Antiemetic Drugs Flashcards by Shaquan Moore

▪Serotonin Receptor Antagonists

a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic
d. dronabinol (Marinol®)
e. scopolamine
f. meclizine (Antivert®), dimenhydrinate, hydroxyzine
g. Ginger
h. Doxylamine + Vitamin B6 (Pyridoxine)

a. ondansetron (Zofran®)

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▪Dopamine Antagonists

b. phenothiazines- promethazine, prochloperazine

c. Metoclopramide (also a prokinetic

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▪Cannabinoids

d. dronabinol (Marinol®)

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▪Anticholinergic Drugs

e. scopolamine

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▪Antihistamines

f. meclizine (Antivert®), dimenhydrinate, hydroxyzine

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▪Morning Sickness

f. meclizine (Antivert®), dimenhydrinate, hydroxyzine
g. Ginger
h. Doxylamine + Vitamin B6 (Pyridoxine)

g. Ginger

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▪ ? (also a prokinetic)

b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide

c. Metoclopramide

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Unpleasant feeling that often precedes vomiting

Nausea
Retching
Emesis (vomiting)

▪ Nausea

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Diaphragm, chest/abdominal wall contractions

Nausea
Retching
Emesis (vomiting)

▪ Retching

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Forcible emptying of gastric, and occasionally, intestinal
contents

Nausea
Retching
Emesis (vomiting)

▪ Emesis (vomiting)

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Which is three stages of Emesis

Nausea
Retching
Emesis (vomiting)
Hypertension

Nausea
Retching
Emesis (vomiting)

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USED TO TREAT
Chemotherapy induced N/V)
Post-Op
Radiation/anesthesia N/V
a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

a. ondansetron (Zofran®)

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ADVERSE EFFECTS
▪ QT prolongation-meaning risk for torsades de pointes (remember
this is an additive effect with other drugs)
a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

a. ondansetron (Zofran®)

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▪ QT prolongation
▪ Diarrhea
▪ Headache (fairly common!) and Dizziness!
a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

a. ondansetron (Zofran®)

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GIVE 1 HOUR PRIOR TO CHEMOTHERAPY!

a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

a. ondansetron (Zofran®)

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

a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

a. ondansetron (Zofran®)

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Ondastreton
Chemotherapy
PRE-MEDICATE!
? hour prior to start of chemotherapy
FOLLOW UP!
Give another round ? hours after chemotherapy
Give another round ? hours after chemotherapy

PRE-MEDICATE!
1 hour prior to start of chemotherapy
FOLLOW UP!
Give another round 4 hours after chemotherapy
Give another round 8 hours after chemotherapy

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MECHANISM OF ACTION:
1) Primary mechanism: antagonist
at D2 receptors in the brain (CTZ)
a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

b. phenothiazines- promethazine, prochloperazine

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ADVERSE EFFECTS
▪Extrapyramidal Symptoms (EPS)
a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

b. phenothiazines- promethazine, prochloperazine

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◦ BOXED WARNING: tissue injury- extravasation

a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

b. phenothiazines- promethazine, prochloperazine

c. Metoclopramide (also a prokinetic

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◦ BOXED WARNING: respiratory depression
resulting in death in pediatric patients (<2 years)
◦ Compounding effect with other meds, such as???
a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

b. phenothiazines- promethazine, prochloperazine

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Respiratory depression
resulting in death in pediatric patients (<2 years)
a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

b. phenothiazines- promethazine, prochloperazine

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Caution
◦ Benzos, Barbiturates, Booze (alcohol), Benadryl
a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

b. phenothiazines- promethazine, prochloperazine

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CNS sedation, avoid with other depressants

(opioids) and avoid in children
a. ondansetron (Zofran®)
b. phenothiazines- promethazine, prochloperazine
c. Metoclopramide (also a prokinetic

b. phenothiazines- promethazine, prochloperazine

``` Always DILUTE to avoid tissue damage (recommended as IVPB) a. ondansetron (Zofran®) b. phenothiazines- promethazine, prochloperazine c. Metoclopramide (also a prokinetic ```

b. phenothiazines- promethazine, prochloperazine

USED TO TREAT- "prokinetic" a. ondansetron (Zofran®) b. phenothiazines- promethazine, prochloperazine c. Metoclopramide (also a prokinetic

c. Metoclopramide (also a prokinetic

``` USED TO TREAT ◦ diabetic gastroparesis a. ondansetron (Zofran®) b. phenothiazines- promethazine, prochloperazine c. Metoclopramide (also a prokinetic ```

c. Metoclopramide (also a prokinetic

``` MECHANISM OF ACTION: blocks dopamine and enhances actions of acetylcholine a. ondansetron (Zofran®) b. phenothiazines- promethazine, prochloperazine c. Metoclopramide (also a prokinetic ```

c. Metoclopramide (also a prokinetic

``` BOXED WARNING ▪ Extrapyramidal Symptoms ▪ Specifically Tardive Dyskinesia a. ondansetron (Zofran®) b. phenothiazines- promethazine, prochloperazine c. Metoclopramide (also a prokinetic ```

c. Metoclopramide (also a prokinetic

``` BOXED WARNING ▪ Extrapyramidal Symptoms a. ondansetron (Zofran®) b. phenothiazines- promethazine, prochloperazine c. Metoclopramide (also a prokinetic ```

b. phenothiazines- promethazine, prochloperazine | c. Metoclopramide (also a prokinetic

``` ▪Not to be used in Bowel Obstruction, GI perforation/hemorrhage a. ondansetron (Zofran®) b. phenothiazines- promethazine, prochloperazine c. Metoclopramide (also a prokinetic ```

c. Metoclopramide (also a prokinetic

▪Cholinergic adverse effects- diarrhea a. ondansetron (Zofran®) b. phenothiazines- promethazine, prochloperazine c. Metoclopramide (also a prokinetic

c. Metoclopramide (also a prokinetic

``` USED TO TREAT ▪Nausea/Vomiting (CINV) ▪ appetite stimulant d. dronabinol (Marinol®) e. scopolamine f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

d. dronabinol (Marinol®)

``` USED TO TREAT- appetite stimulant (patients w/ AIDS and muscle wasting/anorexia) d. dronabinol (Marinol®) e. scopolamine f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

d. dronabinol (Marinol®)

``` ADVERSE EFFECTS- Sedation Tachycardia  euphoria, addictive?- SUD Mental changes/dysphoria  hallucinations d. dronabinol (Marinol®) e. scopolamine f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

d. dronabinol (Marinol®)

``` ADVERSE EFFECTS euphoria Tachycardia • Mental Status Changes d. dronabinol (Marinol®) e. scopolamine f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

d. dronabinol (Marinol®)

``` USED TO TREAT- ▪motion sickness ▪ Post op N/V ▪ Pre-op to decrease saliva d. dronabinol (Marinol®) e. scopolamine f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

e. scopolamine

USED TO TREAT- ▪motion sickness d. dronabinol (Marinol®) e. scopolamine

e. scopolamine

``` Contraindication- Narrow Angle Glaucoma d. dronabinol (Marinol®) e. scopolamine f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

e. scopolamine

``` ▪Metal in the patch-must remove patch prior to MRI d. dronabinol (Marinol®) e. scopolamine f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

e. scopolamine

``` Educate patients about sedation (avoid activities that require alertness) d. dronabinol (Marinol®) e. scopolamine f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

e. scopolamine

``` Educate patients about anticholinergic profile (constipation, xerostomia, mydriasis) d. dronabinol (Marinol®) e. scopolamine f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

e. scopolamine

e. scopolamine | Apply at least ? hours ? to travel or surgery

e. scopolamine | Apply at least 4 hours prior to travel or surgery

e. scopolamine Change patch every ? days, placed ? the ear

e. scopolamine Change patch every 3 days, placed behind the ear

General Patch Considerations - Dry/Hairless Part of Body - Wash with Soap and Water (not alcohol) - Rotate sites to prevent skin irritation if frequently using - Don’t cover patch - Patches can get wet

PATCHES MAY CONTAIN METAL- MRI RISK!

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

``` USED TO TREAT- ▪motion sickness ▪Vertigo ▪Nausea and vomiting f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

meclizine (Antivert®), dimenhydrinate, hydroxyzine

``` USED TO TREAT- ▪Vertigo f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

f. meclizine (Antivert®), dimenhydrinate, hydroxyzine

``` USED TO TREAT- ▪motion sickness f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

f. meclizine (Antivert®), dimenhydrinate, hydroxyzine

``` anticholinergic ◦ Brain ◦ Eyes ◦ Mouth ◦ GI Tract ◦ Bladder f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

f. meclizine (Antivert®), dimenhydrinate, hydroxyzine

USED TO TREAT nausea/vomiting associated with Pregnancy f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine)

h. Doxylamine + Vitamin B6 (Pyridoxine)

``` ADVERSE EFFECTS Typical antihistamine effects f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

h. Doxylamine + Vitamin B6 (Pyridoxine)

``` ADMINISTRATION TAKE SCHEDULED, NOT AS NEEDED f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

h. Doxylamine + Vitamin B6 (Pyridoxine)

``` USED TO TREAT Motion Sickness Morning Sickness f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine) ```

g. Ginger

ADVERSE EFFECTS Anorexia, nausea and vomiting, skin reactions f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine)

g. Ginger

NURSING CONSIDERATIONS May increase absorption of oral medications Increase bleeding risk with anticoagulants f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine)

g. Ginger

Morning Sickness f. meclizine (Antivert®), dimenhydrinate, hydroxyzine g. Ginger h. Doxylamine + Vitamin B6 (Pyridoxine)

g. Ginger