Where is the vomiting center in the brain?
The reticular formation of the medulla
What kind of effecct do anti-histamines have?
An anticholinergic effect
What are the uses for Anti-histamines?
- Simple nausea
- Motion sickness
- 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.
Hydroxyzine (Atarax, Vistaril)
What are the SE of the anti-histamines?
- CNS- sedation, dizziness, HA, lassitude
- Anticholinergic effects:
- (constipation, blurred vision, dry mouth, sleepiness)
What is lassitude?
Feeling like "I don't want to"
What do phenothiazine antiemetics do?
Block dopamine receptors in CTZ
What is CTZ?
Chemoreceptor Trigger Zone
Waht are phenothiazine used for?
- Severe N/V.
- Can be used for motion sickness as well.
Originally used for psychoses -- but in larger doses
- Phenothiazine antiemetic
- *sometimes used pre-post- op for nausea
What are the interactions for phenothiazine anti-emetics?
- CNS depressants (additative)
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
Usually used periop.-prob. Acts in chemo receptor trigger zone
Increases GI motility- if you give too much, pt will have the runs
Does antagonize dopamine receptors in the CTZ and CNS
- Legal pot
- THC- active ingredient in pot
- Can lead to dependence
SE: mood changes, memory loss, sleep disorders, altered time perception, poor impulse control
motion sickness patch
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
- 5HT3 blockers (serotonin antagonists)
- *give 30 min before a first chemo dose
- *IV or dissolving tab
- *SE: diarrhea, constipation, HA, rash, inc liver enzymes
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)
- 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.
*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)
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.