Chapter 34: drugs used to treat nausea and vomiting – Flashcards
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Nausea
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•sensation of abdominal discomfort intermittently accompanied by a desire to vomit: -the cerebral cortex is the area of the brain that stimulates or suppresses vomiting
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Vomiting (emesis)
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Forceful expulsion of gastric contents up the esophagus and out of the mouth
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Regurgitation
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Rising of gastric or esophageal contents to the pharynx as a result of stomach pressure
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Retching
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Involuntary, labored, spasmodic contractions of the abdominal and respiratory muscles without the expulsion of gastric contents -aka dry heaves
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Vomiting center located in the
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Medulla, coordinates the vomiting reflex
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Postoperative nausea/vomiting
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-surgical procedure involving general anesthesia and patient with obesity have a higher incidence of PONV -abdominal surgery -reglan given post op to prevent nausea and vomiting
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Pregnancy
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•morning sickness: -varies in frequency throughout the day and does not cause severe effects •hyperemesis gravidarum: -is greater in frequency and can lead to starvation, dehydration, acidosis •psychogenic •self-induced or involuntary vomiting in response to threatening or distasteful situations
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Treatments causing nausea/vomiting
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Chemotherapy and radiation
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Psychogenic vomiting
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-diagnosis made after all other causes eliminated -metoclopramide or antianxiety drug may be prescribed with counseling
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Pregnancy NV control
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-diet -antihistamines -promethazine -ginger -reglan
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CINV
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-zofran -haldol •should be treated prophylactically
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Delayed emesis drug therapy
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-combination of prochlorperazine, lorazepam, and diphenhydramine given orally 1 hour before meals
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RINV
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-granisetron -ondansetron -serotonin antagonists
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How to prescribe antiemetic meds
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Schedule rather than administer PRN
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Dopamine antagonists (phenothiazines, reglan): -actions
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Inhibit dopamine receptors that are part of the pathway to the vomiting center
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Dopamine antagonists (phenothiazines, reglan): -uses
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-treat mild to moderate nausea and vomiting associated with anesthesia, surgery, radiation therapy, chemotherapy
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Dopamine antagonists (phenothiazines, reglan): -watch for
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Extrapyramidal symptoms
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Serotonin antagonists (kytril): -actions
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-block the serotonin 5-HT3 receptors located in the chemoreceptor trigger zone of the medulla and in specialized cells of the GI tract
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Serotonin antagonists (kytril): -uses
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Treat nausea and vomiting associated with chemotherapy, radiation, PONV
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Anticholinergic agents (Dramamine, scopolamine):
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-scopolamine (Rx only) is the drug of choice for short periods of motion sickness actions -counterbalance excessive amounts of acetylcholine thought to cause motion sickness
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Anticholinergic agents (Dramamine, scopolamine): -uses
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-treat motion sickness -nausea and vomiting associated with pregnancy
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Corticosteroids (dexamethasone, methylprednisolone): -uses
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In combination with other antiemetics to relieve nausea and vomiting, also can be used alone
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Corticosteroids (dexamethasone, methylprednisolone): -risk for serious adverse effects
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Lowest risk for having an adverse reaction
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Benzodiazepines (Ativan, Valium): -uses
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In combination with other antiemetics to treat vomiting and nausea, anxiety associated with chemotherapy
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Cannabinoids (marinol):
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•actions: -several mechanisms inhibit pathways to the vomiting center •uses: -in patients refractory to other antiemetic regimens -only for patients receiving chemotherapy
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Neurokinin-1 receptor antagonists (emend, emenda): -actions
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-block effects of substance P, a neuropeptide in the CNS, responsible for vomiting
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Neurokinin-1 receptor antagonists (emend, emenda): -uses
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Prevent acute and delayed CINV
