Cannabinoids.
