ppt chapter 59
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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antiemetic AgentsAntiemetic Agents
Chapter 59
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nausea and VomitingNausea and Vomiting
• Most common and most uncomfortable complaints.
• Vomiting is a complex reflex reaction to various stimuli.
• In some cases, it may be desired to induce vomiting.
• In many clinical conditions, the reflex reaction of vomiting is not beneficial.
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Managing Nausea and Vomiting Managing Nausea and Vomiting
• Emetics
– Cause vomiting
– No longer recommended for at-home poison control
• Antiemetics
– Decrease or prevent nausea and vomiting
– Centrally acting or locally acting
– Varying degrees of effectiveness
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Sites of Action of Emetics/AntiemeticsSites of Action of Emetics/Antiemetics
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Groups of Centrally Acting AntiemeticsGroups of Centrally Acting Antiemetics
• Phenothiazines
• Nonphenothiazines
• Anticholinergics/Antihistamines
• Serotonin (5-HT3) Receptor Blockers
• Substance P/Neurokinin 1 Receptor Antagonists
• Miscellaneous Group
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PhenothiazinesPhenothiazines
• Actions
– Depresses various areas of the central nervous system (CNS)
• Indications
– Treatment of nausea and vomiting
• Adverse Effects
– Drowsiness
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Nonphenothiazines Nonphenothiazines • Actions
– Acts to reduce the responsiveness of the nerve cells in the CTZ to circulating chemicals that induce vomiting
• Indications
– Prevention of nausea and vomiting
• Adverse Effects
– Drowsiness
– Fatigue
– Restlessness
– Extrapyramidal symptoms
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Anticholinergics/AntihistaminesAnticholinergics/Antihistamines• Actions
– Anticholinergics that act as antihistamines and block the transmission of impulses to the CTZ
• Indications
– Prevention and treatment of nausea and vomiting
• Adverse Effects
– Drowsiness
– Confusion
– Dry mouth
– Anorexia
– Urinary frequency
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Serotonin (5-HT3) Receptor BlockersSerotonin (5-HT3) Receptor Blockers
• Actions
– Block those receptors associated with nausea and vomiting in the CTZ and locally
• Indications
– Control of nausea and vomiting
• Pharmacokinetics
– Rapidly absorbed, metabolized in the liver, and excreted in urine and feces
• Caution
– Pregnancy and lactation
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Serotonin (5-HT3) Receptor Blockers (cont.)
Serotonin (5-HT3) Receptor Blockers (cont.)
• Adverse Effects
– Headache, drowsiness, myalgia, urinary retention, constipation, pain at the injection site
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QuestionQuestion
Please answer the following statement as true or false.
Emetic medications are used to induce vomiting and should be kept in the home in case of an accidental poisoning.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
False
Rationale: Emetics cause vomiting and are no longer recommended for at-home poison control.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Substance P/Neurokinin 1 Receptor Antagonists
Substance P/Neurokinin 1 Receptor Antagonists
• Actions
– Act directly in the CNS to block receptors associated with nausea and vomiting
• Indications
– In combination with other agents to prevent nausea and vomiting
• Pharmacokinetics
– Given orally, metabolized in the liver, and excreted in urine and feces
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Substance P/Neurokinin 1 Receptor Antagonists (cont.)
Substance P/Neurokinin 1 Receptor Antagonists (cont.)
• Adverse Effects
– Anorexia, fatigue, constipation, diarrhea, liver enzyme elevation, dehydration
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Miscellaneous AntiemeticsMiscellaneous Antiemetics
• Actions
– Varies with agent
• Indications
– Treatment and prevention of nausea and vomiting
• Pharmacokinetics
– Varies according to agent
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Miscellaneous Agents (cont.)Miscellaneous Agents (cont.)
• Contraindications
– Coma
– Severe CNS depression
– Brain damage or injury
– Hypotension or hypertension
– Severe liver dysfunction
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Miscellaneous Antiemetics (cont.)Miscellaneous Antiemetics (cont.)• Caution
– Renal dysfunction
– Active peptic ulcer disease
– Pregnancy
– Lactation
• Adverse Effects
– Linked to interference with normal CNS stimulation or response
• Drowsiness
• Dizziness
• Weakness
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Miscellaneous Antiemetics (cont.)Miscellaneous Antiemetics (cont.)
• Adverse Effects (cont.)
– Photosensitivity
– Hypotension, hypertension, and cardiac arrhythmias
• Drug-to-Drug Interactions
– Alcohol
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Use of Drugs Affecting the Female Reproductive System Antiemetic Agents
Across the Lifespan
Use of Drugs Affecting the Female Reproductive System Antiemetic Agents
Across the Lifespan
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Prototype PhenothiazinesPrototype Phenothiazines
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Prototype Nonphenothiazines Prototype Nonphenothiazines
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Prototype Anticholinergics/Antihistamines
Prototype Anticholinergics/Antihistamines
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Serotonin (5-HT3) Receptor Blockers
Prototype Serotonin (5-HT3) Receptor Blockers
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Prototype Substance P/Neurokinin 1 Receptor Antagonists
Prototype Substance P/Neurokinin 1 Receptor Antagonists
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Nursing Considerations for Antiemetics Nursing Considerations for Antiemetics
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation
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QuestionQuestion
What is an anticholinergic antiemetic recommended for vestibular (inner ear) problems?
A. Granisetron
B. Meclizine
C. Palonosetron
D. Perphenazine
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
B. Meclizine
Rationale: These drugs—buclizine, cyclizine and meclizine - are anticholinergics that act as antihistamines and block the transmission of impulses to the CTZ. They are recommended for the nausea and vomiting associated with motion sickness or vestibular (inner ear) problems.
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