Motion Sickness Flashcards
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Nausea
the uncomfortable, queasy feeling that one may vomit.
Treatment for Nausea:
(CTZ) chemoreceptor trigger zone in the CNS contains receptors for _________ and _________ and ________.
Each receptor can set off a chemical pathway leading to nausea and vomiting. Blocking the receptors reduces nausea.
dopamine (DA)
serotonin (5-HT)
acetylcholine (Ach)
Vertigo
- dizziness with sensation that the environment is moving or spinning.
Vertigo is typically an inner-ear condition that affects balance.
Treatment for Vertigo:
vestibular (inner-ear) suppressants
antihistamines (meclizine, dimenhydrinate)
benzodiazepines
____________ are not useful for vertigo because they do not affect the inner ear.
5HT-3 receptor antagonists.
Motion Sickness:
Treatment-
- dizziness, with a sensation of being off-balance and woozy due to repetitive motions, such as boat moving over waves or an airplane flying in turbulent weather.
Treatment_ anticholinergics (scopolamine) and antihistamines (meclizine)
motion sickness also called _________
kinetosis
Non-drug treatment for motion sickness:
- some patients find benefit with the wrist band that presses on an acupuncture point located on the inside of the wrist, about the length of 2 fingernails up the arm from the center of the wrist crease. One popular brand is Sea-Band.
Natural Supplements for motion sickness:
- Ginger in teas or supplements is used commonly for nausea
- peppermint may also be helpful
Drug Treatment for Motion Sickness:
Antihistamines AND anticholinergics are recommended for motion sickness.
Antihistamines used for motion sickness include:
cyclizine (Marezine)
diphenhydramine (Benadryl)
dimenhydrinate (Dramamine)
meclizine (Bonine, Dramamine All Day Less Drowsy)
- all antihistamines have anticholinergic effects similar to scopolamine. Oral agents must be taken 30-60 minutes prior to the needed effect.
dimenhydrinate, meclizine, and cyclizine are all less sedating than diphenhydramine but still sedating.
They are long acting agents
Transderm Scop
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scopolamine
class: anticholinergic
Indications: motion sickness, nausea associated with surgeries,
MOA:
Dosage forms: transdermal patch 1.5mg programmed delivery of 1mg
Dosing:
*Motion sickness:
- Apply 1 patch behind the ear at least 4 hours before the effect is needed. May use a new patch every 3 days PRN.
*Preoperative (e.g. cesarean section):
Apply one patch the night before surgery or 1 hour prior to surgery. Remove patch 24 hours after surgery.
Max dose:
Contraindications:
** Hypersensitivity to belladonna alkaloids
** Closed-angle glaucoma
Side Effects:
dry mouth, CNS effects [drowsiness, dizziness, confusion (can be significant in elderly, frail) hallucinations (rare) stinging of the yes and pupil dilation (if eyes are touched after handling), risk of increasing IOP, tachycardia (rare).
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** Is NOT more effective than generically available OTC drugs but is applied topically behind the ear and is taken less frequently (lasts 3 days).
**Remove patch before an MRI
*Avoid alcohol while wearing the patch
* Do not use in children
primarily for motion sickness, occasionally used inpatient
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Counseling on Scopolamine patch:
For N/V due to motion sickness or anesthesia/surgery
- apply at least 4 hours before needed or the night before surgery
- press firmly to skin behind the ear for 30 seconds
- try to avoid placing the patch over hair, or when the patch is removed, the hair may be removed too.
- Lasts 3 days; if continued treatment needed, remove the first patch and place a new patch behind the other ear
-wash hands after applying - painful/mydriasis (dilated pupils) if it gets in eyes
-remove patch prior to an MRI (aluminum coil)
Do NOT drive; high level of sedation, dizziness, confusion - these anticholinergic side effects are worse and not well tolerated, in elderly patients (Avoid use when possible)
Dramamine
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dimenhydrinate
class: antihistamine
Indications: motion sickness
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Dosage forms: tablet, injection
Dosing:
Motion Sickness:
-Oral: 50-100mg every 4-6 hours
Nausea and Vomiting:
-IM, IV: 50-100mg every 4 hours
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*CNS depression (may impair physical or mental abilities, caution in elderly), worsening of BPH symptoms, increase IOP (glaucoma)
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Bonine
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meclizine
class: antihistamine
Indications: motion sickness
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25-50mg PO 1 hour before travel, can repeat every 24 hours an needed
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*CNS depression (may impair physical or mental abilities, caution in elderly), worsening of BPH symptoms, *increase IOP (glaucoma)
Side Effects:
* sedation, dry mouth/blurry vision, tachycardia
Pearls/Notes:
* commonly used for vertigo; it was branded as Antivert
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Dramamine All
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meclizine
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Travel Sickness
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meclizine
Zofran
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ondansetron
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MOA: 5HT-3 receptor antagonist, blocking serotonin from binding to receptor.
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Compro
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prochloroperazine
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MOA: blocks dopamine from binding to receptors
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can cause parkinsonism
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Reglan
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metoclopramide
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MOA: (a prokinetic drug that moves food through the gut), it blocks 5HT and DA from binding to receptors.
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Gimoti
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metoclopramide
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promethazine is prescription only and should NOT be used in children due to the risk of respiratory depression.
All promethazine products carry a boxed warning to avoid use in children less than 2 years old and strongly caution against use in children age 2 and older.
metoclopramide and the 5HT-3 receptor antagonists (ondansetron) are generally NOT effective for _________
motion sickness
