Chapter 52 - Antiemetic and Antinausea Drugs

Question 1

What is nausea?

Answer 1

Unpleasant feeling preceding vomiting

Question 2

What is Emesis?

Answer 2

Vomiting.

Forcible emptying of gastric/intestinal contents

Question 3

What drugs are used to relieve nausea/vomiting?

Answer 3

Antiemetic drugs

Question 4

6 pharmacologic managemetn of nausea/vomiting?

Answer 4

1. Dopamine antagonists
2. Antihistamines
3. Anticholinergics
4. Prokinetic agents
5. Serotonin blockers
6. Tetrahydrocannabinoids (THC)

Question 5

Causes of nausea/vomiting? (11, and they literally all start with M)

Answer 5

Metastases
Meningeal irritation
Movement
Mental anxiety
Medications
Mucosal irritation
Mechanical obstruction
Motility
Metabolic
Microbes
Myocardial

Question 6

What is the MOA of anticholinergic drugs?

MOA = Mechanism of Action

Answer 6

1. bind to and block ACh receptors in inner ear labyrinth
2. block transmission of nauseating stimuli to CTZ
3. also block transmission of nauseating stimula from reticular formation to the VC

Question 7

Indications of anticholinergic drugs?

Answer 7

motion sickness, pre-surgical secretion reduction, N/V

Question 8

What is scopolamine and what is it used for?

Answer 8

Anticholinergic drug in transdermal patch form used for motion sickness

Question 9

What is the MOA of antihistamine drugs (H1 receptor blockers)?

Answer 9

1. inhibit ACh by binding to H1 receptors

2. prevent cholinergic stimulation in vestibular/reticular areas, preventing N/V

Question 10

Indications of antihistamine drugs?

Answer 10

motion sickness, nonproductive cough, allergy symptoms, sedation, N/V

Question 11

3 Antihistamine drugs

ADDM

Answer 11

1. dimenhydrinate (Dramamine(
2. diphenhydramine (Benadryl)
3. meclizine (Antivert)

Antihistamines Don’t Deliver Madness

Question 12

MOA of antidopaminergic drugs

Answer 12

block dopamine receptors on the CTZ

Question 13

Indications of antidopaminergic drugs?

Answer 13

used for psychotic disorders, intractable hiccups (i find this funny), N/V

Question 14

3 antidopaminergic drugs, and which is controversial/why?

Answer 14

1. prochlorperazine (Compazine)
2. promethazine (Phenergan)
3. droperidol (Inapsine): controversial use b/c associated cardiac dysrhythmia

Question 15

MOA of prokinetic drugs

Answer 15

1. block dopamine in the CTZ
2. cause CTZ to be desensitized to ipulses it receives from the GI tract
3. stimulates peristalsis in GI tract, enhancing emptying of stomach contents

Question 16

Indications of prokinetic drugs

Answer 16

GERD, delayed gastric emptying, N/V

Question 17

Example of a prokinetic drug

Answer 17

metoclopramide (Reglan)

long term use may cause irreversible tardive dyskinesia

Question 18

MOA of serotonin blockers

Answer 18

block serotonin receptors in the GI tract, CTZ, and VC

Question 19

Indication of serotonin blockers

Answer 19

N/V in pt’s receiving chemotherapy and for postoperative n/v

Question 20

4 examples of serotonin blocker drugs

Answer 20

1. dolasetron (Anzemet)
2. granisetron (Kytril)
3. ondansetron (Zofran)
4. palonosetron (Aloxi)

Question 21

MOA of tetrahydrocannabinoids (THC)

Answer 21

1. major psychoactive substance in marijuana
2. inhibitory effects on reticular formation, thalamus, cerebral cortex
3. alter mood and body’s perception of its surroundings

Question 22

Indications of tetrahydrocannabinoids

Answer 22

N/V associated with chemo, and anorexia associated with weight loss in AIDS/cancer pts
-may also stimulate appetite

Question 23

Example of tetrahydrocannabinoid drug

Answer 23

dronabinol (Marinol)

Question 24

Common adverse effects

Answer 24

1. dizziness, h/a
2. drowsiness, sedation, fatigue
3. disorientation, confusion
4. dry mouth, blurred vision, dilated pupils, urinary retention

for other specific adverse effects, use table 52-5 on page 831. btw there’s a lot.

Question 25

Ginger: used for, adverse effects, and interactions

Answer 25

used for: n/v, caused by chemo, morning sickness, and motion sickness adverse: anorexia, n/v, skin reactions drug interactions: increase absorption of oral meds, increase bleeding risk with anticoagulants, not recommended during pregnancy

Question 26

Nursing implications: what to assess?

Answer 26

N/V history, including causes | assess allergies, current meds (everything, literally everything), contraindications, potential drug interactions

Question 27

Do antidiabetic/antiemetic drugs cause drowsiness?

Answer 27

Many of them do! | Warn pt's about driving

Question 28

Taking antiemetics with alcohol can cause __________

Answer 28

severe CNS depression

Question 29

When are antiemetics given for chemo?

Answer 29

30-60 minutes before chemo begins

Question 30

What must we monitor for?

Answer 30

therapeutic and adverse effects

Question 31

What must be taught to pts?

Answer 31

change position slowly (avoid hypotensive effects) and VS frequently