MCP Nausea & Vomiting

Question 1

What Causes N/V

Answer 1

• Birth Control
• Pain Med
• Vitamins
• Anesthesia
• Chemotherapy
  
  • classified by emetogenic potential
• Problem with stomach/intestines
  
  • Gasteroparesis
  • Intestinal blockage
• GERD
• Gastroenteritis
• Pregnancy
• Migraines
• Alcohol

Question 2

N/V: When to Refer

Answer 2

• Severe or persistant
• Chest or belly pain
• Signs of GI bleed
• Fever >101
• Severe headache/stiff neck
• Dizziness

Question 3

Signs of Dehydration

Answer 3

• thirst/dry mouth
• not needing to urinate for more than 5 hours or urine that is dark yellow
• Fatique
• Muscle cramps
• Confusion

Question 4

N/V nonpharmcologic

Answer 4

• Drink lots of fluids if possible
• Eat
  
  • liquid-rich food, Jello and popsicles
  • Soft, bland foods
  • Food that are high in carbs
  • Ginger or peppermint
  • Avoid fatty food
• Avoid strong smell
• Tkae meds with meals

Question 5

Approach to Management

Answer 5

• Persistant N/V
  
  • Find cause
• Consequence found and corrects
  
  • Hypokalemia, fluid depletion
• Targeted therapy should be provided when possible
  
  • surgery for bowel obstruction
• Symptoms should be managed with meds

Question 6

5-HT3 Receptor Antagonist: Name, MOA, Indication, Onset, Duration

Answer 6

• Ondansetron (Zofran)
• MOA
  
  • anatgonist of serotonin subtype 3
  • peripherally on vagal neve terminalis
  • Centrally in the chemoreceptor trigger zone
• Indications
  
  • Prevention of n/v associated with chemo and radiation
  • prevent treatment of post operative
  • Hyperemisis gravidarum (last resort)
  • acute gastroenteritis in children
• Onset
  
  • 30 min
• Duration
  
  • 8-12 hours

Question 7

Ondansetron: Administration of oral dosage forms

Answer 7

• 30 min prior to chemo
• 1-2 hour before radiation
• 1 hour prior to anesthesia

Question 8

Ondansteron: Admin of ODT

Answer 8

• Do not remove from blister until needed
• Peel backing off the blister do not push tablet through
• Use dry hands, place tablet on tongue and allow to dissolve
• Swallow with saliva

Question 9

Ondansteron: Admin Oral Soluable Film

Answer 9

• Do not remove from pouch until needed
• Use dry hands and place on tongue and allow to dissolve
• swallow with or without liquid
• if using more than one film, each film should be allowed to dissolve completely before administering next

Question 10

Ondansteron: SE, Cations

Answer 10

• SE:
  
  • Headache, fatigue, constipation
  • Dose-dependent QT prolongation
  • <1% abnormal hepatic function, anaphylaxis, angioedema
    
    • use caution in patients allergic to other 5-HT3 receptor antagonists
• ​Cautions:
  
  • Hepatic Impairment
  • Long QT syndrome: use caution in patients with congential long QT syndrom or other risk factors for QT prolongation
    
    • meds known to prolong QT interval
    • electrolute abnormalities (hypokalemia or hypmagnesemia)