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Antiemetic Agents 
Chapter 59 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nausea and Vomiting 
• Most common and most uncomfortable complaints. 
• Vomiting is a complex reflex reaction to various stimuli. 
• In some cases, it may be desired to induce vomiting. 
• In many clinical conditions, the reflex reaction of 
vomiting is not beneficial. 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Managing Nausea and Vomiting 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 
• Emetics 
– Cause vomiting 
– No longer recommended for at-home poison control 
• Antiemetics 
– Decrease or prevent nausea and vomiting 
– Centrally acting or locally acting 
– Varying degrees of effectiveness
Sites of Action of Emetics/Antiemetics 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Groups of Centrally Acting Antiemetics 
• Phenothiazines 
• Nonphenothiazines 
• Anticholinergics/Antihistamines 
• Serotonin (5-HT3) Receptor Blockers 
• Substance P/Neurokinin 1 Receptor Antagonists 
• Miscellaneous Group 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Phenothiazines 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 
• Actions 
– Depresses various areas of the central nervous 
system (CNS) 
• Indications 
– Treatment of nausea and vomiting 
• Adverse Effects 
– Drowsiness
Nonphenothiazines 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 
• Actions 
– Acts to reduce the responsiveness of the nerve cells 
in the CTZ to circulating chemicals that induce 
vomiting 
• Indications 
– Prevention of nausea and vomiting 
• Adverse Effects 
– Drowsiness 
– Fatigue 
– Restlessness 
– Extrapyramidal symptoms
Anticholinergics/Antihistamines 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 
• Actions 
– Anticholinergics that act as antihistamines and block the 
transmission of impulses to the CTZ 
• Indications 
– Prevention and treatment of nausea and vomiting 
• Adverse Effects 
– Drowsiness 
– Confusion 
– Dry mouth 
– Anorexia 
– Urinary frequency
Serotonin (5-HT3) Receptor Blockers 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 
• Actions 
– Block those receptors associated with nausea and 
vomiting in the CTZ and locally 
• Indications 
– Control of nausea and vomiting 
• Pharmacokinetics 
– Rapidly absorbed, metabolized in the liver, and 
excreted in urine and feces 
• Caution 
– Pregnancy and lactation
Serotonin (5-HT3) Receptor Blockers 
(cont.) 
• Adverse Effects 
– Headache, drowsiness, myalgia, urinary retention, 
constipation, pain at the injection site 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question 
Please answer the following statement as true or false. 
Emetic medications are used to induce vomiting and should 
be kept in the home in case of an accidental poisoning. 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer 
False 
Rationale: Emetics cause vomiting and are no longer 
recommended for at-home poison control. 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Substance P/Neurokinin 1 Receptor 
Antagonists 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 
• Actions 
– Act directly in the CNS to block receptors associated 
with nausea and vomiting 
• Indications 
– In combination with other agents to prevent nausea 
and vomiting 
• Pharmacokinetics 
– Given orally, metabolized in the liver, and excreted in 
urine and feces
Substance P/Neurokinin 1 Receptor 
Antagonists (cont.) 
• Adverse Effects 
– Anorexia, fatigue, constipation, diarrhea, liver 
enzyme elevation, dehydration 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Miscellaneous Antiemetics 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 
• Actions 
– Varies with agent 
• Indications 
– Treatment and prevention of nausea and vomiting 
• Pharmacokinetics 
– Varies according to agent
Miscellaneous Agents (cont.) 
• Contraindications 
– Coma 
– Severe CNS depression 
– Brain damage or injury 
– Hypotension or hypertension 
– Severe liver dysfunction 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Miscellaneous Antiemetics (cont.) 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 
• Caution 
– Renal dysfunction 
– Active peptic ulcer disease 
– Pregnancy 
– Lactation 
• Adverse Effects 
– Linked to interference with normal CNS stimulation or 
response 
• Drowsiness 
• Dizziness 
• Weakness
Miscellaneous Antiemetics (cont.) 
• Adverse Effects (cont.) 
– Photosensitivity 
– Hypotension, hypertension, and cardiac arrhythmias 
• Drug-to-Drug Interactions 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins 
– Alcohol
Use of Drugs Affecting the Female 
Reproductive System Antiemetic Agents 
Across the Lifespan 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Phenothiazines 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Nonphenothiazines 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Anticholinergics/ 
Antihistamines 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Serotonin (5-HT3) Receptor 
Blockers 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Prototype Substance P/Neurokinin 1 
Receptor Antagonists 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Considerations for Antiemetics 
• Assessment: History and Physical Exam 
• Nursing Diagnosis 
• Implementation 
• Evaluation 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Question 
What is an anticholinergic antiemetic recommended for 
vestibular (inner ear) problems? 
A. Granisetron 
B. Meclizine 
C. Palonosetron 
D. Perphenazine 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer 
B. Meclizine 
Rationale: These drugs—buclizine, cyclizine and meclizine - 
are anticholinergics that act as antihistamines and block 
the transmission of impulses to the CTZ. They are 
recommended for the nausea and vomiting associated 
with motion sickness or vestibular (inner ear) problems. 
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

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Ppt chapter 59

  • 1. Antiemetic Agents Chapter 59 Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 2. Nausea and Vomiting • Most common and most uncomfortable complaints. • Vomiting is a complex reflex reaction to various stimuli. • In some cases, it may be desired to induce vomiting. • In many clinical conditions, the reflex reaction of vomiting is not beneficial. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 3. Managing Nausea and Vomiting Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Emetics – Cause vomiting – No longer recommended for at-home poison control • Antiemetics – Decrease or prevent nausea and vomiting – Centrally acting or locally acting – Varying degrees of effectiveness
  • 4. Sites of Action of Emetics/Antiemetics Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 5. Groups of Centrally Acting Antiemetics • Phenothiazines • Nonphenothiazines • Anticholinergics/Antihistamines • Serotonin (5-HT3) Receptor Blockers • Substance P/Neurokinin 1 Receptor Antagonists • Miscellaneous Group Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 6. Phenothiazines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Actions – Depresses various areas of the central nervous system (CNS) • Indications – Treatment of nausea and vomiting • Adverse Effects – Drowsiness
  • 7. Nonphenothiazines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Actions – Acts to reduce the responsiveness of the nerve cells in the CTZ to circulating chemicals that induce vomiting • Indications – Prevention of nausea and vomiting • Adverse Effects – Drowsiness – Fatigue – Restlessness – Extrapyramidal symptoms
  • 8. Anticholinergics/Antihistamines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Actions – Anticholinergics that act as antihistamines and block the transmission of impulses to the CTZ • Indications – Prevention and treatment of nausea and vomiting • Adverse Effects – Drowsiness – Confusion – Dry mouth – Anorexia – Urinary frequency
  • 9. Serotonin (5-HT3) Receptor Blockers Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Actions – Block those receptors associated with nausea and vomiting in the CTZ and locally • Indications – Control of nausea and vomiting • Pharmacokinetics – Rapidly absorbed, metabolized in the liver, and excreted in urine and feces • Caution – Pregnancy and lactation
  • 10. Serotonin (5-HT3) Receptor Blockers (cont.) • Adverse Effects – Headache, drowsiness, myalgia, urinary retention, constipation, pain at the injection site Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 11. Question Please answer the following statement as true or false. Emetic medications are used to induce vomiting and should be kept in the home in case of an accidental poisoning. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 12. Answer False Rationale: Emetics cause vomiting and are no longer recommended for at-home poison control. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 13. Substance P/Neurokinin 1 Receptor Antagonists Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Actions – Act directly in the CNS to block receptors associated with nausea and vomiting • Indications – In combination with other agents to prevent nausea and vomiting • Pharmacokinetics – Given orally, metabolized in the liver, and excreted in urine and feces
  • 14. Substance P/Neurokinin 1 Receptor Antagonists (cont.) • Adverse Effects – Anorexia, fatigue, constipation, diarrhea, liver enzyme elevation, dehydration Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 15. Miscellaneous Antiemetics Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Actions – Varies with agent • Indications – Treatment and prevention of nausea and vomiting • Pharmacokinetics – Varies according to agent
  • 16. Miscellaneous Agents (cont.) • Contraindications – Coma – Severe CNS depression – Brain damage or injury – Hypotension or hypertension – Severe liver dysfunction Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 17. Miscellaneous Antiemetics (cont.) Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins • Caution – Renal dysfunction – Active peptic ulcer disease – Pregnancy – Lactation • Adverse Effects – Linked to interference with normal CNS stimulation or response • Drowsiness • Dizziness • Weakness
  • 18. Miscellaneous Antiemetics (cont.) • Adverse Effects (cont.) – Photosensitivity – Hypotension, hypertension, and cardiac arrhythmias • Drug-to-Drug Interactions Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins – Alcohol
  • 19. Use of Drugs Affecting the Female Reproductive System Antiemetic Agents Across the Lifespan Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 20. Prototype Phenothiazines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 21. Prototype Nonphenothiazines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 22. Prototype Anticholinergics/ Antihistamines Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 23. Prototype Serotonin (5-HT3) Receptor Blockers Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 24. Prototype Substance P/Neurokinin 1 Receptor Antagonists Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 25. Nursing Considerations for Antiemetics • Assessment: History and Physical Exam • Nursing Diagnosis • Implementation • Evaluation Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 26. Question What is an anticholinergic antiemetic recommended for vestibular (inner ear) problems? A. Granisetron B. Meclizine C. Palonosetron D. Perphenazine Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
  • 27. Answer B. Meclizine Rationale: These drugs—buclizine, cyclizine and meclizine - are anticholinergics that act as antihistamines and block the transmission of impulses to the CTZ. They are recommended for the nausea and vomiting associated with motion sickness or vestibular (inner ear) problems. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins