Antiemetics - Parker

Tx for migraines with HA and Nausea

metoclorpramide or prohlorperazine, D2R antag

TX for migraines nausea only

oral antiemetics

metoclopramide

prochlorperazine

serotonin antags

vestibular nausea tx

antihistamines, anticholinergics (scopolamine)

Preg Nausea TX

Ginger

Vit B6, pyridoxamine, doxylamine

hyperemesis gravidarum tx 1st and 2nd line

1st- promethazine

2nd- 5HT antag and corticosteroids

gastroenteritis tx

dopamine antag

postop N/V prevention

5HT3 antag

droperidol

dexamethasone

postop N/V tx

DA antag

5HT antag

dexamethasone

substituted benzamines

use for gastroparesis

3rd line for N/V

BBW→ tardive dyskinesia

metoclopramide

trimethobenzamide

antipsychotics with antiemetic and sedative properties

2nd line for n/v

phenothiazines

Highly! sedative

neuroleptic malignant syndrome

promethamzine,

-perazines (prochlor- and thiethyl-)

butyrophenes

antipsychotics

4/5th line for N/V

highly sedatives

prolonged QT

EPS

haloperiodol

droperidol

use for emesis from vagal stimulation (postop) and chemo

5HT3 receptor antag in vomiting center and chemotrigger zone

1st line in N/V related to chemo

extensice hepatic metabolism

QT prolongation

HA

constipation

serotonin syndrome (high body temp, agitation, increased reflexes, tremor, sweating, dilated pupils, diarrhea)

-setrons (ondansetron, etc)

NV assoc with chemo in those who have failed traditional therapy

cannabinoids

droNABINol

NABIlone

motion sickeness tx

vestibular disturbances like positional vertigo

AE sedation

antihistamines H1 centrally acting

dimenhydrinate, diphenhydramine, cyclizine, hydroxyzine, meclizine, doxylamine

only med approved for NV in pregnancy

diclegis= pyridoxine + doxylamine (b6 + antihistamine)

what can’t 2nd and 3rd gen antihistamines be used for N/V

they don’t cross BBB

neurokinin receptor antagonist

central blockade in area postrema

NK1 highly selective antag

cross BBB occupy NK1 receptor

-pitants (aprepitant)

AE of NK1R antags

fatigue

decreased INR in warfarin pts

cyp3a4 inhib

reacts with dexamethasone

reduced effectiveness of contraceptives

which drugs enhance efficacy of 5HT3 receptor antagonists

corticosteroids

deamethasone, methylprednison, prednison

MOA of benzodiazepens

increase freq of Cl conductance by binding GABAa complex

useful in vomiting from fear, anxiety, memory

benzos

which drug can help with Meniere’s disease NV

benzo, esp diazepam

AE benzo

dose related CNS depression

increased sensitivity in elderly

addiction potential

1st line to prevent motion sickness

muscarinic receptor antag, scopalamine