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Ppt chapter 59

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Ppt chapter 59

  1. 1. Antiemetic Agents Chapter 59 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  2. 2. Nausea 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  3. 3. Managing Nausea and Vomiting Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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
  4. 4. Sites of Action of Emetics/Antiemetics Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  5. 5. Groups of Centrally Acting Antiemetics • Phenothiazines • Nonphenothiazines • Anticholinergics/Antihistamines • Serotonin (5-HT3) Receptor Blockers • Substance P/Neurokinin 1 Receptor Antagonists • Miscellaneous Group Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  6. 6. Phenothiazines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Actions – Depresses various areas of the central nervous system (CNS) • Indications – Treatment of nausea and vomiting • Adverse Effects – Drowsiness
  7. 7. Nonphenothiazines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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
  8. 8. Anticholinergics/Antihistamines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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
  9. 9. Serotonin (5-HT3) Receptor Blockers Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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
  10. 10. Serotonin (5-HT3) Receptor Blockers (cont.) • Adverse Effects – Headache, drowsiness, myalgia, urinary retention, constipation, pain at the injection site Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  11. 11. Question 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
  12. 12. Answer False Rationale: Emetics cause vomiting and are no longer recommended for at-home poison control. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  13. 13. Substance P/Neurokinin 1 Receptor Antagonists Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • 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
  14. 14. Substance P/Neurokinin 1 Receptor Antagonists (cont.) • Adverse Effects – Anorexia, fatigue, constipation, diarrhea, liver enzyme elevation, dehydration Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  15. 15. Miscellaneous Antiemetics Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Actions – Varies with agent • Indications – Treatment and prevention of nausea and vomiting • Pharmacokinetics – Varies according to agent
  16. 16. Miscellaneous Agents (cont.) • Contraindications – Coma – Severe CNS depression – Brain damage or injury – Hypotension or hypertension – Severe liver dysfunction Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  17. 17. Miscellaneous Antiemetics (cont.) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Caution – Renal dysfunction – Active peptic ulcer disease – Pregnancy – Lactation • Adverse Effects – Linked to interference with normal CNS stimulation or response • Drowsiness • Dizziness • Weakness
  18. 18. Miscellaneous Antiemetics (cont.) • Adverse Effects (cont.) – Photosensitivity – Hypotension, hypertension, and cardiac arrhythmias • Drug-to-Drug Interactions Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins – Alcohol
  19. 19. Use of Drugs Affecting the Female Reproductive System Antiemetic Agents Across the Lifespan Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  20. 20. Prototype Phenothiazines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  21. 21. Prototype Nonphenothiazines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  22. 22. Prototype Anticholinergics/ Antihistamines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  23. 23. Prototype Serotonin (5-HT3) Receptor Blockers Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  24. 24. Prototype Substance P/Neurokinin 1 Receptor Antagonists Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  25. 25. Nursing Considerations for Antiemetics • Assessment: History and Physical Exam • Nursing Diagnosis • Implementation • Evaluation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  26. 26. Question 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
  27. 27. Answer 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. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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