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Antiemetic Drugs Flashcards

1
Q 
Serotonin Receptor Antagonists?
Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

ondansetron

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2
Q 
Dopamine Antagonists
Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

phenothiazines- promethazine, prochloperazine

Metoclopramide (also a prokinetic)

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3
Q 
Cannabinoids?
Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

dronabinol

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4
Q 
Anticholinergic Drugs?
Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Scopolamine

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5
Q 
Antihistamines?
Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

meclizine (Antivert®), dimenhydrinate, hydroxyzine

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6
Q 
Herbal?
Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Ginger

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7
Q 
Morning Sickness
Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Doxylamine + Vitamin B6 (Pyridoxine)

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8
Q 
Substance P/Neurokinin 1 Antagonist:?
Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Aprepitant

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9
Q 
EXTRA
Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Lorazepam, dexamethasone

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10
Q

Anti-emeticsTHREE MAIN STAGES OF EMESIS

Nausea, Refraction, Retching, Emesis (vomiting), Hemophrage.

A

Nausea
Retching
Emesis (vomiting)

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11
Q

Forcible emptying of gastric, and occasionally, intestinal contents

Retching, Emesis (vomiting), Nausea

A

Emesis (vomiting)

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12
Q

Diaphragm, chest/abdominal wall contractions

Retching, Emesis (vomiting), Nausea

A

Retching

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13
Q

Unpleasant feeling that often precedes vomiting

Retching, Emesis (vomiting), Nausea

A

Nausea

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14
Q

Treat:
CINV (chemotherapy induced N/V)
Post-Op N/V
radiation/anesthesia N/V

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Serotonin Receptor Antagonists- Ondansetron

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15
Q

MECHANISM OF ACTION
antagonist at serotonin/5-HT3 receptors located in the CTZ as well as in the G.I. tract.

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Serotonin Receptor Antagonists- Ondansetron

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16
Q

ADVERSE EFFECTS
Headache (sort of the opposite of our “triptans”
Otherwise, pretty mild- diarrhea, dizziness

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Serotonin Receptor Antagonists- Ondansetron

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17
Q

Headache (sort of the opposite of our “triptans”
Otherwise, pretty mild- diarrhea, dizziness

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Serotonin Receptor Antagonists- Ondansetron

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18
Q

Nursing Considerations
EKG in patients with history of cardiac issues

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Serotonin Receptor Antagonists- Ondansetron

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19
Q

Also, make sure to give early (premed) for exposure (such as for chemo or for surgery)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Serotonin Receptor Antagonists- Ondansetron

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20
Q

Administration
GIVE 1 HOUR PRIOR TO CHEMOTHERAPY

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Serotonin Receptor Antagonists- Ondansetron

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21
Q

!SLOW IV INFUSION- Remember the QT risk

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Serotonin Receptor Antagonists- Ondansetron

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22
Q

Treat:
Surgery
Toxins
CINV

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Dopamine Antagonists:Phenothiazines> Promethazine, Prochlorperazine

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23
Q

MECHANISM OF ACTION

1) antagonist at D2 receptors in the brain (CTZ)
2) Antagonism at H1 receptors and M1receptors

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Dopamine Antagonists:Phenothiazines> Promethazine, Prochlorperazine

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24
Q

ADVERSE EFFECTS
extrapyramidal symptoms
anticholinergic properties
drowsiness

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Dopamine Antagonists:Phenothiazines> Promethazine, Prochlorperazine

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25
Q

BOXED WARNING
respiratory depression (pediatrics especially)
tissue injury

Dopamine Antagonists:
Phenothiazines
Promethazine
Prochlorperazine

A

Dopamine Antagonists:

PROMETHAZINE

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26
Q

Narrow Therapeutic Index

Dopamine Antagonists:
Phenothiazines
Promethazine
Prochlorperazine

A

Dopamine Antagonists:

PROMETHAZINE

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27
Q

? Injection Dangers- gangrene

Dopamine Antagonists:
Phenothiazines
Promethazine
Prochlorperazine

A

Dopamine Antagonists:

PROMETHAZINE

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28
Q

Nursing Considerations
Dilute the drug prior to administration (IVPB)
Monitor for S/S of EPS
Monitor for respiratory depression

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Dopamine Antagonists:Phenothiazines> Promethazine, Prochlorperazine

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29
Q

Administration
GIVE 1 HOUR PRIOR TO CHEMOTHERAPY!
MEDICATION MUST BE DILUTED! (Normal Saline is a default diluent for most medications)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Dopamine Antagonists:Phenothiazines> Promethazine, Prochlorperazine

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30
Q

Treat:
diabetic gastroparesis
N/V- CINV, Post-Op
off label- hiccups

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

PROKINETIC/Dopamine Antagonists: Metoclopramide

31
Q

Treat:
PROKINETIC

Aprepitant
Metoclopramide 
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

PROKINETIC/Dopamine Antagonists: Metoclopramide

32
Q

MECHANISM OF ACTION
Blocks dopamine receptors in the CTZ, when doses are increased, also blocks 5-HT3receptors

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

PROKINETIC/Dopamine Antagonists: Metoclopramide

33
Q

ADVERSE EFFECTS
Diarrhea/ Abdominal Cramping

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

PROKINETIC/Dopamine Antagonists: Metoclopramide

34
Q

CONTRA-IDNICATION: Not to be used in Bowel Obstruction, GI perforation/hemorrhage

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

PROKINETIC/Dopamine Antagonists: Metoclopramide

35
Q 
BOXED WARNING
Tardive Dyskinesia ( a sub type of EPS)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

PROKINETIC/Dopamine Antagonists: Metoclopramide

36
Q

Nursing Considerations
Assess for any bowel obstructions

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

PROKINETIC/Dopamine Antagonists: Metoclopramide

37
Q

Treat:
Nausea/Vomiting (CINV)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Cannabinoids: Dronabinol

38
Q

Appetite stimulant (patients w/ AIDS and muscle wasting/anorexia)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Cannabinoids: Dronabinol

39
Q

MECHANISM OF ACTION
Agonist at cannabinoid receptors in the brain (CB1 and CB2

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Cannabinoids: Dronabinol

40
Q 
ADVERSE EFFECTS
Sedation
Tachycardia
euphoria, addictive?- SUD
Mental changes/dysphoria 
hallucinations

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Cannabinoids: Dronabinol

41
Q

Nursing Considerations
Not recommended in hx of mental health disorders

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Cannabinoids: Dronabinol

42
Q

Not recommended in cardiac disorder

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Cannabinoids: Dronabinol

43
Q

Treat:
motion sickness
Post op N/V

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

44
Q

Pre-op to decrease saliva

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

45
Q

MECHANISM OF ACTION
Block ACh receptors in the vestibular nuclei and reticular formation

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

46
Q

ADVERSE EFFECTS
Our usual Anticholinergic

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

47
Q

Contraindication- Narrow Angle Glaucoma

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

48
Q

Metal in the patch-must remove patch prior to MRI

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

49
Q

Nursing Considerations
Educate patients about sedation (avoid activities that require alertness)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

50
Q

Educate patients about anticholinergic profile (constipation, xerostomia, mydriasis)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

51
Q

Apply at least 4 hours prior to travel or surgery
Change patch every 3 days, placed behind the ear

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

52
Q

General Patch Considerations

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Anticholinergics:Scopolamine

53
Q

Anticholinergics:Scopolamine
General Patch Considerations

Dry/Hairless Part of Body
Wet/Hairless Part of Body
Wash with Soap, Water and Alcohol
Wash with Soap and Water (not alcohol)
Rotate sites to prevent skin irritation if frequently using
A

Dry/Hairless Part of Body
Wash with Soap and Water (not alcohol)
Rotate sites to prevent skin irritation if frequently using

54
Q

Anticholinergics:Scopolamine
General Patch Considerations

You can cover Patch
Don’t cover patch
Don’t get patch wet (don’t bathe/shower with patch)
Get patch wet (bathe/shower with patch)
PATCHES MAY CONTAIN METAL- MRI RISK!Any other patches you remember?- Fentanyl- flush them!

A

Don’t cover patch
Don’t get patch wet (don’t bathe/shower with patch)
PATCHES MAY CONTAIN METAL- MRI RISK!Any other patches you remember?- Fentanyl- flush them!

55
Q

General Patch Considerations

PATCHES MAY CONTAIN METAL- ? RISK!

56
Q

General Patch Considerations

Any other patches you remember?- Fentanyl- flush them!

57
Q

Anticholinergics:Scopolamine

Administration
Apply at least ? hours prior to event (some recommend ? before!)
Behind the ?

A

4 Hours
night
ear

58
Q

Treat:
Motion sickness
Vertigo
Nausea and vomiting

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamines: Meclizine, hydroxyzine, dimenhydrinate

59
Q

MECHANISM OF ACTION
Block H1 receptors from the inner ear to the vomiting center, also has anticholinergic properties

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamines: Meclizine, hydroxyzine, dimenhydrinate

60
Q

ADVERSE EFFECTS
Sedation◦No driving
Avoid the B’s (benzos, barbiturates, booze, opioids, Benadryl)
Anticholinergic

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamines: Meclizine, hydroxyzine, dimenhydrinate

61
Q

Avoid the B’s (benzos, barbiturates, booze, opioids, Benadryl)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamines: Meclizine, hydroxyzine, dimenhydrinate

62
Q

Nursing Considerations
Educate patients about sedation (avoid activities that require alertness)
Educate patients about anticholinergic profile (constipation, xerostomia)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamines: Meclizine, hydroxyzine, dimenhydrinate

63
Q

Cautious with other CNS sedating agents◦No alcohol, benzos, opioids etc.!

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamines: Meclizine, hydroxyzine, dimenhydrinate

64
Q

PRE-MEDICATE

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamines: Meclizine, hydroxyzine, dimenhydrinate

65
Q

Treat:
Motion Sickness Morning Sickness

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
66
Q

ADVERSE EFFECTS
Anorexia, nausea and vomiting, skin reactions

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
67
Q

Nursing Considerations
May increase absorption of oral medications
Increase bleeding risk with anticoagulants (WARFARIN!)

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
68
Q

Treat:
nausea/vomiting associated with Pregnancy

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamine + Water soluble Vitamin Diclegis®Doxylamine + Vitamin B6 (Pyridoxine)

69
Q

ADVERSE EFFECTS
Typical antihistamine effects

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamine + Water soluble Vitamin Diclegis®Doxylamine + Vitamin B6 (Pyridoxine)

70
Q

Administration
TAKE SCHEDULED, NOT AS NEEDED

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Antihistamine + Water soluble Vitamin Diclegis®Doxylamine + Vitamin B6 (Pyridoxine)

71
Q

Treat
For CIN
anticipatory nausea

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Benzodiazepines- ◦Lorazepam◦

72
Q

For CINV-

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Glucocorticoids Dexamethasone and Methylprednisolone

73
Q

Treat
Used exclusively for Operative/ Chemotherapy induced Nausea

Aprepitant
Metoclopramide (also a prokinetic)
dronabinol 
Ginger
Scopolamine
phenothiazines- promethazine, prochloperazine
meclizine (Antivert®), dimenhydrinate, hydroxyzine
Doxylamine + Vitamin B6 (Pyridoxine)
ondansetron 
Lorazepam, dexamethasone
A

Substance P/ Neurokinin Antagonist◦Aprepitant

Phamacology (13 decks)

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