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Antinausea

  • Nausea - sensation of abdominal discomfort intermittently and the desire to vomit

  • Vomiting (emesis) - forceful expulsion of gastric contents out of the mouth

  • Regurgitation - rising of gastric or esophageal contents to the pharynx as a result of stomach pressure

  • Vomiting center (vc) located in medulla, coordinates the vomiting reflex

    • Nerves from the pharynx, stomach, intestinesm and other tissues connect to vc via vagus and splanchnic nerves

    • Vc responds to cerebral cortex, inner ear, and blood

  • Causes of Nausea and Vomiting

    • Postoperative (PONV), motion sickness, pregnancy (morning sickness & hyperemesis gravidarum)

    • Psychogenic - vomiting in response to threatening or distasteful situations

    • Chemotherapy (CINV) - anticipatory, acute CINV, delayed emesis

    • Radiation (RINV) - associated w/ high-energy radiation, external or implanted

  • Drug Therapy

    • PONV - multimodal treatment, hydration, supplemental oxygen, combination of antiemetics, NG tube (to prevent abdominal distension)

    • Motion sickness - most meds chemically related to antihistamine/anticholinergic

    • Psychogenic (diagnosis made after other cause eliminated) - metoclopramide or anti anxiety med

    • Pregnancy - diet, antihistamines (diphenhydramine, meclizine, promethazine), phenothiazines, ginger

    • CINV - combination of meds b/c emesis 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)

      • Should be treated preventally

    • Anticipatory - benzodiazepin, muscle relaxation, mind diversion, hypnosis, systematic desensitization

    • Delayed emesis - combo of prochlorperazine, lorazepam, diphenhydramine PO 1hr before meals

    • RINV - granisetron, ondansetron, serotonin antagonists

  • Nursing process

    • Assessment - history , baseline vitals, hydration status, labs

    • Implementation - prescribed diet, progression of diet, stop solid foods, PO hydration solutions/clear liquids, NPO/NG tube (infants - milk and solids dq (liquids q 30-60 mins)

      • Scheduled meds

  • Dopamine Antagonists

    • Drugs - phenothiazines, butyrophenones, metoclopramide (reglan)

    • Inhibits dopamine receptors that are a part of the pathway to VC

    • Treats mild-moderate nausea and vomiting associated w/ anesthesia, surgery, radiation therapy, chemo

  • Serotonin Antagonists

    • Blocks the serotonin 5-HT receptors located in the chemoreceptor trigger zone of the medulla and in specialized cells of the GI tracts

    • Treats nausea and vomiting associated w/ chemo, radiation, PONV

    • ADVERSE EFFECTS - headache, diarrhea, constipation, sedation

  • Anticholinergic Agents

    • Counterbalances excessive amounts of acetylcholine thought to cause motion sickness

    • Treats motion sickness, nausea and vomiting associated w/ pregnancy

    • ADVERSE EFFECTS - anticholinergic effects (rapid pulse, dry), sedative effects

  • Corticosteroids - dexamethasone (decadron, hexadrol), methylprednisolone (solu/depo Medrol)

    • Mechanism of action unknown

    • In combo w/ other antiemetics to relieve nausea and vomiting (can used alone)

  • Benzodiazepines - lorazepam (ativan), diazepam (valium)

    • Combination of effects - sedation, reduction in anxiety, depression of vc, amnesic effect

    • ADVERSE EFFECTS - over sedation (hypoventilation)

Antinausea

  • Nausea - sensation of abdominal discomfort intermittently and the desire to vomit

  • Vomiting (emesis) - forceful expulsion of gastric contents out of the mouth

  • Regurgitation - rising of gastric or esophageal contents to the pharynx as a result of stomach pressure

  • Vomiting center (vc) located in medulla, coordinates the vomiting reflex

    • Nerves from the pharynx, stomach, intestinesm and other tissues connect to vc via vagus and splanchnic nerves

    • Vc responds to cerebral cortex, inner ear, and blood

  • Causes of Nausea and Vomiting

    • Postoperative (PONV), motion sickness, pregnancy (morning sickness & hyperemesis gravidarum)

    • Psychogenic - vomiting in response to threatening or distasteful situations

    • Chemotherapy (CINV) - anticipatory, acute CINV, delayed emesis

    • Radiation (RINV) - associated w/ high-energy radiation, external or implanted

  • Drug Therapy

    • PONV - multimodal treatment, hydration, supplemental oxygen, combination of antiemetics, NG tube (to prevent abdominal distension)

    • Motion sickness - most meds chemically related to antihistamine/anticholinergic

    • Psychogenic (diagnosis made after other cause eliminated) - metoclopramide or anti anxiety med

    • Pregnancy - diet, antihistamines (diphenhydramine, meclizine, promethazine), phenothiazines, ginger

    • CINV - combination of meds b/c emesis 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)

      • Should be treated preventally

    • Anticipatory - benzodiazepin, muscle relaxation, mind diversion, hypnosis, systematic desensitization

    • Delayed emesis - combo of prochlorperazine, lorazepam, diphenhydramine PO 1hr before meals

    • RINV - granisetron, ondansetron, serotonin antagonists

  • Nursing process

    • Assessment - history , baseline vitals, hydration status, labs

    • Implementation - prescribed diet, progression of diet, stop solid foods, PO hydration solutions/clear liquids, NPO/NG tube (infants - milk and solids dq (liquids q 30-60 mins)

      • Scheduled meds

  • Dopamine Antagonists

    • Drugs - phenothiazines, butyrophenones, metoclopramide (reglan)

    • Inhibits dopamine receptors that are a part of the pathway to VC

    • Treats mild-moderate nausea and vomiting associated w/ anesthesia, surgery, radiation therapy, chemo

  • Serotonin Antagonists

    • Blocks the serotonin 5-HT receptors located in the chemoreceptor trigger zone of the medulla and in specialized cells of the GI tracts

    • Treats nausea and vomiting associated w/ chemo, radiation, PONV

    • ADVERSE EFFECTS - headache, diarrhea, constipation, sedation

  • Anticholinergic Agents

    • Counterbalances excessive amounts of acetylcholine thought to cause motion sickness

    • Treats motion sickness, nausea and vomiting associated w/ pregnancy

    • ADVERSE EFFECTS - anticholinergic effects (rapid pulse, dry), sedative effects

  • Corticosteroids - dexamethasone (decadron, hexadrol), methylprednisolone (solu/depo Medrol)

    • Mechanism of action unknown

    • In combo w/ other antiemetics to relieve nausea and vomiting (can used alone)

  • Benzodiazepines - lorazepam (ativan), diazepam (valium)

    • Combination of effects - sedation, reduction in anxiety, depression of vc, amnesic effect

    • ADVERSE EFFECTS - over sedation (hypoventilation)

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