Nausea Meds

Question 1

How does Nausea stimulates the Vomiting center (VC) directly and indirectly?

Answer 1

1. Direct stimulation: inflammation, hypoxia, & GI distention
2. Indirect Stimulation: Vestibular input & emotions

Question 2

WHAT CAN STIMULATE THE CHEMORECEPTOR TRIGGER ZONE (CTZ) AND VC/vomiting cancer?????****

Answer 2

1) Uremic, acidosis, pregnancy, and Toxins
2) Receptors:
1. Opiate
2. Histamine
3. Serotonin
4. Substance P

Question 3

Ondansetron (Zofran)?

Answer 3

• generally WELL tolerated
• Headache & constipation

Patient care:
1. Serotonin Syndrome
2. Steven-Johnson Syndrome
3. QT Prolongation (TORSEDES potential)

Question 4

With Ondansetron (Zofran), what can the QT prolongation cause??

Answer 4

TORSEDES potential!!!

Question 5

Promethazine (Phenergan)???

Answer 5

Patient care:
1. Dilute in at least 9mL NS if giving IV
2. Ensure patency & integrity of IV
3. Administer slowly for at least 2 minutes!!!
4. Expect a sedation!! (sleepy)
5. Monitor Respiration!!!
6. Caution when giving to OLDER PATIENTS in particular!!

Question 6

Example of Corticosteroids?

Answer 6

Dexamethasone (Decadron)

Question 7

Corticosteroids??

Answer 7

Patient Care:
1. Irritability/moody
2. Insomnia
3. Fluid retention, BP increase
4. Muscle weakness**
5. Impaired wound healing
6. Infection risk
7. Blood sugar increased

Question 8

Example of Dopamine Antagonist???

Answer 8

Metoclopramide (Reglan)

Question 9

Dopamine Antagonist???

Answer 9

Patient Care:
1. Generally well tolerated!
2. Adverse effects: Fatigue, headache, drowsiness, and diarrhea!!
3. Contraindicated with: Complete Bowel Obstruction!!
4. Risk for: Tardive Dyskinesia

Question 10

Metoclopramide (Reglan) has a risk for developing what?????

Answer 10

Dopamine Antagonist!
Risk for Tardive Dyskinesia

Question 11

Metoclopramide (Reglan) is contraindicated with what??

Answer 11

Dopamine Antagonist!
Contraindicated with Complete Bowel Obstruction!!!

Question 12

Example of NK-1 Inhibitor????

Answer 12

Aprepitant (Emend)

Question 13

NK-1 Inhibitor????

Answer 13

Patient care:
1) Generally well tolerated
2) May cause FATIGUE!!!!
3) Teach:
1. NOT effective if N/V has already started!!
2. Reduce effectiveness Birth Control!! NOT FOR use in PREGNANCY
4. Dangerous drug interaction with PIMOZIDE (QT Prolongation)

Question 14

Aprepitant (Emend) should not be combined with what drug????????***

Answer 14

NK-1 inhibitor!!!!
Dangerous drug interaction with PIMOzide (QT prolongation)!!!!!

Question 15

Example of Cannabinoids???

Answer 15

Dronabinol (Marinol)

Question 16

Cannabinoids????

Answer 16

Patient care:
1. Can worsen Mania, Depression, and Schizophrenia!!!
2. Impair mental and physical ability
3. Caution in patients with cardiac disorders & w/ hx of seizures!!!!
—–
4. Paradoxical N/V
5. Habit forming
6. NOT USE DURING PREGNANCY!!!!

Question 17

Which drug is it that can cause Paradoxical N/V???

Answer 17

Cannabinoids:
Dronabinol (Marinol)

Question 18

Example of Benzodiazepine???

Answer 18

Lorazepam (Ativan)

Question 19

Benzodiazepine????

Answer 19

Patient care:
1. May cause: Sedation & Respiratory depression. AND DEPENDANCE
2. Teach: AVOID other CNS depressants (like alcohol)
3. Taper dosing with prolonged use to avoid withdrawal!!

Question 20

Example of Anticholinergic??????

Answer 20

Scopolamine (Tranderm Scop)

Question 21

Anticholinergic???

Answer 21

1) May cause: Dizziness, Drowsiness, and DRY MOUTH.
Can increase EYE PRESSURE & BLURRED VISSION, AGITATION, AND CONFUSION!!
2) Teach:
1. AVOID other CNS depressants (like alcohol)
2. ICE, sugarless candy, and gum for dry mouth
3. Report signs of ANTICHOLINERGIC TOXICITY!!

Question 22

What are the Anticholinergic Toxicity Signs????

Answer 22

1. Altered mental status
2. Papillary dilation w/ loss of accomodation
3. ## Vasodilation w/ skin HYPEREMIA
4. ## AHNYDROSIS with Temp ELEVATION
5. Drying of mucous membrane & skin
6. Urinary retention
7. Constipation