Pharmacology Ch. 19 (Part 1) Drugs for nausea and vomiting

Nausea
the unpleasant sensation of the need to vomit

3 phases of vomiting
nausea, retching, vomiting

Retching
labored respiratory movements against a closed throat, with contractions of the abdominal muscles, chest wall muscles, and diaphragm without vomiting

Vestibular Apparatus
the inner ear structures associated with balance and position sense. When balance or sense of position is upset, vomiting can occur.

Why do we vomit?
When a person vomits, the body is often trying to remove harmful substances that were ingested. Other possible triggers might include disgusting sights, smells, or memories.

Nausea and vomiting are..
common, severe side effects of chemotherapy. Can create complications such as bleeding, aspiration pneumonia, dehydration, and reopening of surgical wounds, which can lead to longer hospital stays.

Antiemetic Drugs
control nausea and prevent vomiting.

Classes of antiemetic drugs
phenothiazines, anticholinergics, antihistamines, 5HT3-receptor antagonists, dopamine receptor agonists

5HT3-receptor antagonists
work against nausea and vomiting caused by chemotherapy treatments.

Antihistamines
work against nausea and vomiting caused by opiate drugs or motion.

Phenothiazines
block dopamine receptors in the chemotrigger zone of the brain. This action inhibits one or more of the vomiting reflex pathways. The sedating effects help control the sensation of nausea.

Anticholinergic Drugs
stop intestinal cramping and inhibit vestibular input (balance and position) into the central nervous system (CNS).

Phenothiazine drug names
Promethazine (Phenergan); Prochlorperazine (Compazine)

Promethazine (Phenergan)
Also helps with fever and pain; May give patient a buzz if given IV; It used to be given a lot but it is really rough on the veins so it is given orally, but not IV. Now, zofran is more commonly given.

Prochlorperazine (Compazine)
When you give this drug, educate your patient that it will turn their urine either red or brown. This drug can cause neutropenia.

Anticholinergic drug names
Scopolamine (L-hyoscine)

Antihistamine drug names
Cyclizine (Marezine); Meclizine (Antivert)

5HT3 Receptor Antagonists drug names
Granisetron (Kytril); Ondansetron (Zofran)

Ondansetron (Zofran)
The new Phenergan; Zofran is given to cancer patient’s 30 minutes before they get a chemotherapy treatment; Used to be very expensive ($28 per pill) but it is not anymore; Very common drug

Dopamine Antagonists drug names
Metoclopramide (Reglan); Trimethobenzamide (Tigan)

Metoclopramide (Reglan)
Can cause depression; Should not be given to breastfeeding mothers; Can cause an anaphylactic reaction (red, swollen face)

Antiemetic Drugs Intended Responses
Inhibit or disrupt vomiting reflex pathways; Patient is sedated; Relieve nausea; Prevent vomiting

Antiemetic Drugs Side Effects
Vary with drug type; Dizziness, fatigue, headache, blurred vision, constipation

Antiemetic Drugs Adverse Effects
Vary with drug type;

Promethazine (Phenergan), prochlorperazine (Compazine), and metoclopramide (Reglan) can cause neuroleptic malignant syndrome, a rare and life-threatening side effect in which dangerously high body temperatures can occur.

Promethazine (Phenergan) and prochlorperazine (Compazine) may cause neutropenia, a decrease in the number of neutrophils (white blood cells), putting the patient at a higher risk for infections.

When given by IV push, undiluted promethazine has been associated with severe tissue necrosis.

Respiratory depression (decreased drive for breathing) is a life-threatening effect that can occur with cyclizine (Mariezine), promethazine (Phenergan), and scopolamine (L-hyoscine).

Before Giving Antiemetic Drugs
Get baseline vital signs. Check the patient’s temperature, BP, HR and rhythm. Also check his or her respiratory rate and level of consciousness. Obtain a baseline weight and electrolyte lab values.

Use your stethoscope to listen for active bowel sounds.

Assess for abdominal distention.

If the patient is prescribed metoclopramide (Reglan), has whether he or she has experienced depression in the past. If so, notify the prescriber before giving the drug.

If the drug is to be given IV, be sure to dilute it first to decrease the risk of tissue necrosis.

After Giving Antiemetic Drugs
Keep track of any episodes of nausea or vomiting to determine the effectiveness of these drugs.

Recheck the patient’s temperature, BP, HR and rhythm, and respiratory rate.

Obtain daily weights.

Continue to listen for active bowel sounds and assess for abdominal distention.

Ask the patient about nausea and vomiting at least every shift.

Monitor for respiratory depression. Immediately report any of these signs to the prescriber.

Watch for signs of side effects or adverse effects. Report immediately to prescriber.

Keep track of input and output (both food and fluid). Ask about GI upset.

Watch for signs of depression in patients taking metoclopramide (Reglan).

Patient Teaching for Antiemetic Drugs
Instruct patients to check their body temperature every day and report abnormal signs and symptoms to their prescriber.

Warn patients that prochlorperazine (Compazine) may cause urine to change color to pink or reddish-brown. This condition usually disappears within a few days after the drug is discontinued.

Tell patients about eating foods with increased bulk and about the importance of drinking enough fluids to prevent constipation. Explain that moderate exercise may also help prevent the side effect of constipation.

Remind patients that for best control of nausea or vomiting, antiemetic drugs should be taken before events that usually cause nausea.

Advise against using CNS depressants such as alcohol, antihistamines, sedatives, tranquilizers, or sleeping drugs while taking antiemetic drugs.

Suggest the use of a mild analgesic such as acetaminophen for relief from headaches.

Pediatric considerations for antiemetics
Children may experience abnormal side effects such as muscle spasms of the jaw, neck, and back, along with jerky movements of the head and face while taking metoclopramide

Pregnancy and Breastfeeding considerations for antiemetics
Consult prescriber

Metoclopramide passes into the breast milk and should be avoided while breast feeding.

Older adults considerations for antiemetics
Older adults are more likely to experience side effects such as acute confusion and dizziness.

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