Motion Sickness

Question 1

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
Contraindications:
Warnings:
Side Effects:
Monitoring:
Pearls/Notes:
Drug-Drug/Food interactions:

Answer 1

class:

Indications:

MOA:

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

Question 2

Nausea

Answer 2

the uncomfortable, queasy feeling that one may vomit.

Question 3

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.

Answer 3

dopamine (DA)
serotonin (5-HT)
acetylcholine (Ach)

Question 4

Vertigo

Answer 4

• dizziness with sensation that the environment is moving or spinning.
  Vertigo is typically an inner-ear condition that affects balance.

Question 5

Treatment for Vertigo:

Answer 5

vestibular (inner-ear) suppressants
antihistamines (meclizine, dimenhydrinate)
benzodiazepines

Question 6

____________ are not useful for vertigo because they do not affect the inner ear.

Answer 6

5HT-3 receptor antagonists.

Question 7

Motion Sickness:

Treatment-

Answer 7

• 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)

Question 8

motion sickness also called _________

Answer 8

kinetosis

Question 9

Non-drug treatment for motion sickness:

Answer 9

• 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.

Question 10

Natural Supplements for motion sickness:

Answer 10

• Ginger in teas or supplements is used commonly for nausea
• peppermint may also be helpful

Question 11

Drug Treatment for Motion Sickness:

Answer 11

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.

Question 12

dimenhydrinate, meclizine, and cyclizine are all less sedating than diphenhydramine but still sedating.

They are long acting agents

Question 13

Transderm Scop

class:
Indications:
MOA:
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Dosing:
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Pearls/Notes:
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Answer 13

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).

Pearls/Notes:
** 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

Drug-Drug/Food interactions:

Question 14

Counseling on Scopolamine patch:

For N/V due to motion sickness or anesthesia/surgery

Answer 14

• 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)

Question 15

Dramamine

class:
Indications:
MOA:
Dosage forms:
Dosing:
Max dose:
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Answer 15

dimenhydrinate

class: antihistamine

Indications: motion sickness

MOA:

Dosage forms: tablet, injection

Dosing:

Motion Sickness:
-Oral: 50-100mg every 4-6 hours

Nausea and Vomiting:
-IM, IV: 50-100mg every 4 hours

Contraindications:

Warnings:
*CNS depression (may impair physical or mental abilities, caution in elderly), worsening of BPH symptoms, increase IOP (glaucoma)

Side Effects:

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

Question 16

Bonine

class:
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MOA:
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Answer 16

meclizine

class: antihistamine

Indications: motion sickness

MOA:

Dosage forms:

Dosing:
25-50mg PO 1 hour before travel, can repeat every 24 hours an needed

Max dose:

Contraindications:

Warnings:
*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

Drug-Drug/Food interactions:

Question 17

Dramamine All

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Answer 17

meclizine

class:
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MOA:
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Question 18

Travel Sickness

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Answer 18

meclizine

Question 19

Zofran

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Answer 19

ondansetron

class:

Indications:

MOA: 5HT-3 receptor antagonist, blocking serotonin from binding to receptor.

Dosage forms:

Dosing:

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Question 20

Compro

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Answer 20

prochloroperazine

class:

Indications:

MOA: blocks dopamine from binding to receptors

Dosage forms:

Dosing:

Max dose:

Contraindications:

Warnings:

Side Effects:
can cause parkinsonism

Monitoring:

Pearls/Notes:

Drug-Drug/Food interactions:

Question 21

Reglan

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Answer 21

metoclopramide

class:

Indications:

MOA: (a prokinetic drug that moves food through the gut), it blocks 5HT and DA from binding to receptors.

Dosage forms:

Dosing:

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Question 22

Gimoti

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Answer 22

metoclopramide

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MOA:
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Question 24

promethazine is prescription only and should NOT be used in children due to the risk of respiratory depression.

Answer 24

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.

Question 25

metoclopramide and the 5HT-3 receptor antagonists (ondansetron) are generally NOT effective for _________

Answer 25

motion sickness