By G. Baldar. Nevada State College.

Although phenothiazines are effective antiemetic agents 10mg motilium amex gastritis what to eat, • Compare current weight with baseline weight buy motilium 10mg with amex gastritis diet of hope. Consequently, phenothiazines other than promethazine usually should not be used, especially for PRINCIPLES OF THERAPY pregnant, young, elderly, and postoperative clients, un- less vomiting is severe and cannot be controlled by Drug Selection other measures. The 5-HT3 receptor antagonists (ondansetron, grani- setron, and dolasetron) are usually the drugs of first choice for clients with chemotherapy-induced or post- Dosage and Administration Factors operative nausea and vomiting. In chemotherapy, stud- ies indicate greater effectiveness when combined with Dosage and route of administration depend primarily on the a corticosteroid (eg, dexamethasone). Doses of phenothiazines are much smaller for antiemetic ties are preferred for motion sickness. CLIENT TEACHING GUIDELINES Antiemetic Drugs General Considerations mood changes, and other mind-altering effects. You should ✔ Try to identify the circumstances that cause or aggravate avoid alcohol and other drugs that cause drowsiness. Several of the drugs cause sedation and ✔ Once your stomach has settled down, try to take enough other adverse effects, which are more severe if too much fluids to prevent dehydration and potentially serious prob- is taken. This includes Several drugs interact with antiemetic agents, to increase cancer chemotherapy, radiation therapy, painful dress- adverse effects. Most antiemetic agents are available in oral, par- enteral, and rectal dosage forms. As a general rule, Nursing Notes: Apply Your Knowledge oral dosage forms are preferred for prophylactic use and rectal or parenteral forms are preferred for ther- Sally Roberts is being treated in an outpatient chemotherapy unit. When nausea and vomiting are likely to occur because of travel, administration of emetogenic anticancer drugs, diag- nostic tests, or therapeutic procedures, an antiemetic drug Use in Children should be given before the emetogenic event. Pretreatment usually increases client comfort and allows use of lower drug Few studies of antiemetics have been done in children and doses. It also may prevent aspiration and other potentially se- their usage is not clearly defined. With the 5-HT3 receptor antagonists, safety and efficacy of granisetron and dolasetron have not been established Chemotherapy-Induced for children younger than 2 years of age, and there is lit- Nausea and Vomiting tle information available about the use of ondansetron in children 3 years of age and younger. Phenothiazines are more likely to cause dystonias and ing and much discomfort for clients. Cisplatin is one of the most other neuromuscular reactions in children than in emetogenic drugs. Promethazine is preferred because its action is compared with older drugs in the treatment of cisplatin-induced more like that of the antihistamines than the phenothi- nausea and vomiting. Excessive doses may cause halluci- if they avoid or decrease food intake for a few hours be- nations, convulsions, and sudden death. Antiemetic drugs should be given before the emeto- amine) are not recommended for use in children genic drug to prevent nausea and vomiting when pos- younger than 12 years of age. Metoclopramide often causes extrapyramidal reactions rapid effects and continued for 2 to 3 days. The 5-HT receptor antagonists (eg, ondansetron) are dren who do not respond to other antiemetic drugs. However, the drug should be used cautiously in chil- They may be given in a single daily dose. Metoclopramide, given intravenously in high doses, may be used alone or in combination with various other drugs. Diphenhydramine (Benadryl) may be Use in Older Adults given at the same time or PRN because high doses of metoclopramide often cause extrapyramidal effects Most antiemetic drugs cause drowsiness, especially in older (see Chap. Various combinations of antiemetic and sedative-type be made to prevent nausea and vomiting when possible. A adults are at risk of fluid volume depletion and electrolyte im- commonly used regimen for prophylaxis is a cortico- balances with vomiting. Cholestatic jaundice has been reported than young or middle-aged adults. Dronabinol normally undergoes extensive first-pass hepatic metabolism to active and inactive metabolites.

Drugs that increase effects of heparins: (1) Antiplatelet drugs (eg order motilium 10mg amex gastritis diet , aspirin 10mg motilium gastritis diet 80%, clopidogrel, others) (2) Warfarin Additive anticoagulant effects and increased risks of bleeding (3) Parenteral penicillins and cephalosporins Some may affect blood coagulation and increase risks of bleeding c. Drugs that decrease effects of heparins: (1) Antihistamines, digoxin, tetracyclines These drugs antagonize the anticoagulant effects of heparin. Drugs that increase effects of warfarin: Mechanisms by which drugs may increase effects of warfarin in- (1) Analgesics (eg, acetaminophen, aspirin and other non- clude inhibiting warfarin metabolism, displacing warfarin from steroidal anti-inflammatory drugs) binding sites on serum albumin, causing antiplatelet effects, in- hibiting bacterial synthesis of vitamin K in the intestinal tract, (2) Androgens and anabolic steroids and others. Drugs that decrease effects of warfarin: (1) Antacids and griseofulvin May decrease GI absorption (2) Carbamazepine, disulfiram, rifampin These drugs activate liver metabolizing enzymes, which acceler- ate the rate of metabolism of warfarin. Drug that may increase or decrease effects of warfarin: (1) Alcohol Alcohol may induce liver enzymes, which decrease effects by ac- celerating the rate of metabolism of the anticoagulant drug. How- ever, with alcohol-induced liver disease (ie, cirrhosis), effects may be increased owing to impaired metabolism of warfarin. Drugs that increase effects of cilostazol: (1) Diltiazem These drugs inhibit the main cytochrome P450 enzyme (CYP3A4) that metabolizes cilostazol. Grapefruit juice also inhibits drug (2) Erythomycin metabolism and should be avoided. When is it appropriate to use vitamin K as an antidote for Nursing Notes: Apply Your Knowledge warfarin? How do antiplatelet drugs differ from heparin and war- Answer: Low-dose subcutaneous heparin is administered pro- farin? How do aminocaproic acid and tranexamic acid stop low-dose heparin therapy. When giving the injection, take care to bleeding induced by thrombolytics? Compare and contrast nursing care needs of clients 1⁄ -inch needle is used. Leave a small air bubble in the syringe to 2 receiving anticoagulant therapy in hospital and home follow the dose and lock the heparin into the subcutaneous space. The area is cleansed and grasped firmly and the needle is inserted at a 90-degree angle. Avoid injections within 2 inches of incisions or SELECTED REFERENCES the umbilicus and any areas that are scarred or abnormal. The Medical research indicates that various sites (abdomen, arms, and legs) can Letter on Drugs and Therapeutics, 44 (1124), 17–18. Treatment of unstable angina: The role of platelet inhibitors signs of bleeding. Outpatient treatment of deep vein throm- bosis: Translating clinical trials into practice. Before giving anticoagulants, it is important to ing of low-molecular-weight heparins in special populations. Pharma- check lab work (activated partial thromboplastin time for heparin, cotherapy, 21(2), 218–234. Philadelphia: may have interfered with the synthesis of vitamin K in the intes- Lippincott Williams & Wilkins. Because no signs of bleeding have been noted, he or she ology: Concepts of altered health states, 6th ed. What are the major functions of the endothelium, platelets, North American Nursing Diagnosis Association. Nursing diagnoses: and coagulation factors in hemostasis and thrombosis? Review of the action, onset and duration of action, and method of ad- Fifth American College of Chest Physicians Consensus Conference on Antithrombotic Therapy: Outpatient management for adults. List interventions to protect clients from anticoagulant- Skidmore-Roth, L. When is it appropriate to use protamine sulfate as an after hospitalization for deep-venous thrombosis. Describe dyslipidemic drugs in terms of mecha- nism of action, indications for use, major ad- verse effects, and nursing process implications. Critical Thinking Scenario During a routine physical examination, 26-year-old William Halls is diagnosed with dyslipidemia.

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