Antiemetics

Question 1

tumor in CNS or Meninges

Answer 1

Cortical
sx: neuro signs
Tx: Dexamethasone, radiation therapy

Question 2

increased intracranial pressure

Answer 2

Cortical
sx: projectile vomiting, headache
Tx: Dexamethasone

Question 3

Anxiety

Answer 3

Cortical
sx: anticipatory nausea, predictable vomiting
tx: counseling, benzos (lorazepam)

Question 4

Vestibular disease

Answer 4

tx: meclizine 25mg PO BID

Question 5

middle ear infection

Answer 5

Sx: ear pain, bulging TM
Tx: antibiotics and or decongestant

Question 6

motion sickness

Answer 6

tx: scopolamine 1.5mg patch q3d
Dimenhydrinate 50-100 q4h

Question 7

Common Medications that cause nausea

Answer 7

opioids, digoxin, chemo, antibiotics, theophylline

Question 8

Hyponatremia

Answer 8

sx: confusion
tx: fluid restriction, demeclocyline

Question 9

Metabolic

Answer 9

Renal or liver failure, tumor products
tx: haloperidol 0.5-1mg po/sc q4h prn

Question 10

hypercalcemia

Answer 10

somnolence, delirium
tx: hydration, pamidronate, dexamethasone

Question 11

incomplete obstruction

Answer 11

tx metaclopramide

Question 12

tumor infiltration, radiation therapy to GI tract or infection

Answer 12

promethazine, hydroxyzine, zofran

Question 13

Metoclopramide

Answer 13

Dopamine block and 5HT3 receptor antagonist at higher doses
PO: 0.1mg-0.15mg/kg/dose (5-15mg in adults) (sc/iv = po)
use: gi stasis
SE: dystonia (reverse with diphenhydramine)

Question 14

Hydroxyzine

Answer 14

antihistamine
use: vestibular and gut receptor nausea
PO: 0.5mg/kg q4h, max 600
Not good for SC or IV
SE: constipation and anticholinergic

Question 15

Diphenhydramine

Answer 15

antihistamine
use: vestibular and gut receptor nausea
1mg/kg/dose q4h (sc/iv=po)
SE: constipation and anticholinergic

Question 16

Promethazine

Answer 16

antihistamine
25mg q4h (IM/PO = PR)
Not good for IV
SE: dystonia** constipation and anticholinergic

Question 17

haloperidol

Answer 17

Dopamine antagonists
Use: medication and metabolic caused n/v
SE: dystonia, postural hypotension, QTc prolongation
Good for SC
0.5-1.5mg q6-12h with max 5mg BID (SC/IV = 1/2 PO)

Question 18

Chlorpromazine

Answer 18

Dopamine antagonists
Use: medication and metabolic caused n/v
SE: VERY sedating** dystonia, postural hypotension, QTc prolongation
NO SC
10-25mg q8h (IV=PO)

Question 19

Prochlorperazine

Answer 19

Dopamine antagonists
Use: medication and metabolic caused n/v
SE: dystonia, postural hypotension, QTc prolongation
0.2mg/kg q4h
NO SC

Question 20

Olanzapine

Answer 20

Dopamine antagonists (plus others)
Use: medication and metabolic caused n/v
SE: SOMNOLENCE and WT GAIN dystonia, postural hypotension, QTc prolongation

Question 21

Ondansetron

Answer 21

Serotonin antagonist
Use: Chemo induced**, postoperative and radiation induced
SE: HA, dizziness, arrhythmias, nervousness, constipation
4-8mg q6h PO (PO=IV)

Question 22

Granisetron

Answer 22

Serotonin antagonist
Use: Chemo induced** n/v
PO: 1mg q12h adults
0.04mg/kg/dose in kids>2yo
IV: 0.01mg/k q8h

Question 23

Aprepitant

Answer 23

NK1 receptor antagonists
Use: delayed chemo induced n/v
125mg on day 1 then 80mg daily (only PO)

Question 24

Diazepam

Answer 24

Benzodiazepine
Use: anticipatory nausea
0.05mg/kg-0.2mg/kg/dose q6h (PO/PR)
Kids <5yo max dose 5, >5yo max dose 10mg

Question 25

Lorazepam

Answer 25

Benzo
Use: anticipatory nausea
Shorter half life, no active metabolites
0.5-1mg (max 4mg/dose)
IV=PO/SL

Question 26

Dexamethasone

Answer 26

Steroid
Use: hepatic capsular distention, anorexia, increased intracranial pressure
6-10mg loading, then 2-4mg 1-4times daily (IM/IV =PO)

Question 27

Prednisone

Answer 27

1.5mg dex=10mg pred

Question 28

Dronabinol

Answer 28

Cannabinoids
Use: Chemo induced n/v
2.5mg 2-4 times daily (max 20mg/d)
SE: confusion, ataxia

Question 29

Scopolamine

Answer 29

Anticholinergic
Use: motion or movement related n/v
good SC
SE: dry mouth, blurred vision, confusion, sedation

Question 30

Anticholinergic receptors

Answer 30

Location: Mechano and chemoreceptors, higher cortical centers
Meds:

Question 31

opioid induced n/v

Answer 31

Dopamine antagonist (haldol, chlorpromazine, prochlorperazine)
Ondansetron

Question 32

electrolyte imbalances

Answer 32

Dopamine antagonist (haldol, chlorpromazine, prochlorperazine)

Question 33

GERD

Answer 33

H2 blocker
PPI

Question 34

Small bowel obstruction

Answer 34

Dexamethasone
octreotide
metoclopramide (if partial)
H2 blocker (famotidine)

Question 35

GVHD

Answer 35

Dopamine antagonist
ondansetron
octreotide

Question 36

Tx for dystonic reactions

Answer 36

benztropine or diphenhydramine
Benzo
Stop the med or reduce dose

Question 37

Tx for parkinsonism

Answer 37

reduce or stop med
Benztropine or diphenhydramine
Amantadine

Question 38

Tx for akathisia

Answer 38

Reduce or stop med
add beta blocker (propranolol)
NOT anticholinergics

Question 39

Acute chemo induced nausea

Answer 39

w/in 24h (usually 1-2 hr with peak at 4-6h)
Tx: antiserotonergics (ondansetron, granisetron)

Question 40

Delayed chemo induced nausea

Answer 40

After 24hr (peak w/in 48-72h and subsides in 2-3 days)
Agents: cisplatin, carboplatin, cyclophosphamide other anthracyclines
Tx: Antineurokinins (aprepitant) + serotonin inhibitor + dexamethasone

Question 41

Anticipatory chemo nausea

Answer 41

conditioned response
Best to prevent with aggressive treatment
Tx: CBT, benzo
?peppermint oil, ginger

Question 42

Dopamine antagonist

Answer 42

Haldol
Chlorpromazine
Prochlorperizine
Olanzapine