Motion Sickness

Question 1

Motion sickness (kinetosis),
aka seasickness or airsickness

Symptoms

Answer 1

Nausea
Dizziness
Fatigue

Question 2

Motion sickness

NON-PHARMACOLOGIC TREATMENT

Answer 2

Wrist band (Sea-Band)
Ginger (in teas or supplements)
Peppermint

Question 3

Motion sickness

PHARMACOLOGIC TREATMENT

Answer 3

Scopolamine (Transderm Scop)
Antihistamines include:
 - Cyclizine (Marezine)
 - Diphenhydramine (Benadryl)
 - Dimenhydrinate (Dramamine)
 - Meclizine (Bonine)
Promethazine

Question 4

Scopolamine (Transderm Scop)
Dosing
SE
CI
Preg

Answer 4

• 1.5 mg, patch placed behind ear (hairless), 4-6 hours before needed (or evening before AM surgery, remove 24 hrs after surgery)
• Q72 hrs (rotate ears)
• Do not cut patch, wash hands after application

SIDE EFFECTS

• Dry mouth, dizziness, stinging eyes (if touch eyes after handling patch), pupil dilation
• Confusion (can be significant in elderly, frail)

RARELY= Hallucinations, tachycardia
Remove patch prior to MRI

Preg Cat C

Question 5

Meclizine (Medi-meclizine, Univert, Antivert, Bonine, Dramamine Less Drowsy, D-Vert)

Answer 5

12.5-25 mg 30–60 minutes before needed

SE
Sedation, dry mouth, urinary retention, constipation, dry/blurry vision, tachycardia

Preg Cat B

worsening of BPH symptoms, can elevate IOP (glaucoma), and worsen cognition (elderly)

Question 6

Promethazine Warnings

Answer 6

Rx-do not use in children due to (primarily) risk of respiratory depression

Comes in oral tablets, suppository, and injection. DO NOT give IV due to tissue necrosis. IM is preferred

black box warning contraindicating use in children less than 2 years and strongly cautioning use in children age 2 and older

Against promethazine with codeine cough syrups in children less than 6 years of age, due to the risk of respiratory depression, cardiac arrest and neurological problems

Question 7

Transderm Scop Counseling

Answer 7

• Wear only one patch at any time.
• No alcohol. Avoid other drugs that make you tired/ causes significant drowsiness
• Do not use in children.
• Most common SE is dryness of the mouth
• Other common SE are drowsiness, temporary blurring of vision and dilation (widening) of the pupils may occur,
  especially if the drug is on your hands and comes in contact with the eyes.
• Remover prior to an MRI procedure or the patch will burn your skin.
• Infrequently, some people get disoriented, and others can get confusion, hallucinations or heart palpitations. If any of these occur remove the patch and contact your doctor.

Question 8

Transderm Scop

How to use

Answer 8

• Peel off the clear backing from the patch and apply it to a clean, dry, hairless area of the skin behind the ear
• Press firmly for at least 30 seconds to make sure the patch sticks well, especially around the edges. The patch will slowly release the medication into your body
  over 3 days.
• Do not use the patch if it appears broken, cut, or damaged.
• Apply at least 4 hours before activity that will cause motion sickness.
• Be sure to wash your hands thoroughly with soap and water immediately after handling the patch, so that any drug that might get on your hands will not come into contact with YOUI‘ EYES.
• Also wash the area behind the ear where the patch was removed.