N/V- Ochs

n/v is considered chronic if it is >__ month(s) of symptoms

n/v is considered chronic if it is >__ month(s) of symptoms

1

What should you correct before pharm tx for n/v?

electrolyte disturbances

What are the tx options for n/v?

• 5-HT3 antagonists

• phenothiazines

• antipsychotics

• antihistamines

• miscellaneous

  • metoclopramide, dexamethasone, scopolamine

What the brand/generic names of the following:

Generic	Brand
ondansetron
haloperidol
olanzapine
promethazine
Prochlorperazine
Metoclopramide
Dexamethasone

Generic	Brand
ondansetron	zofran
haloperidol	haldol
olanzapine	zxprexa
promethazine	phenergan
Prochlorperazine	compazine
Metoclopramide	reglan
Dexamethasone	decadron

Answer the following about 5-HT3 Receptor Antagonist:

• names

• side effect

• ondansetron, palonosetron, granisetron, dolasetron

  • “-setron”

• side effects: constipation, HA, hypersensitivity, QT prolongation (use alternative agent if you have)

What is classified as a prolonged QT interval in men and women?

men- >440 ms

women- >460 ms

Answer the following about phenothiazines:

• names (generic)

• side effects

• drug-drug interactions

• BBW

• promethazine, prochlorperazine

• side effects: tissue injury (promethazine), CNS/respiratory depression, anticholinergic side effects

• D/I: CNS depressants

• BBW- increased risk of mortality when used in elderly pt. dementia-related psychosis

Promethazine has a lot of safety concerns. What is the BBW for promethazine? What is the preferred ROA? What route is contraindicated? What route should be diluted prior to administration?

• BBW- severe tissue injury, including gangrene (injection)

• preferred ROA is deep IM

• SQ is CONTRAINDICATED

• if IV administration required—> dilute

Answer the following about antipsychotics:

• med names

• side effects

• BBW

• haloperidol, droperidol, olanzapine

• side effects- QT prolongation, sedation, orthostasis (w/ Olanzapine)

• BBW- increased risk of mortality when used in elderly pt. dementia-related psychosis (haloperidol, olanzapine)

• BBW- arrythmias (droperidol)

Where is the place of each antipsychotic in therapy?

• haloperidol

• droperidol

• olanzapine

• haloperidol- NOT 1st line for uncomplicated n/v (used in chemotherapy or palliative care)

• droperidol- requires EKG PRIOR TO USE w/ cardiac monitoring following use (limited to use after surgery)

• olanzapine- commonly used for n/v in chemotherapy

Ochs- “used for niche areas”

Answer the following about Metoclopramide:

• Place in therapy

• side effects

• BBW

• place in therapy: often used in n/v associated w/ diabetic gastroparesis, and alternative agent for acute n/v

• side effects- EPS, CNS depression, sedation

• BBW- TARDIVE DYSKINESIA, avoid tx for >12 weeks due to increased risk w/ prolonged use

Answer the following about dexamethasone:

• place in therapy

place in therapy- chemotherapy or post-op N/V, NOT for simple n/v due to metabolic risk

What is cannabinoid hyperemesis syndrome? How does it present? What is the main tx?

• presents as cyclic n/v associated with PROLONGED, REGULAR CANNABIS USE

  • basically: n/v from smoking so often

• main tx: cessation of cannabis and “tolerance breaks”

  • can also use pharm

What is the pharm tx for cannabinoid hyperemesis syndrome? Which is preferred?

• Ondansetron (PREFERRED)

• others: metoclopramide, lorazepam, topical capsaicin

• (if all else fails: droperidol/haloperidol)

Which is the non-pharm tx for cannabinoid hyperemesis syndrome?

hot water baths/showers

Persistent vomiting can lead to dehydration, which can lead to what electrolyte imbalance?

hypokalemia

Hypokalemia can also be caused by _______ diuretics or hypo___________.

loop diuretics or hypomagnesemia

What is tx for hypokalemia?

• potassium repletion or Mg repletion (if hypomagnesemia is the cause)

• (KCl 10 mEq PO or IV)

PRACTICE:

Which antiemetic medications can prolong QTc interval?

• olanzapine

• ondansetron

• haloperidol

• droperidol

PRACTICE:

Which antiemetic medication has a BBW for severe tissue injury? What ROA is contraindicated?

• Promethazine (Phenergan)

• SQ is C/I

PRACTICE:

What antiemetic agent has prokinetic effects that can support use in diabetic gastroparesis? What is the BBW for this medication?

• Metoclopramide

• BBW- Tardive Dyskinesia

PRACTICE:

What is the preferred pharm tx for cannabinoid hyperemesis syndrome? What is the preferred non-pharm?

pharm tx- ondansetron (Zofran)

nonpharm tx- hot bath/shower

Which antiemetics are available for rectal administration?

• promethazine

• prochlorperazine