Ch 62 Pharm

Front 1

____________ drugs are used to prevent or treat nausea and vomiting.

Back 1

Antiemetic

Front 2

___________ is an unpleasant sensation of abdominal discomfort accompanied by a desire to vomit.

Back 2

Nausea

Front 3

________ is the expulsion of stomach contents through the mouth.

Back 3

Vomit

Front 4

Nausea and vomiting are the most common ____________ of drug therapy.

Back 4

Adverse effects

Front 5

Vomiting occurs when the _________ a nucleus of cells in the medulla oblongata is stimulated

Back 5

Vomiting center

Front 6

Prokinetic agent that increases GI motility and the rate of gastric emptying by peripheral cholinergic effects

Back 6

Metoclopramide (Reglan)

Front 7

Effective in preventing or treating nausea and vomiting induced by drugs radiation therapy surgery and most other stimuli

Back 7

Prochlorperazine (Compazine)

Front 8

Often prescribed for patients who experience anticipatory nausea and vomiting before administration of anticancer drugs.

Back 8

Lorazapam (Ativan)

Front 9

Commonly used in the management of chemotherapy induced emesis and poster-operative nausea and vomiting.

Back 9

Dexamethasone and methylprednisolone

Front 10

Antagonized serotonin receptors preventing their activation by the effects of emetogenic drugs and toxins.

Back 10

Ondanstron (zofran), Ganisetron (Kytril) Dolasetron (Anzemet), and palonosetron (Aloxi)

Front 11

What drugs are most commonly associated with the adverse effects of nausea and vomiting.

Back 11

Nausea and vomiting are the most common adverse effects of drug therapy. Although the symptoms may occur with most drugs they are especially associated with alcohol, aspirin digoxin, anticancer drugs antimcrobials, estrogen preparations and opioid analgesics.

Front 12

Identify three causes other than drugs that may produce nausea and vomiting.

Back 12

Nausea and vomiting may be caused by pain and other noxious stimuli such as unpleasant sights and odors; emotional disturbances; physical or mental stress; radiation therapy; motion sickness; postoperative status which may include pain impaired GI motility; and pregnancy.

Front 13

Located in the vomiting center CTZ, and GI tract which are stimulated by emetogenic drugs and toxins.

Back 13

The vomiting center and the GI track contain benzodiazepine, cholinergic, dopamine, histamine, opiate, substance P/neurokinin, and serotonin receptors which are stimulated by emetogenic drugs and toxins.

Front 14

Describe the physiologic process that occur during vomiting beginning with the stimulation of the vomiting center and ending with the stomach contents arriving toward the mouth for ejection.

Back 14

When stimulated the vomiting center initiates efferent impulses that stimulate the salivary center causing closure of the glottis; contraction of abdominal muscles and the diaphragm; relaxation of the gastroesophageal sphincter; and reverse peristalsis, which moves stomach contents toward the mouth for ejection.

Front 15

Define the term anticipatory nausea.

Back 15

Anticipatory nausea is triggered by memories and fear of nausea and vomiting is mediated by afferent signals from the higher centers of the cerebral cortex to the vomiting center.

Front 16

How does metoclopramide decrease nausea and vomiting? How is metoclopramide typically used?

Back 16

Metoclopramide (Reglan) is a prokinetic agent that increases GI motility and the rate of gastric emptying by increasing the release of acetylcholine from nerve endings in the GI tract (peripheral cholinergic effects). Historically, metoclopramide has been used intravenously during chemotherapy with cisplatin (Platinol) and other antineoplastic drugs to treat acute nausea and vomiting; however, 5 - HT3 receptor antagonists are now the preferred antiemetic for this indication.

Front 17

What can you tell Mrs. Homan about when the effect of the medication begins and how long it lasts?

Back 17

With oral administration of metoclopramide action begins in 30 to 60 mins and peaks in 60 to 90 mins. With IM use, action onset occurs in 10 to 15mins and peaks in 60 to 90 mins. with IV use action onset occurs in 1 to 3 mins and peaks in 60 to 90 mins.

Front 18

Mrs Homan remains on the metoclopramide after chemotherapy for residual symptoms related to gastroparesis. Two years later she develops Parkinson's disease. What would you expect teh physician to do with Mrs. Holmans metoclopramide prescription?

Back 18

The sedation that the drug causes many affect her ability to return to work. Other averse effects include restlessness and extrapyramidal reaction (ex akathisia, dystonia, symptoms of prkinsons disease). Metoclopramide. Metoclopramide may increase the effects of alcohol and cyclopporine (by increasing their absorption and decrease the effects of cimetidine and digoxin (by accelerating passage through the GI tract and decreasing time for absorption.)

Front 19

Mrs. Jenks is going on a cruise to Nova Scotia with her husband to celebrate their 15th wedding anniversary. She is concerned because she has experienced severe debilitating sea sickness in the past. Which of the following would you expect the physician to order?

a. Scopolamine

b. Dexamethasone

c. Metoclopramide

d. Ondansetron

Back 19

a

Rationale: Scopolamine is a anticholinergic drug that is effective in relieving nausea and vomiting associated with motion sickness and radiation therapy for cancer.

Front 20

Mrs. Blanching is receiving chemotherapy to treat her cancer. Several antiemetics have been prescribed and each has been unsuccessful in treating her nausea and vomiting. The physician chooses to prescribe which of the following cannabinoid drug to manage her symptoms?

a. Scopolamine

b. Metoclopramide

c. Ondansetron

d. Dronabinol

Back 20

d

Rationale: Dronabinol is a cannabinoid used in the management of nausea and vomiting associated with chemotherapy unrelieved by other antiemetic drugs. It is a Schedule III drug under federal narcotic laws.

Front 21

Which of the following drugs antagonizes the neurokinin 1 receptor preventing activation by emetogenic chemotherapuetic drugs:

a. Metoclopramide

b. Aprepitant

c. Ondansetron

d. Dronadinol

Back 21

b

Ratonale: Subtance P a peptide neurotransmitter in the neurokinin family plays a role in acute and delayed chemotherapy induced nausea and vomiting. A precipitation antagonizes the neurokin 1 receptor preventing activation by emetogenic chemotherapeutic drugs.

Front 22

Which of the following drugs is a prokinetic agent that functins by increasing the release of acetycholine from nerve endings in the GI tract thereby increasing GI motility and gastric emptying?

a. Metoclopramide

b. Aprepitant

c. Ondansetron

d. Dronabinol

Back 22

a

Rationale: Prokinetic agents such as metoclopramide increase the release of acetylcholine from never endings in the GI tract, thereby increasing GI motility and gastric emptying. Metoclopramide also antagonizes dopamine in the brain. It is prescribed to treat nausea and vomiting associated with gastroparesis and other non obstructive disorders characterized by gastric retention of food and fluids, and in the treatment of esophageal reflux. It is also useful in prevention of delayed nausea and vomiting associated with chemotherapy.

Front 23

Mrs. Gantry prepares to begin her second round of chemotherapy. She tells the physician that she knows that the nausea and vomiting will be worse this time around. The physician orders lorazepam because it has which of the following effects? (select all that apply)

a. Producing relaxation

b. relieving anxiety

c. Inhibiting cerebral cortex input to the vomiting center

d. Creating a sense of euphoria

Back 23

a, b, d

Rationale: Benzodiazepines such as lorazepam produce relaxation relieve anxiety and inhibit cerebral cortex input to the vomiting center. They are prescribed for anticipatory nausea associated with cancer chemotherapy.

Front 24

Which of the following medications may be used in combination with a 5 HT3 serotonin receptor antagonist to manage chemotherapy induced emesis?

a. Scopolamine

b. Dexmethasone

c. Metoclopramide

d. Ondansetron

Back 24

b

Rationale: The antiemetic mechanism of action of corticosteroids such as dexmethasone and methylprednisolone is unknown. These drugs are commonly used alone or in combination with 5 HT3 serotonin receptor antagonists and or substance P / neurokinin 1 receptor antagonists in the management of chemotherapy induced emesis and postoperative nausea and vomiting.

Front 25

Antiemetic drugs are most effective when given ________ nausea and vomiting occurs.

Back 25

Before

Front 26

what tasks are included in the role of the home care nurse visiting a client who is receiving antiemetics? (select all that appy)

a. Assessing patients for possible causes of nausea and vomiting

b. Assisting patients and caregivers with appropriate use of the drugs

c. Providing interventions to prevent fluid and electrolyte depletion.

d. Administering all antiemetics to clients who experience nausea and vomiting.

Back 26

a, b, c

Rationale: Antiemetics are usually given orally or by rectal suppository in the home setting. The home care nurse may need to assess patients for possible causes of nausea and vomiting and assist patients and caregivers to prevent fluid and electrolyte depletion. Teaching safety precautions with seating drugs may also be needed.

Front 27

As a result of chemotherapy, Mr. Redford experiences hepatic dysfunction. Part of the clients medication regimen includes the use of phenothiazines. Which of the following would you expect the physician to do?

a. Use an alternative medication

b. Increase the dose of the medication.

c. Decrease the dose of the medication

d. Maintain the current dose of the medication

Back 27

a

Rationale: Phenothizaines are metabolized in the liver and elimination half lives prolonged with resultant accumulation and increased risk of adverse effects. Therefore, the drugs should be used cautiously in patients with hepatic impairment. Cholestatic jaundice has been reported with promethazine.

Front 28

Most antiemetic drugs are metabolized in the liver and should be used cautiously in patients with impaired hepatic function. For clients diagnosed with hepatic impairment the dose of ondansetron should not exceed which of the following amounts?

a. 8mg

b. 6mg

c. 10mg

d. 12mg

Back 28

a

Rationale: Most antiemetic drugs are metabolized in the liver and should be used cautiously in patients with impaired hepatic function. Which oral ondansetron, do not exceed an 8mg dose; with IV use a single maximal daily dose of 8mg is recommended.

Front 29

As an adverse effect on her chemotherapy, Mrs. Pearson develops moderate to severe renal impairment. She routinely takes metoclopramide for chemotherapy related nausea and vomiting with success and does not wish to change drugs. Which of he following would you expect the physician to do?

a. Maintain the current dose of the metoclopramide

d. Decrease the dosage of the metoclopramide

c. Increase the dosage of the metoclopramide

d. Discontinue the metoclopramide

Back 29

b

Rationale: Metoclopramide dosage should be reduced in patients with severe renal impairment to decrease drowsiness and extra-pyramidal effects.

Front 30

Mr. Benjamin age 75 develops nausea and vomiting secondary to administration of a new drug regimen to treat his Parkinson's disease. He is at risk for which of the following?

a. Increased extra-pyramidal effects

b. Fluid and electrolyte imbalance

c. Prostatisis

d. Anxiety induced vomiting

Back 30

b

Rationale: Most antiemetic drugs cause drowsiness especially in older adults and therefore should be used cautiously. Efforts should be made to prevent nausea and vomiting when possible. Older adults are at risk of fluid volume depletion and electrolyte imbalances with vomiting.

Front 31

The American Society of Clinical Oncology recommends that use of which of the following drug combination before administration of high dose chemotherapy or chemotherapy with high to moderate emetic risk to pediatric oncology patients?

a. a 5 HT3 receptor antagonists plus a phenothiazine.

b. An 5 HT3 receptor antagonist plus a anti anxiety agent.

c. An 5 HT3 receptor antagonists plus a cannabiniod.

d. An 5 HT3 receptor antagonist plus a corticosteroid.

Back 31

d

Rationale: The American Society of clinical oncology recommends the use of a 5 HT3 receptor antagonist plus a corticosteroid before administration of high dose chemotherapy or chemotherapy with high to moderate emetic risk to pediatric oncology patients.

Front 32

A black box warning alerts nurses that promethazine is contraindicated in children younger than 2 yrs of age because of which of the following risks?

a. Fetal hypovolemia secondary to hemorrhage

b. Life threatening cardiac dysrhythmias

c. Fatal respiratory depression

d. Fatal hypertension and subsequent cerebral vascular accident.

Back 32

c

Rationale: A black box warning alerts nurses that promethazine is contraindicated in children younger than 2 yrs of age because of the risk potentially fatal respiratory depression. When using promethazine the lowest effective dosage should be used and other drugs with respiratory depressant effects should not be given concurrently. Excessive doses may cause hallucinations convulsions and sudden death.

Front 33

The ___________ ___________ _________ are usually considered the most effective antiemetics. They may be given in a single daily dose.

Back 33

5 HT3 receptor antagonists

Front 34

If nausea and vomiting are likely to occur because of travel, administration of emetogenic anticancer drugs diagnostic test or therapeutic procedures an emetic drug should be given before the emetogenic event. Pretreatment has which of the following effects? (select all that apply)

a. Increasing patient comfort

b. Allowing use of lower drug doese

c. Possibly preventing aspiration

d. Possibly preventing extra-pyramidal symptoms.

Back 34

a, b, c

Rationale: If nausea and vomiting are likely to occur because of travel administration of emetrogenic anticancer drugs diagnostic test or therapeutic procedures an antiemetic drug should be given before the emetogenic event. Pretreatment usually increases patient comfort and allows use of lower drug doses. It also may prevent aspiration and other potentially serious complications of vomiting.

Front 35

A client is experiencing nausea and vomiting related to non obstructive gastric retention after abdominal surgery. Which of the following would you expect the physician to order?

a. Scopolamine

b. Dexamethasone

c. Metoclopramide

d. Ondasetron

Back 35

c

Rationale: Metoclopramide (Reglan) may be preferred when nausea and vomiting are associated with non obstructive gastric retention.

Front 36

A client develops labyrinthitis. What would you expect the physician to order?
a. Scopolamine

b. Dexamethasone

c. Metoclopramide

d. Meclizine

Back 36

d

Rationale: Antihistamines such as meclizine and dimenhydrinate are useful for vomiting caused by labyrinthitis, uremia, or post operative status.

Front 37

Promethazine (phenergan) a phenothiazine is often used clinically for its ________________ antiemetic and sedative effects.

Back 37

antihistaminic