ANTIEMETICS

ALCANTARA, BAARDE, DAQUER,MELLOMEDA

ANTIEMETICS 

ANTIEMETIC AGENTS (Anti-emetic) -is the drug used in the management of nausea and vomiting, -it can be centrally acting or locally acting, and they have varying degrees of effectiveness.  Mechanism of Action: Works by reducing the hyperactivity of the vomiting reflex in one of two ways: locally, to decrease the local response to stimuli that are being sent to the medulla to induce vomiting, or centrally, to directly block the CTZ or suppress the vomiting center.

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ANTIEMETICS

Agents:  Phenothiazines  Nonphenothiazine  Anticholinergics/Antihistamines  Miscellaneous drugs  5-HT3 Receptor blockers

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ANTIEMETICS 
Indication: The centrally acting antiemetics change the responsiveness or stimulation of the CTZ in the medulla. The phenothiazines are recommended for the treatment of nausea and vomiting, including that specifically associated with anesthesia; severe vomiting, intractable hiccoughs, which occur with repetitive stimulation of the diaphragm and lead to persistent diaphragm spasm; and nausea and vomiting. The anticholinergics that act as antihistamines are recommended for the nausea and vomiting associated motion sickness or vestibular (inner ear) problems. Some of these agents are available over the counter in a reduced dose HT3 receptor blockers are specific for the treatment of nausea and vomiting associated with emetogenic therapy. These are relatively new drugs, and the drug of choice depends on personal preference and experience.

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ANTIEMETICS 

Contraindication: In general, antiemetics should not be used in patients with coma or severe CNS depression, or in those who have experience brain damage or injury because of the risk of further CNS depression. Other contraindications include severe hypotension or hypertension and severe liver dysfunction, which might interfere with the metabolism of the drug. Caution should be used when individuals with renal dysfunction, active peptic ulcer, or pregnancy and lactation.

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ANTIEMETICS 
Common Drugs: Phenothiazines  chlorprozamine (Thorazine)  perphenazine (Trilafon)  prochlorperazine (Compazine)  promethazone (Phenergan)  thiethylperazine (Torecan)  triflupromazine (Vesprin)  Nonphenothiazine  metoclopropamide (Reglan) Anticholinergics/Antihistamines  buclizine (Bucladin-S)  cyclizine (Marezine)  meclizine (Antiverf)

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ANTIEMETICS 

5-HT3 Receptor blockers  dolasetran (Anzemef)  granisetron (Kytril)  ondansetron (Zofran)  Miscellaneous drugs  dronabinol (Marinol)  hydroxyzine (generic)  trimethobenzamide (Tigan)

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ANTIEMETICS

Drug-to-drug interaction: Additive CNS depression can be seen with any of the antiemetics if they are combines with other CNS depressants, including alcohol. Patients should be advised to avoid this combination and any over-thecounter preparation unless they check with their health care provider.

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ANTIEMETICS

Classification: Anti-emetic Nursing Considerations: a. Assessment: History and Examination  Screen for the following considerations, which could be cautions or contraindications to the use of the drug: history of allergy to antiemetic; impaired renal or hepatic function; pregnancy or lactation; coma or semiconscious state, CNS depression, hypotension or hypertension; active peptic ulcer; and CNS injury. Include screening for orientation, affect, and reflexes; baseline pulse and blood pressure; skin lesions and color; liver and abdominal examination; and liver and renal function tests. 

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ANTIEMETICS
b. Nursing Diagnoses  The patient receiving an antiemetic may have the following nursing diagnoses related to drug therapy:  acute pain r/t CNS, skin, and GI effects  risk for injury r/t to CNS effects  decreased cardiac output r/t to cardiac effects  deficient knowledge regarding drug therapy c. Implementation:  Assess the patient carefully for any potential drug-drug interactions if giving antiemetic in combination with other drugs, to avert potentially serious drug-drug interactions.  Provide comfort and safety measures, including mouth care, ready access to bath room facilities, assistance with ambulation and periodic orientation, ice chips to suck, protection from sun exposure, and remedial measures to treat dehydration if it occurs, to protect patient form injury and to increase patient comfort.  Provide support and encouragement, as well as other measures (quiet environment, carbonated drinks, deep breathing), to help the patient cope with the discomfort of nausea and vomiting and drug effects.  Provide thorough patient teaching, including name of drug, dosage prescribed, proper administration, measures to avoid adverse effects, warning signs of problems, the importance of periodic monitoring and evaluation, and the need to avoid overdose and poisoning, to enhance patient knowledge about drug therapy and promote compliance with the drug regimen.
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ANTIEMETICS
d. Evaluation:  Monitor patient response to the drug (relief of nausea and vomiting).  Monitor for adverse effects (dizziness, confusion, GI alterations, cardiac arrhythmias, hypotension, and gynecomastia).  Evaluate effectiveness of teaching plan (patient can name the drug and dosage as well as describe adverse effects to watch for and specific measures to avoid these adverse effects).  Side effects:  Drowsiness or dizziness  Do not drive a car or operate dangerous equipment, such as lawnmowers or electric saws.  Headache  Talk to your doctor about a pain reliever.  Restlessness and jitteriness  Difficulty swallowing or speaking, spasms in the neck and face muscles, tightness in the neck or back muscles and difficulty walking  Constipation  If any of these symptoms occur, call your doctor. Your doctor will determine if these symptoms are related to your current medication, and whether a different medication may be more appropriate for you.

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