Lecture 68 Flashcards
NV (Scott)
symptoms associated with NV
pallor
tachycardia
diaphoresis
etiology of NV
GI disorders (most notable, flu)
CNS disorders (anxiety, tumors, HA)
pain (acute or chronic)
excessive intake of anything
pregnancy
treatment induced
drug induced
treatment induced NV
cancer chemotherapy
radiation therapy (CNS and abdominal)
anesthesia (around 30%)
procedures (especially abdominal)
drug induced
main - anti-neoplastic agents
others - opioids, aspirins, NSAIDs, iron, some antibiotics (tetracycline, erythromycin), estrogen, anti-parkinson meds, SSRIs
Nonpharm treatment of NV
- determine the cause and put the gut to rest through clear liquid diet, IV hydration
- dietary
- physical
dietary treatment
avoid fatty, fried, sweet, and spicy foods
eat food that is cold or at room temp
physical treatment of IV
avoid unpleasant sights, sounds, and odors that may aggravate the NV
fresh air
avoid sudden movements
dim lights
acupressure - 3 fingers above the wrist
pharm treatments of NV
antihistamines, anticholinergics
phenothiazines
serotonin antagonists
NK1 antagonists
other
antihistamines treatment of NV
drugs - meclizine, dimenhydramine, scopolamine
mechanism - block histamine and/or muscarinic receptors in the CTZ and NTS centers
SE - drowsiness, sedation, dry mouth, constipation, blurred vision
phenothiazines treatment of NV
drugs - prochlorperazine, promethazine, chlorpromazine
mechanism - dopamine inhibition at CTZ
SE - dizziness, sedation, dry mouth, hypotension, EPS
serotonin antagonist treatment of NV
drugs - ondansetron, granisetron, palonosetron, dolasetron
mechanism - serotonin inhibition at CTZ, VC, and GI tract
SE - mild headache, dizziness, fatigue, constipation, recent concern about QT prolongation
ondansetron pros
multiple dosage forms including ODT
generic and low cost
under 10 per treatment course
granisetron pros
multiple dosage forms including patch and injection
generic and lower cost
under 10 per treatment course
palonosetron pros/cons
pros - longest duration of action (40hours)
cons - brand only; expensive; no oral dosage form
dolasetron pros/cons
pros - mouth only
cons - expensive
NK1 antagonist
drugs - aprepitant, fosaprepitant, rolapitant
mechanism - neurokin receptor inhibition
USE - primarily CINV
SE - fatigue hiccups, constipation, decreased appeptite
other options for NV treatment
butyrophenone (haloperidol, droperidol)
metoclopramide
corticosteroids (dexamethasone)
cannabinoids
metoclopramide in NV
dopamine inhibition and at high doses, serotonin inhibitions
give with benadryl due to EPS at high dose
haloperidol, droperidol
BBW - EKG abnormalities so rarely used in treatment of NV
corticosteroids (dexamethasone) in treatment of NV
inhibition of cortical input into vomiting center
enhances the efficacy of other anti-emetics
cannabinoids treatment in NV
SE of sedation, dry mouth, euphoria, dysphoria, facial flushing, visual changes
motion sicknessNK
prevention based
drugs - scopolamine (72h), dimehydrinate, meclizine
take 30-60 minutes before needed usually
treatment of CINV
NK1 antagonists
treatment of gastroenteritis or pain induced NV
treat the symptoms while treating the cause
drugs - ondansetron, promethazine
