Antiemetic Agents

Question 1

Lifespan considerations for
Antiemetic Agents
In Children

Answer 1

• Ingestion of toxic substances: Call healthcare provider or poison control center
• Higher risk of adverse effects: fluid and electrolyte imbalances

Question 2

Lifespan considerations for
Antiemetic Agents
In Adults

Answer 2

• CNS effects can interfere with daily activities
• Safety not established in pregnancy or lactation

Question 3

Lifespan considerations for
Antiemetic Agents
In Older Adults

Answer 3

• Institute safety measures for adverse effects
• Renal and hepatic impairment
• Start low, go slow

Question 4

Phenothiazines
Mechanism of Action

Answer 4

• 🧠 Depresses various areas of the Central Nervous System

Question 5

Phenothiazines
Indications

Answer 5

Nausea and Vomiting

Question 6

Phenothiazines
Contraindications

Answer 6

Absolute:
* Allergy

Relative:
* CNS depression: coma, brain injury or damage
* Severe HYPO or HYPERtension
* Severe liver dysfunction

Caution:
* Renal dysfuntion
* Moderate liver impairment
* Active peptic ulcer

Question 7

Phenothiazines
Drug Interactions

Answer 7

Other CNS depressants
Including alcohol

Question 8

Phenothiazines
Adverse Effects

Answer 8

Serious:
* Neuroleptic Malignant Syndrome (rare): can be fatal, muscle stiffness, high fever, tachycardia, diaphoresis
* Extrapyramidal symptoms (EPS): abnormal movements in the body including tardive dyskinesia (abnormal movements in face and mouth)

More common:
🧠 CNS: Drowsiness, dizziness, weakness, dry mouth
💓 CV: hypotension, dysrhythmias
Endocrine: Menstrual disorders, gynecomastia
Other: Photosensitivity; pink to reddish brown urine color (non-worrisome finding)

Question 9

NONphenothiazines
Mechanism of Action

Answer 9

Acts to reduce the responsiveness of the nerve cells in the Chemoreceptor Trigger Zone (CTZ) to circulating chemicals that induce vomiting

Question 10

NONphenothiazines
Indication

Answer 10

Nausea and vomiting

Question 11

NONphenothiazines
Drug Name

Answer 11

Metoclopramide (Reglan)

(Also a gastrointestinal stimulant)

Question 12

NONphenothiazines
Adverse Effects

Answer 12

💩 GI: Nausea, vomiting, diarrhea, intestinal spasms, cramping
💓 CV: ⬇️ decreased blood pressure and ⬇️ heart rate
🧠 CNS: Extrapyramidal effects, weakness, fatigue

Question 13

NONphenothiazine
Contraindications

Answer 13

Absolute:
* Allergy

Relative:
* GI obstruction

Caution:
* History of tardive dyskinesia
* History of seizures

Question 14

NONphenothiazines
Drug Interactions

Answer 14

• Alcohol (increased sedative effect)
• Antipsychotics (inc. risk of extrapyramidal effects)

Question 15

5-HT3 Receptor Blockers
Mechanism of Action

Answer 15

• Blocks specific receptor sites associated with N&V, peripherally, and in the CTZ

Question 16

5-HT3 Receptor Blockers
Indications

Answer 16

Nausea & Vomiting

Question 17

5-HT3 Receptor Blockers
Drug Names

Answer 17

“-setron”
* Granisetron
* Ondansetron (Zofran)
* Palonosetron

Question 18

5-HT3 Receptor Blockers
Contraindication

Answer 18

Absolute:
* Allergy

Question 19

5-HT3 Receptor Blockers
Adverse Effects

Answer 19

🧠 CNS: Headache, dizziness, myalgia (muscle pain)
💩 GI: constipation

Question 20

5-HT3 Receptor Blockers
Drug Interactions

Answer 20

Other Serotonin Receptor Blockers
(Increases Serotonin Syndrome Risk)

Question 21

Substance P/Neurokinin 1 Receptor Antagonists
Mechanism of Action

Answer 21

Acts directly in the 🧠 CNS to block receptors associated with nausea & vomiting

Question 22

Substance P/Neurokinin 1 Receptor Antagonists
Indications

Answer 22

Nausea and Vomiting due to chemotherapy

Newer drug to market for N&V

Question 23

Substance P/Neurokinin 1 Receptor Antagonists
Drug Names

Answer 23

“-pitant”
* Aprepitant
* Rolapitant
* Fosaprepitant

Question 24

Substance P/Neurokinin 1 Receptor Antagonists
Contraindication

Answer 24

Absolute:
* Allergy

Question 25

Substance P/Neurokinin 1 Receptor Antagonists
Adverse Effects

Answer 25

🧠 CNS: Headache, fatigue
💩 GI: Diarrhea or constipation, nausea, anorexia
🩸 Blood: Neutropenia, anemia, leukopenia

Question 26

Cannabinoids
Indications

Answer 26

• Nausea & Vomiting in chemotherapy
• Stimulate the appetite for pts with AIDS

Question 27

Cannabinoids
Drug Names and Action

Answer 27

• Dronabinol
• Nabilone

Contain the active ingredient of cannabis

Question 28

Antihistamines as Antiemetics
Drug Names

Answer 28

• Meclizine (Dramamine)
• Hydroxyzine

Question 29

Antihistamines as Antiemetics
Indications

Answer 29

• Nausea & Vomiting
• Motion Sickness

Question 30

Antihistamines as Antiemetics
Action

Answer 30

Block histamine and muscarinic receptors

Question 31

Scopolamine
Info to know

Answer 31

• Anticholinergic
• Indication: N&V due to motion sickness
• Adverse Effects: sedation, and anticholinergic effects

Question 32

Antiemetic Agents
Assessment

Answer 32

History:
* Allergy, pregnancy, lactation
* Impaired renal or hepatic function
* Underlying neuro conditions or active peptic ulcer

Physical:
* CNS: orientation, affect, and reflexes
* Cardiac: baseline pulse and BP
* Abdominal: bowel sounds and emesis (color, frequency, amount)
* Skin: any rashes or lesions

Labs:
* Liver function
* Kidney function

Question 33

Antiemetic Agents
Nursing Conclusions

Answer 33

• Impaired comfort (r/t adverse effects)
• Injury Risk (r/t CNS effects)
• Altered cardiac output (r/t CV effects)
• Knowledge Deficit

Question 34

Antiemetic Agents
Implementation/Patient Teaching

Answer 34

• Assure route of admin. is appropriate (IV or rectal for major vomiting)
• Prevention vs treatment
• Provide other measures to help pt cope with discomfort of nausea & vomiting
• Readily available emesis basin
• Ice chips
• ginger ale