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Where is the vomiting center in the brain?
The reticular formation of the medulla
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What kind of effecct do anti-histamines have?
An anticholinergic effect
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What are the uses for Anti-histamines?
- Simple nausea
- Motion sickness
- Vertigo
- Meniere's syndrome(inner ear problems)
- *This works on the inner ear, so that is why it helps with motion sickness, vertigo, meniere's, etc.
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Dimenhydrinate (Dramamine)
Antihistamine/Anticholergics
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Diphenhydramine (Benadryl)
Antihistamine/Anticholergics
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Hydroxyzine (Atarax, Vistaril)
Antihistamine/Anticholergics
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Trimethobenzamide (Tigan)
Antihistamine/Anticholergics
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What are the SE of the anti-histamines?
- CNS- sedation, dizziness, HA, lassitude
- Anticholinergic effects:
- (constipation, blurred vision, dry mouth, sleepiness)
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What is lassitude?
Feeling like "I don't want to"
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What do phenothiazine antiemetics do?
Block dopamine receptors in CTZ
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What is CTZ?
Chemoreceptor Trigger Zone
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Waht are phenothiazine used for?
- Severe N/V.
- Can be used for motion sickness as well.
Originally used for psychoses -- but in larger doses
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Prochlorperazine (Copazine)
Phenothiazine antiemetic
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Promethazine (Phenergan)
- Phenothiazine antiemetic
- *sometimes used pre-post- op for nausea
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What are the interactions for phenothiazine anti-emetics?
- CNS depressants (additative)
- Anticholinergics***
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What are the side effects for phenothiazine antiemetics?
Sedation, hypotension, EPS (extrapyramidal symptoms--EPS include parkinsonism, akathisia, dystonia, and tardive dyskinesia)
Confusion in the elderly
Lower seizure threshold -- so they will have more seizures if they already have them
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Benzquinamide (Emete-con)
Usually used periop.-prob. Acts in chemo receptor trigger zone
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Metoclorpramide (Reglan)
Increases GI motility- if you give too much, pt will have the runs
Does antagonize dopamine receptors in the CTZ and CNS
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Dronabinol (Marinol)
- Legal pot
- THC- active ingredient in pot
- Can lead to dependence
SE: mood changes, memory loss, sleep disorders, altered time perception, poor impulse control
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Scopolamine transdermal
motion sickness patch
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What are 5HT3 blockers?
AKA serotonin type 3 recpetor antagonists
- *block receptors in brain and GI tract
- *really helpdul for pt on chemo, to help with NV
- *"-tron" medications
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ondansetron (Zofran)
- 5HT3 blockers (serotonin antagonists)
- *give 30 min before a first chemo dose
- *IV or dissolving tab
- *SE: diarrhea, constipation, HA, rash, inc liver enzymes
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Granisetron [kytril]
5HT3 Blockers- serotitonin antagonists
- *excreted in urine and feces
- *Start 30 min before a chemo dose. Only given on chemo dats, once a day
- *SE: HA, asthenia-loss of strength, somnolence-sleepy, diarrhea, (or) constipation, FEVER (let patient know this is a SE)
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Dolasetron [Anzemet]
- 5HT3 Blockers, serotonin antagonists
- *PO or IV (both work the same)
- *single dose a chemo
- *SE: HA, diarrhea, FEVER, fatigue, ABD pain, transient PR & QT changes in EKG-- nut nothing too significant.
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Aprepitant [Emend]
*Substance P/Nk1 Receptor
- *give 1 hour a chemo (1st day), 2nd day (lower dosage PO)
- *SE: dizziness, weakness, hiccups, ,diarrhea
- *many interactions (at least coumadin and dilantin)
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Megestrol Acetate (Megace)
- Artificial progesterone-- not quite sure how it works
- Increases appetite (helps with cachexia)
- SE: edema, diarrhea
- Gets weight back on person, but not muscle mass, so it doesn't cure cachexia.
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