Antiemetics

Question 1

Patient is experiencing blurred vision after using ____ to prevent motion sickness while driving through the mountains. What drug did this patient most likely use?

Answer 1

Scopolamine

Question 2

Patient is planning on taking a bush plane down the Aleutian peninsula to King Cove, Alaska. The patient is worried about feeling nauseous while riding in the bush plane. What med might be helpful in preventing this patient’s motion sickness?

Answer 2

Scopolamine

Question 3

Fred begins experiencing involuntary muscle contractions after taking ______ for his motion sickness. What drug is the most likely cause?

Answer 3

Prochlorperazine

Dopamine Receptor Antagonists -> Phenothiazines -> Prochlorperazine

Question 4

Fred develops acute dystonia after taking prochlorperazine. What can be used to treat this adverse effect?

Answer 4

Diphenhydramine 25-50mg IV or IM

Question 5

Fred is 90 yrs old, he becomes hypotensive after receiving an IV drug infusion for his nausea. The drug that Fred was given is most likely a ____, a subclass of dopamine receptor antagonists.

Answer 5

Phenothiazines

Question 6

Fred is 90yrs old, is an alcoholic, has chronic Hep C, and has poorly controlled seizures. He now wants a medication for his motion sickness, what two drugs would you be cautious about prescribing?

Answer 6

Prochlorperazine & Promethazine

Question 7

Fred takes valium for his panic attacks, and is planning on taking a bush plane deep into the Alaskan wilderness and wants a medication for motion sickness. What two drugs would you be cautious about prescribing?

Answer 7

Prochlorperazine & Promethazine

Question 8

Fred has poorly controlled seizures and is planning on going deep sea fishing, and is worried about getting sea sick. What two drugs would you be cautious about prescribing?

Answer 8

Prochlorperazine & Promethazine

Question 9

Gretchen has developed involuntary lip smacking as a result of prolonged use of her antiemetic. However, Gretchen cannot remember the name of the antiemetic she has been taking. What two drugs might have caused Gretchen’s involuntary lip smacking?

Answer 9

Prochlorperazine & Promethazine

Question 10

Gretchen is depressed because she has cancer, and has now started taking Zoloft. She is prescribed an antiemetic for her chemotherapy induced nausea and vomiting. While taking her antiemetic she becomes agitated, restless, confused, develops a rapid heart rate and high blood pressure and her pupils are dilated. What class of antiemetic was this patient likely prescribed?

Answer 10

5-HT3 Receptor Antagonist

Gretchen has symptoms of serotonin syndrome, due to concomitant use of an SSRI & 5-HT3 Receptor Antagonist

Question 11

Phil was just prescribed Ondansetron for his chemotherapy induced nausea and vomiting, his provider tells him that the most common adverse effects include: _____, _____, & _____.

Answer 11

Headache, dizziness, and constipation.

Question 12

Fred is given Ondansetron for his nausea and vomiting following his total knee arthroplasty. However, despite the Ondansetron, Fred still feels nauseous, what other drug could Fred be given in addition to the Ondansetron?

Answer 12

Dexamethasone

Question 13

Ondansetron can be used to treat most cases of nausea and vomiting, EXCEPT it is NOT great at treating nausea secondary to: ____________________

Answer 13

Vestibular system etiology (Vertigo)

Question 14

Phil has migraines with associated headache and nausea, what two drugs could his provider consider prescribing?

Answer 14

Metoclopramide or Prochlorperazine

Question 15

Gretchen has vertigo with associated nausea what two classes of antiemetic could her provider recommend?

Answer 15

Antihistamine

1. Diphenhydramine
2. Cylizine
3. Dimenhydrinate
4. Meclizine

Anticholinergics
1. Scopolamine

Question 16

Fred has gastroenteritis, what is the first-line agent to treat this condition? What is the second-line agent?

Answer 16

First-line: Dopamine antagonists

1. Prochlorperazine (Compazine)
2. Promethazine (Phenergan)
3. Metachlopramide (Reglan)
4. Trimethobenzamide (Tigan)

Second-line: Serotonin antagonists

1. Ondansetron (Zofran)
2. Granisetron (Kytril)
3. Dolasetron (Anzemet)
4. Palonosetron (Aloxi)

Question 17

Gretchen has pregnancy induced nausea, what might her provider recommend as treatment?

Answer 17

Ginger, vitamin B6

Question 18

Gretchen has hyperemesis gravidarum, what could her provider prescribe for her? First-line? Second-line?

Answer 18

First-line: Promethazine

Second-line: Serotonin antagonists and corticosteroids

Question 19

Gretchen has hyperemesis gravidarum, and severe liver dysfunction from biliary atresia, what might her provider prescribe for her?

Answer 19

Ondansetron (+/-) dexamethasone

Serotonin antagonist and corticosteroid

Question 20

Fred has a history of postoperative nausea and vomiting, he is now undergoing a right total knee arthroplasty, what can Fred’s provider give him to prevent his postoperative nausea and vomiting?

Answer 20

Serotonin antagonists, dexamethasone

Question 21

Fred is currently experiencing postoperative nausea and vomiting following an ORIF of his right humerus fx, what might Fred’s provider prescribe to treat his N&V?

Answer 21

Ondansetron (+/-) dexamethasone

Serotonin antagonist and corticosteroid