Drugs Used to Treat Nausea and Vomiting

Chapter 34Chapter 34

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Chapter 34Lesson 34.1

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ObjectivesObjectives

• Compare the purposes of using antiemetic products

• State the therapeutic classes of antiemetics• Discuss scheduling of antiemetics for

maximum benefit

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Nausea and VomitingNausea and Vomiting

• Nausea Sensation of abdominal discomfort

intermittently accompanied by a desire to vomit

• Vomiting (emesis) Forceful expulsion of gastric contents up the

esophagus and out of the mouth• Regurgitation

Rising of gastric or esophageal contents to the pharynx as a result of stomach pressure

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Common Causes Common Causes of Nausea and Vomitingof Nausea and Vomiting

• Postoperative (PONV)• Motion sickness• Pregnancy

Morning sickness Hyperemesis gravidarum

• Psychogenic Self-induced or involuntary vomiting in

response to threatening or distasteful situations

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Common Causes Common Causes of Nausea and Vomiting (cont’d)of Nausea and Vomiting (cont’d)

• Chemotherapy (CINV) Anticipatory nausea and vomiting Acute CINV Delayed emesis

• Radiation (RINV) Associated with high-energy radiation,

external source or implanted

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Drug Therapy Drug Therapy for Nausea and Vomitingfor Nausea and Vomiting

PONV• Multimodal treatment approach• Hydration• Supplemental oxygen• Combination of antiemetics• Nonpharmacologic techniques prior to

surgery• NG tube to prevent abdominal distention

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Drug Therapy Drug Therapy for Nausea and Vomiting (cont’d)for Nausea and Vomiting (cont’d)

• Motion sickness Most medications chemically related to

antihistamines, probably because of anticholinergic properties

• Psychogenic vomiting Diagnosis made after all other causes

eliminated Metoclopramide or antianxiety drug may be

prescribed with counseling

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Drug Therapy Drug Therapy for Nausea and Vomiting (cont’d)for Nausea and Vomiting (cont’d)

• Pregnancy Morning sickness controlled by diet Antihistamines: diphenhydramine,

dimenhydrinate, meclizine, cyclizine Phenothiazines: promethazine,

prochlorperazine Ginger used in many cultures

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Drug Therapy Drug Therapy for Nausea and Vomiting (cont’d)for Nausea and Vomiting (cont’d)

• CINV Combination of drugs used because emesis

likely produced by more than one mechanism • Ondansetron (Zofran), dolasetron (Anzemet),

granisetron (Kytril)• High doses of metoclopramide (Reglan);

dexamethasone (Decadron, Hexadrol); lorazepam (Ativan), diphenhydramine (Benadryl, Diphenhist)• Haloperidol (Haldol) may be substituted for

metoclopramide Should be treated prophylactically

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Drug Therapy Drug Therapy for Nausea and Vomiting (cont’d)for Nausea and Vomiting (cont’d)

• Anticipatory nausea and vomiting Progressive muscle relaxation, mind diversion,

hypnosis, self-hypnosis, systematic desensitization

• Delayed emesis Combination of prochlorperazine, lorazepam,

and diphenhydramine given orally 1 hour before meals

• RINV Granisetron, ondansetron, serotonin

antagonists

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Drug Class: Dopamine AntagonistsDrug Class: Dopamine Antagonists

• Drugs Phenothiazines Butyrophenones Metoclopramide (Reglan)

• Actions Inhibit dopamine receptors that are part of the

pathway to the vomiting center• Uses

Treat mild to moderate nausea and vomiting associated with anesthesia, surgery, radiation therapy, cancer chemotherapy

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Drug Class: Serotonin AntagonistsDrug Class: Serotonin Antagonists

• Actions Block the serotonin 5-HT3 receptors located in

the chemoreceptor trigger zone of the medulla and in specialized cells of the GI tract

• Uses Treat nausea and vomiting associated with

chemotherapy, radiation; PONV• Common adverse effects

Headache, diarrhea, constipation, sedation

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Drug Class: Anticholinergic AgentsDrug Class: Anticholinergic Agents

• Actions Counterbalance excessive amounts of

acetylcholine thought to cause motion sickness

• Uses Treat motion sickness; nausea and vomiting

associated with pregnancy• Common adverse effects

Anticholinergic effects, sedative effects

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Drug Class: CorticosteroidsDrug Class: Corticosteroids

• Drugs Dexamethasone (Decadron, Hexadrol) Methylprednisolone (Solu-Medrol, Depo-Medrol)

• Actions Mechanism of action unknown

• Uses In combination with other antiemetics to relieve

nausea and vomiting; can also be used alone• Common and serious adverse effects

See Chapter 38 for further discussion

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Drug Class: BenzodiazepinesDrug Class: Benzodiazepines

• Drugs: lorazepam (Ativan), diazepam (Valium)

• Actions Combination of effects – sedation, reduction in

anxiety, possible depression of the vomiting center – and an amnesic effect

• Uses In combination with other antiemetics to treat

vomiting and nausea, anxiety associated with chemotherapy

• Common and serious adverse effects See Chapter 16 for further discussion

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Drug Class: CannabinoidsDrug Class: Cannabinoids

• Drugs Dronabinol (Marinol) Nabilone (Cesamet)

• Actions Several mechanisms inhibit pathways to the

vomiting center• Uses

In patients refractory to other antiemetic regimens; only for patients receiving chemotherapy

• Common adverse effects Dysphoric effects

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Drug Class: Drug Class: Neurokinin-1 Receptor AntagonistsNeurokinin-1 Receptor Antagonists

• Drugs Aprepitant (Emend) Fosaprepitant (Emenda)

• Actions Block effects of substance P, a neuropeptide

in the CNS, responsible for vomiting• Uses

Prevent acute and delayed CINV• Common and serious adverse effects

Tiredness, nausea, hiccups, constipation, diarrhea, loss of appetite, headache, hair loss

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