Antiemetic and Antinausea Drugs

Question 1

Meclizine (Dramamine)

Chemical Classification

Answer 1

H1-receptor antagonist, piperazine derivative

Question 2

Meclizine (Dramamine)

Mechanism of Action

Answer 2

Acts centrally by blocking chemoreceptor trigger zone, which in turn acts on vomiting center

Question 3

Meclizine (Dramamine)

Uses

Answer 3

Vertigo, motion sickness

Question 4

Meclizine (Dramamine)

Contraindications

Answer 4

hypersensitivity to cyclizines, shock

Question 5

Meclizine (Dramamine)

Side Effect

Answer 5

CNS: Drowsiness, fatigue, restlessness, headache, insomnia
CV: hypotension
EENT: dry mouth, blurred vision
GI: nausea, anorexia, constipation, increased appetite
GU: urinary retention

Question 6

Meclizine (Dramamine)

Nursing Considerations

Answer 6

ASSESS:

• VERTIGO/MOTION SICKNESS: nausea, vomiting after 1hr; assess vertigo periodically
• Signs of toxicity of other products, masking of symptoms of disease: brain tumor, intestinal obstruction
• Observe for drowsiness, dizziness, level of consciousness

Question 7

Metoclopramide (Reglan)

Functional Classification

Answer 7

Cholinergic, antiemetic

Question 8

Metoclopramide (Reglan)

Chemical Classification

Answer 8

Central DOPamine receptor antagonist

Question 9

Metoclopramide (Reglan)

Mechanism of Action

Answer 9

Enhances response to acetylcholine of tissue in upper GI tract, which causes the contraction of gastric muscle; relaxes pyloric, duodenal segments; increases peristalsis without stimulating secretions; blocks dopamine in chemoreceptor trigger zone of CNS

Question 10

Metoclopramide (Reglan)

Uses

Answer 10

Prevention of nausea, vomiting induced by chemotherapy, radiation, delayed gastric emptying, gastroesophageal reflux

Question 11

Metoclopramide (Reglan)

Contraindications

Answer 11

Hypersensitivity to this product, procaine, or procainamide; seizure disorder, pheochromocytoma, breast cancer (Prolactin dependent), GI obstruction

Question 12

Metoclopramide (Reglan)

Side Effects

Answer 12

CNS: Sedation, Fatigue, Restlessness, Headache, Sleeplessness, Dystonia, dizziness, drowsiness, SUICIDAL IDEATION, SEIZURES, EPS, NEUROLEPTIC MALIGNANT SYNDROME; TARDIVE DYSKINESIA (>3MO, HIGH DOSES)
CV: hypotension, supraventricular tachycardia
GI: dry mouth, constipation, nausea, anorexia, vomiting, diarrhea
GU: decreased libido, prolactin secretion, amenorrhea, galactorrhea
HEMA: NEUTROPENIA, LEUKOPENIA, AGRANULOCYTOSIS
INTEG: urticaria, rash

Question 13

Metoclopramide (Reglan)

Nursing Considerations

Answer 13

ASSESS:

• EPS, tardive dyskinesia; more likely to occur in geriatric patients
• NEUROLEPTIC MALIGNANT SYNDROME: hyperthermia, change in BP, pulse, tachycardia, sweating, rigidity, altered consciousness
• Mental status: depression, anxiety, irritability
• GI complaints: nausea, vomiting, anorexia, constipation

Question 14

Ondansetron (Zofran)

Functional Classification

Answer 14

Antiemetic

Question 15

Ondansetron (Zofran)

Chemical Classification

Answer 15

5-HT3 receptor antagonist

Question 16

Ondansetron (Zofran)

Mechanism of Action

Answer 16

Prevents nausea, vomiting by blocking serotonin peripherally, centrally, and in the small intestine

Question 17

Ondansetron (Zofran)

Uses

Answer 17

Prevention of nausea, vomiting associated with cancer chemotherapy, radiotherapy; prevention of postoperative nausea, vomiting

Question 18

Ondansetron (Zofran)

Contraindications

Answer 18

Hypersensitivity; phenylketonuric hypersensitivity (oral disintegrating tab), torsades de pointes

Question 19

Ondansetron (Zofran)

Side Effects

Answer 19

CNS: Headache, Dizziness, Drowsiness, Fatigue, EPS
GI: Diarrhea, Constipation, abdominal pain, dry mouth
MISC: rash, BRONCHOSPASM (rare), Musculoskeletal Pain, Wound Problems, Shivering, Fever, Hypoxia, Urinary Retention

Question 20

Ondansetron (Zofran)

Nursing Considerations

Answer 20

ASSESS:

• Absence of nausea, vomiting during chemotherapy
• Hypersensitivity reaction: rash, bronchospasm (rare)
• EPS: shuffling gait, tremors, grimacing, rigidity periodically

Question 21

Prochlorperazine

Functional Classification

Answer 21

Antiemetic, antipsychotic

Question 22

Prochlorperazine

Chemical Classification

Answer 22

Phenothiazine, piperazine derivative

Question 23

Prochlorperazine

Mechanism of Action

Answer 23

Decreases dopamine neurotransmission by increasing dopamine turnover through the blockade of the D2 somatodendritic autoreceptor in the mesolimbic system

Question 24

Prochlorperazine

Uses

Answer 24

Nausea, Vomiting, Psychotic Disorders

Question 25

Prochlorperazine

Contraindications

Answer 25

Hypersensitivity to phenothiazines, coma; infants, neonates, children <2yr; surgery

Question 26

Prochlorperazine

Side Effects

Answer 26

CNS: NEUROLEPTIC MALIGNANT SYNDROME, Extrapyramidal Reactions, Tardive Dyskinesia, Euphoria, DEPRESSION, Drowsiness, restlessness, tremor, dizziness, headache
CV: CIRCULATORY FAILURE, TACHYCARDIA, hypotension, ECG changes
EENT: blurred vision
GI: nausea, vomiting, anorexia, dry mouth, diarrhea, constipation, weight loss, metallic taste, cramps
HEMA: AGRANULOCYTOSIS
MISC: impotence
RESP: RESPIRATORY DEPRESSION

Question 27

Prochlorperazine

Nursing Considerations

Answer 27

ASSESS:

• EPS: abnormal movement, tardive dyskinesia, akathisia
• VS, BP; check patients with cardiac disease more often
• NEUROLEPTIC MALIGNANT SYNDROME: seizures, hypo/hypertension, fever, tachycardia, dyspnea, fatigue, muscle stiffness, loss of bladder control; notify prescriber immediately
• CBC, LFTs during course of treatment; blood dyscrasias, hepatotoxicity may occur
• Respiratory status before, during, after administration of emetic; check rate, rhythm, character; respiratory depression can occur rapidly among geriatric or debilitated patients

Question 28

Meclizine (Dramamine)

Functional Classification

Answer 28

Antiemetic, antihistamine, anticholinergic