Antiemetics Flashcards
name the antiemetics (8)
- bismuth subsalicylate (salicylate)
- diphenhydramine (antihistamine)
- promethazine (antihistamine, anticholinergic, dopamine antagonist)
- scopolamine (anticholinergic)
- ondansetron (serotonin antagonist)
- Benzodiazepines (-pam/-lam)
- dexamethasone (Glucocorticoid)
- dronabinol (Cannabinoid)
- methylprednisolone (Glucocorticoid)
bismuth subsalicylate route (1.5)
PO - liquid or chewable tablet
bismuth subsalicylate MOA (3)
- adsorbs bacteria/toxins that are causing nausea
- diarrhea/indigestion
- decreases absorption of other drugs
bismuth subsalicylate nursing (3)
- avoid taking other drugs
- avoid if under 19 years old = will cause Reye’s syndrome
- avoid if allergic reaction to ASA or NSAIDs (aspirin has the salicylate in it just like this drug)
bismuth subsalicylate side effects (6)
- slurred speech
- hearing loss
- vision problems
- AMS
- muscle spasm
- harmless and temporary black discoloration of stools/tongue
bismuth subsalicylate contraindications (1)
pregnancy (teratogenic: fetal malformation)
causes of the vomiting center stimulated by visceral and the NTs
visceral: nose, mouth, stomach, intestine stimulation
- odor, smell, taste
- food intolerance
- pregnancy
- infection
- pain
NTs:
- dopamine
- serotonin
causes of the vomiting center stimulated by CTZ and the NTs
- drugs
- toxins like opioids, chemo, anesthesia
NTs:
- dopamine
- serotonin
causes of the vomiting center stimulated by vestibular nerve and CNS and the NTs
- inner ear disease
- motion sickness
- ear infection/inflammation
NTs:
- histamine
- Ach
vomiting will result in / nursing
- loss of fluid/electrolytes => monitor I/O & replace - metabolic alkalosis => monitor ABG and correct - aspiration => treat nausea & prevent vomiting - esophageal ulcer => treat nausea & prevent vomiting
non-pharm measures to treat vomiting
- flat ginger ale
- weak tea
- gelatin, crackers/saltines, toast
- acupressure
- Pedialyte (for children) or Gatorade (for adults) or IVF (for all)
- vitamin B6 (motion sickness and morning sickness)
- NG tube and intermittent suctioning (decompression)
bismuth subsalicylate OTC or Rx?
OTC, this is the brand name pepto-bismal
diphenhydramine routes (3)
- PO
- IM
- IV
diphenhydramine and promethazine MOA (1)
inhibit vestibular stimulation in the inner ear
diphenhydramine indication (2)
- nausea
2. motion-sickness
diphenhydramine side effects (2)
- crossing the BBB: drowsiness, dizziness, fatigue, disturbed coordination, FALL
- –> 2nd use: insomnia, motion sickness - anticholinergic effects (SCARY BEAR)
promethazine routes (2)
- PO
- IV BUT it is a vesicant so only in an intact central line
promethazine and scopolamine indication (4)
- nausea
- motion-sickness
- Meniere’s Disease
- allergies
me, mine, Meniere’s Disease
diphenhydramine and promethazine nursing (2 w/ things to monitor)
- Anticholinergic effects
- Monitor VS (see code phrases)
- Monitor I/Os (urinary retention)
- Avoid with BPH, urinary retention, glaucoma, HTN, tachycardia
-
CNS depression
- Assess breath sounds (CNS depression => respiratory depression)
- avoid driving or operating dangerous machinery (FALL)
- Avoid other CNS depressants (ETOH, codeine)
- Hangover effect (residual drowsiness effect)
diphenhydramine and promethazine contraindications
- pregnancy
- lactation
- newborns
- children
scopolamine routes (4)
- transdermal patch
- PO
- IM
- IV
scopolamine and promethazine MOA (1)
inhibit vestibular stimulation in the inner ear
scopolamine and promethazine side effects
- CNS depressant: drowsiness!
- memory impairment:
- caution w/ older adults
- chronic resp diseases
promethazine (dopamine antagonist) MOA (1)
block dopaminergic receptors in the intestine and CTZ