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What are the 5 common causes of N/V?
GI disorders, CNS disorders, pain, excessive intake of food/alcohol and pregnancy
What are some treatment-induced causes of N/V?
cancer chemotherapy, radiation therapy, anesthesia and NV associated with procedures
What are some drug-induced causes of N/V?
anti-cancer drugs, opioids, aspirin, NSAIDs, iron, antibiotics, estrogens, anti-parkinsons and SSRIs
What are common complications of N/V?
patient discomfort, dehydration, malnutrition, aspiration pneumonia, anxiety, decreased QOL
What are some non-pharmacologic treatments for N/V?
clear liquid diet, IV hydration, avoid fatty, sweet and spicy foods, avoid trigger sounds/odors/sights or physical acupressure
What are the different drug therapy options for N/V?
Antihistamines-anticholinergics, phenothiazines, serotonin antagonists, neurokinin-1 antagonists, etc.
What are examples of antihistamine-anticholinergics?
Meclizine, diphenhydramine and scopolamine
What is the mechanism of action of antihistamine-anticholinergics?
block histamine and/or muscarinic receptors in the CTZ and NTS centers
What are some side effects associated with antihistamine-anticholinergics?
drowsiness, sedation, dry mouth, constipation and blurred vision
What are some examples of phenothiazines?
Prochlorperazine, promethazine and chlorpromazine
What is the mechanism of action of phenothiazines?
dopamine inhibition at CTZ
What are some side effects associated with phenothiazines?
dizziness, sedation, dry mouth, hypotension and unusual muscle movement
What are some examples of serotonin antagonists?
ondansetron, granisetron, palonosteron and dolasteron
What is the mechanism of action of serotonin antagonists?
serotonin inhibition at CTZ, VC, and GI tract
What are some side effects associated with serotonin antagonists?
mild HA, dizziness, fatigue and constipation
What are some examples of neurokinin-1 antagonists?
aprepitant, fosaprepitant and rolapitant
What is the mechanism of action of neurokinin-1 antagonists?
neurokinin receptor inhibition at the CTZ, VC, and GI tract
What are some side effects associated with neurokinin-1 antagonists?
fatigue, hiccups, constipation and decreased appetite
What are the treatment options for motion sickness?
Scopolamine patch applied before needed
Dimenhydrinate PO 50 mg (30-60 min before needed)
Meclizine PO 25 mg (30-60 min before needed)
What is the best treatment options for N/V secondary to gastroenteritis or pain?
Ondansetron or promethazine
What are risk factors for post-op N/V?
female, non-smokers, history of PONV and history of motion sickness; intra-operative use of volatile anesthetics, nitrous oxide and GI tract/brain surgery
If patient is at mod-high risk of PONV, treat with __________
5-HT3 receptor antagonists (-setron)
If patient is at highest risk of PONV, treat with __________
5-HT3 + metoclopramide or aprepitant
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