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NUR 516 > Anti-emetics > Flashcards

Anti-emetics Flashcards

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1
Q

Types of anti-emetics
After Party Nausea Sucks Ass

A
  • anticholinergics (scopolamine, dicyclomine (bentyl))
  • antihistamines
  • neurolytics (chlorpromazine, haldol)
  • prokinetics (metoclopramide, cisaprine)
  • serotonin (ondanestron)
  • adjunct medications: corticosteroids, benzodiazepines, cannabinoids

Can be administered PO, SL, rectal, IV, IM, SQ, transdermal

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2
Q

Anti-emetics: anticholinergics - work how?

A

Block acetylcholine at the muscarinic receptors
- also used to treat motion sickness
- must be removed before an MRI b/c contains aluminum

scopolamine (transderm scop)

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3
Q

Anti-emetics: anticholinergics - side effects

A
  • dry mouth
  • urinary retention
  • blurred vision
  • exacerbation of narrow-angle glaucoma
  • skin irritation
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4
Q

Anti-emetics: 5-HT3 (serotonin) antagonist - works how?

A

Need to be given before N/V experienced
Serotonin receptors are present both peripherally and centrally
- given for chemo, radiation, therapy, or post-op N/V
- metabolized in the liver and excreted in the urine

SETRON DRUGS AKA ondansetron

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5
Q

Anti-emetics: 5-HT3 (serotonin) antagonist - drugs in class

A

Drugs end in “setron”
- ondansetron (zofran)
- granisetron (kytril)
- dolasetron (anzemet)
- palonosetron (aloxi)

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6
Q

Anti-emetics: 5-HT3 (serotonin) antagonist - side effects

A
  • headache (usually r/t spread of infusion IV)
  • diarrhea
  • fever
  • hypotension
  • QT prolongation
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7
Q

Anti-emetics: 5-HT3 (serotonin) antagonist - Ondansetron (Zofran): works how

A

Blocks serotonin in the CTZ
- routes: PO, SL, IV, IM
- dose: 4mg or 8mg
Pregnancy category B

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8
Q

Anti-emetics: 5-HT3 (serotonin) antagonist - Ondansetron (Zofran): Contraindications

A
  • patients taking anticonvulsants b/c can decrease seizure threshold

Use lowest dose in hepatic and renal impairment

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9
Q

Anti-emetics: 5-HT3 (serotonin) antagonist - Ondansetron (Zofran): side effects

A
  • headache
  • constipation
  • diarrhea
  • fatigue

Serotonin syndrome from too much in body; can be mild or life-threatening

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10
Q

Anti-emetics: Dopamine 2 Antagonist - three subtypes?

A
  • piperaze phenotiazine/antipsychotics (prochlorperazine)
  • metoclopramide (reglan)
  • butyrophenon derivate/antipsychotics (droperidol and haloperidol)
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11
Q

Anti-emetics: Dopamine 2 Antagonist - indications

A
  • motion sickness
  • chemo-induced N/V
  • post-op N/V

Considered second-line therapy
Have antihistamine and anticholinergic properties

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12
Q

Anti-emetics: Dopamine 2 Antagonist - work how

A
  • block dopamine receptors in CTZ and acetylcholine
  • are not to be give in Parkinson’s b/c can make it worse
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13
Q

Anti-emetics: Dopamine 2 Antagonist - other drugs in class

A
  • promethazine (phenergan)
  • trimethobenazamide (tigan)
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14
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Metoclopramide (reglan): routes/admin

A

Also classified as a non-phenothiazine
- routes: oral, IV, IM
Pregnancy Category B

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15
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Metoclopramide (reglan): indications

A
  • GERD
  • diabetic gastroparesis
  • N/V
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16
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Metoclopramide (reglan): any black box warnings?

A

May cause tardive dyskinesia

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17
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Metoclopramide (reglan): contraindications

A
  • bowel obstruction
  • GI bleeding
  • pheochromocytoma
  • epileptics
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18
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Metoclopramide (reglan): side effects

A
  • restlessness
  • drowsiness
  • extrapyramidal symptoms (EPS)
  • neuroleptic malignant syndrome (NMS): hypernatremia, change in LOC, rigidity
  • suicidal ideations
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19
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Haloperidol (Haldol): routes/admin

A

Butyrophenone derivative
Routes: PO, IV, IM
Pregnancy Category C - cleft palate

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20
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Haloperidol (Haldol): indications

A
  • schizophrenia
  • control of tics and vocal utterances of Tourette’s disorder
  • N/V
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21
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Haloperidol (Haldol): any black box warnings?

A

elderly patients with dementia-related psychosis

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22
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Haloperidol (Haldol): contraindications

A
  • patients with severe toxic CNS depression or comatose states from any cause
  • hypersensitivity to drug
  • Parkinson’s disease
  • dementia
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23
Q

Anti-emetics: Dopamine 2 Receptor Antagonist: Haloperidol (Haldol): side effects

A
  • sedation
  • EPS
  • tardive dyskinesia
  • dystonia
  • dizziness
  • QT prolongation
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24
Q

Anti-emetics: phenothiazines - work how?

A

Are centrally acting
Routes: oral, suppositories, IM, IV

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25
Anti-emetics: phenothiazines - indications
Used for N/V related to: - anesthesia - severe vomiting - intractable hiccoughs
26
Anti-emetics: phenothiazines - contraindications | PIPERS CRAZY
- patients in comas or severe CNS suppression - severe hypo/hypertension - liver dysfunction - severe renal impairment | Compazine
27
Anti-emetics: phenothiazines - drugs in class
- **prochlorperazone (compazine)** - chlorpromazine (thorazine) - perphenazine (trilafon) - thiethylperazine maleate (torecan (IM) or norazine (PO or PR))
28
Anti-emetics: phenothiazines - adverse effects include
-Pink urine Tardive dyskinesia VESICANT (Black box) | Treats hiccups!
29
Anti-emetics: phenothiazines: Prochlorperazine (compazine) - routes, indications
Piperaze Phenothiazine Routes: PO, IV, IM, PR Metabolized by the liver, excreted in urine Indications: - N/V - schizophrenia - non-psychotic anxiety - morning sickness
30
Anti-emetics: phenothiazines: Prochlorperazine (compazine) - side effects
- drowsiness - hypotension - EPS - tardive dyskinesia - NMS - dystonia - photophobia - blurred vision
31
Anti-emetics: phenothiazines: Prochlorperazine (compazine) - any black box warnings?
is a vesicant
32
Anti-emetics: phenothiazines: Prochlorperazine (compazine) - contraindications?
- patients taking antipsychotic drugs - children - older adults -> psychosis
33
Anti-emetics: H1 Receptor Antagonist - work how? indications?
AKA: antihistamines - also have anticholinergic properties - block muscarinic receptors Indications: - motion sickness - morning sickness - allergies
34
Anti-emetics: H1 Receptor Antagonist - drugs in class?
- **diphenhydramine (benadryl)** - meclizine - promethazine - doxylamine succinate
35
Anti-emetics: H1 Receptor Antagonist - side effects?
- drowsiness - blurred vision - dry mouth - hypo/hypertension - urinary retention
36
Anti-emetics: Corticosteroids - work how? admin?
Precise mechanism of action is not known - suppresses prostaglandin release from hypothalamus - may inhibit the process of N/V - anti-inflammatory Cochrane report: low-degree of evidence for N/V Administer slowly: if you go too fast, weird sensations in the lower region are felt
37
Anti-emetics: Corticosteroids - indication
used as an adjunct to treat CINV
38
Anti-emetics: Corticosteroids - drugs in class
- dexamethasone (decadron): is compatible with zofran - prednisone (deltasone)
39
Anti-emetics: Corticosteroids - side effects?
- insomnia - anxiety - acne - hyperactivity
40
Anti-emetics: Cannabinoids - use, types, efficacy?
Have been used for a variety of ailments Types: - CB-1 receptors: GI tract - CB-2 receptors: inflammatory & epithelial cells Equal in efficacy to ondansetron
41
Anti-emetics: Cannabinoids - drugs in class
- **drobabinol (marinol)** - nabilone (cesamet)
42
Anti-emetics: Cannabinoids - side effects?
- sedation - vertigo - euphoria - dry mouth - tachycardia - paranoid reactions
43
Anti-emetics: Cannabinoids: Dronabinol (marinol) - Route, admin
- oral route - dosage: 2.5mg, 5mg, 10mg - pregnancy category C - **highly protein bound - increases interactions**
44
Anti-emetics: Cannabinoids: Dronabinol (marinol) - indications?
- anorexia - CINV that has failed standard treatment - appetite stimulant
45
Anti-emetics: Cannabinoids: Dronabinol (marinol) - caution with?
- elderly patients due to increased risk of neuro-psychoactive effects - patients with a history of alcohol and/or substance abuse - patient with underlying psychiatric disorders (mania, depression, schizophrenia)
46
Anti-emetics: Cannabinoids: Dronabinol (marinol) - side effects?
- mood changes - euphoria - depression - insomnia - psychosis (in extreme cases)
47
Anti-emetics: Olanzapine (zyprexa) - what is it? route?
Thienobenzodiazepine - also an antipsychotic Routes: PO, IM Pregnancy Category C
48
Anti-emetics: Olanzapine (zyprexa) - indications?
- depressive episodes r/t bipolar I - treatment resistant depression - acute agitation r/t schizophrenia and bipolar I mania - N/V
49
Anti-emetics: Olanzapine (zyprexa) - any black box warnings?
elderly patients with dementia-related psychosis
50
Anti-emetics: Olanzapine (zyprexa) - contraindications?
- elderly patients with dementia-related psychosis - fluoxetine in combination - in combination with lithium or valproate
51
Anti-emetics: Olanzapine (zyprexa) - labs to monitor?
CBC, glucose, lipid profile
52
Anti-emetics: Olanzapine (zyprexa) - side effects? (5)
- hypotension - weight gain - suicidal ideations - NMS - sedation
53
Anti-emetics: Anxiolytics/benzodiazepines - how do they work?
Affects GABA neurotransmitter - CNS depressant; interferes with afferent nerves
54
Anti-emetics: Anxiolytics/benzodiazepines - drugs in class
- alprazolam (xanax) -- dose/route: 0.5-2mg PO - lorazepam (ativan) -- dose/routes: 0.5-2mg PO, SL, IV
55
Anti-emetics: Anxiolytics/benzodiazepines - indications?
- typically used as an adjunct agent for acute or delayed N/V - anticipatory N/V
56
Anti-emetics: Anxiolytics/benzodiazepines - side effects?
- drowsiness - sedation - confusion - agitation - dependence and withdrawal symptoms - hallucinations
57
Anti-emetics: Neurokinin-1 Antagonist (NK-1) - how do they work
Inducer of the CYP450 system - also inhibits substance P Routes: PO and IV Given in combination with other anti-emetics
58
Anti-emetics: Neurokinin-1 Antagonist (NK-1) - indications?
to prevent and treat acute and delayed nausea associated with highly emetogenic chemotherapy
59
Anti-emetics: Neurokinin-1 Antagonist (NK-1) - drugs in class
**Ends in "pitant"** - **arepitant (emend)** - fosaprepitant dimeglumine (emend) - rolapitant (varubi)
60
Anti-emetics: Neurokinin-1 Antagonist (NK-1) - side effects
- diarrhea - constipation - gastritis - anorexia - headache - fatigue
61
Anti-emetics: Neurokinin-1 Antagonist (NK-1): Arepitant (Emend) - route, dosage, patho info
Route: IV Dosage: 150mg Can cross the BBB - metabolized in liver and excreted in the urine and feces
62
Anti-emetics: Neurokinin-1 Antagonist (NK-1): Arepitant (Emend) - drug interactions
- pimozide - warfarin - oral contraceptives - corticosteroids
63
Anti-emetics: Neurokinin-1 Antagonist (NK-1): Arepitant (Emend) - side effects
- liver enzyme elevation - dehydration - hiccups - Steven-Johnson syndrome
64
Anti-Emetic Miscellaneous Medications: other drugs, herbal and vitamin supplements, medications used to augment anti-emetics
Other drugs to control N/V: - scopolamine (anticholinergic) Herbal and vitamin supplements: - ginger - pyridoxine (vitamin B6) Medications used to augment anti-emetics: - diphenhydramine (benadryl) - lorazepam - megestrol acetate (megace)
65
Anti-emetic use across the lifespan: pediatrics
- should be used with caution - increased risk for adverse effects
66
Anti-emetic use across the lifespan: adults
- frequently used for surgery and chemo - pregnancy and lactation: -- has not been studied -- many drugs can enter breast milk
67
Anti-emetic use across the lifespan: older adults
- more likely to experience an adverse effect from drug(s) - issue of hepatic and/or renal impairment
68
Lab studies for anti-emetics
- weight - hydration status - serum electrolytes - creatinine - LFTs - intake and output
69
What are extrapyramidal symptoms (EPS)?
Manifested primarily as acute dystonic reactions Dystonic reactions may include: - sudden onset of muscular spasms esp in head, neck, or opisthotonos - laryngospasm, dysphagia, oculogyric crisis - involuntary spasms of the tongue and mouth: difficultly speaking and swallowing - akathisia, restlessness, akinesia, other Parkinsonian-like symptoms (tremor)
70
Treatment of extrapyramidal symptoms (EPS)?
- depends on severity of symptoms - reduce or discontinue drug - anticholinergic drugs can be used to treat acute dystonic reactions
71
When are emetics given?
- may be given in cases of overdosing or poisoning - used to induce vomiting - no longer recommended for home use
72
What is an example of an emetic?
ipecac
73
Emetics: Ipecac
- standard of practice prior to 2003 - standard of practice now -- dispose of any ipecac in home -- if needed: call poison control center
74
Anti-emetics: nursing considerations
- assess/identify factors contributing to symptoms of N/V - administer antiemetic as prescribed - if patient receiving anticholinergic, monitor for side effects Focused assessment: - skin - cardiac - intake and output - lab studies - s/s of dehydration Evaluation: - did symptoms improve - good urine output - able to tolerate food
75
Anti-emetics: General patient education
- drink plenty of fluids - small frequent meals - avoid strong smells
76
When planning administration of antiemetic medications to a client, the nurse is aware that combination therapy is preferred because of which drug effect?
Different vomiting pathways are blocked - combining antiemetic drugs from various categories allows the blocking of the vomiting center and CTZ through different pathways, enhancing antiemetic effect
77
A patient is receiving an anticholinergic drug to treat their N/V. The nurse should instruct the patient to expect which adverse effect?
Dry mouth - anticholinergic drugs block the PNS -> causes the body to "rest and digest" - blocking of these effects leads to constipation, urinary retention, and decreased secretions (dry mouth)
78
Which drug works by blocking serotonin receptors in the GI tract, vomiting center, and CTZ?
Ondansetron (Zofran) - is a serotonin blocker
79
What are counter-regulatory hormones r/t insulin?
Hormones that counteract the effects of insulin: glucagon, epinephrine, cortisol, and growth hormones ## Footnote They help increase blood glucose levels when they drop.

NUR 516 (30 decks)

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