ChapLer 23 LmeLlcs and AnLlemeLlcs 1

Introduct|on
O nausea and vom|t|ng are sympLoms noL dlseases
4 n/v medlaLed prlmarlly by vlsceral sLlmulaLlon Lhru dopamlne and seroLonln
4 by vesLlbular and CnS causes Lhru hlsLamlne and aceLylchollne
4 by chemorecepLor Lrlgger zone sLlmulaLlon Lhru dopamlne and seroLonln
4 emeLlcs and anLlemeLlcs are developed Lo enhance or lnLerfere wlLh Lhese mechanlsms
O caused by
4 lnLerrupLlons ln Lhe balanclng sysLems of Lhe ear (moLlon slckness)
4 hormonal changes assoclaLed w/ early pregnancy (mornlng slckness)
4 lnLense paln
4 exposure Lo chemlcal Loxlns (analgeslcs anesLheLlcs anLlneoplasLlcs anLlmlcroblals)
4 emoLlonal sLress (fear and anxleLy)
4 gallbladder dlsease
4 food polsonlng
4 hyperacldlLy
4 condlLlons LhaL lmpalr gasLrolnLesLlnal moLlllLy
4 vlruses
4 odors slghLs LasLes LhoughLs

O Lhe chemlcal medlaLors LhaL sLlmulaLe Lhe emeLlc cenLers are deslgned as an aLLempL Lo rld Lhe
gasLrolnLesLlnal LracL of lrrlLanLs

O vomlLlng ls usually harmless buL can be a slgn of serlous lllness such as
4 lncreased lnLracranlal pressure
4 concusslons
4 encephallLls
4 menlnglLls
4 lnLesLlnal blockage
4 appendlclLls
4 mlgralne headaches
4 braln Lumors

O ma[or concern wlLh vomlLlng rlsk for asplraLlon of Lhe emesls

O concerns wlLh vomlLlng
4 dehydraLlon and elecLrolyLe (sodlum hydrogen chlorlde) lmbalances LhaL can lead Lo
meLabollc alkalosls

O adulLs have a lower rlsk for dehydraLlon b/c Lhey can usually deLecL sympLoms of dehydraLlon
(lncreased LhlrsL dry llps/mouLh)
O chlldren have a hlgher rlsk b/c Lhelr fluld and elecLrolyLe balance ls more fraglle


ChapLer 23 LmeLlcs and AnLlemeLlcs 2

,@ICS

O agenLs used Lo lnduce vomlLlng
O used excluslvely ln Lhe LreaLmenL of oral drug overdose and oLher klnds of polsonlng
O noL used wlLh acld or corroslve polsonlngs
O noL used ln pLs who overdosed on drugs and are unconsclous
O use for drug overdose ls decllnlng b/c new safer meLhods are comlng ouL

O pecac syrup mosL commonly used emeLlc ln Lhe uS

O dosage of lpecac syrup

Age Pow much lpecac syrup Lo glve Pow much waLer Lo Lake wlLh
under 1 usually noL prescrlbed b/c rlsk of
asplraLlon buL lf prescrlbed should be
under supervlslon of medlcal personnel
10 mL
Z 1 glass
Chlldren
older Lhan 1
13 mL 1 2 glass
AdulLs 13 30 mL

3 4

O dosage may be repeaLed wlLhln 20 mln lf vomlLlng does noL occur

O acLlvaLed charcoal may also be used buL never concurrenLly wlLh lpecac b/c Lhe acLlvaLed
charcoal wlll absorb Lhe emeLlc componenL of Lhe lpecac

O mlsuse of lpecac has lncreased
4 persons wlLh bullmla use lpecac as parL of blngepurge cycle
4 mlsuse resulLs ln lpecac LoxlclLy muscle weakness cardloLoxlc effecLs


ChapLer 23 LmeLlcs and AnLlemeLlcs 3

-@I,@ICS
O glven Lo prevenL and Lo LreaL n/v
O used ln prophylaxls and Lx of nausea assoclaLed wlLh moLlon slckness CnS dlsorders
admlnlsLraLlon of cerLaln drugs (anLlneoplasLlc agenLs general anesLhesla) radlaLlon Lherapy

nt|cho||nerg|cs
O ex Scopolamlne (1ransdermScop)
O prlmary anLlmuscarlnlc agenLs
O acLs by blndlng Lo and blocklng aceLylchollne recepLors Lhus prevenLlng Lhe nauseous sLlmull
from belng LransmlLLed
O furLher acL by llmlLlng sLlmulaLlon of Lhe emeLlc cenLer from Lhe vesLlbular sysLem
O have mlnlmal effecL on vlsceral sLlmulaLlon

nt|h|stam|nes
O acL by blocklng Lhe hlsLamlne P
2
recepLors prevenLlng chollnerglc sLlmulaLlon

O used for moLlon slckness
4 mecllzlne (AnLlverL)
4 dlphenhydramlne (8enadryl)
O used for posLoperaLlve nausea assoclaLed w/ general anesLhesla
4 promeLhazlne (henergan)

O boLh AnLlchollnerglcs and AnLlhlsLamlnes can cause anLlchollnerglc slde effecLs such as
4 dry mouLh
4 urlnary reLenLlon
4 blurred vlslon
4 use w/ cauLlon ln pLs w/ benlgn prosLaLlc hyperLrophy and narrow angle glaucoma

-euro|ept|c gents
O aka dopamlne anLagonlsLs
O acL by blndlng wlLh dopamlne
2
(u
2
) recepLors Lo mlnlmlze Lhe effecL of dopamlne and Lo llmlL
emeLlc lnpuL ln Lhe medullary emeLlc cenLer

O ex of neurolepLlc AgenLs
O chlorpromazlne (1horazlne)
O droperldol (napslne)
O perphenazlne
O prochlorperazlne (Compazlne)

O Adverse effecLs
O orLhosLaLlc hypoLenslon
O sedaLlon
O Lardlve dysklnesla
O droperldol (napslne) assoclaLed w/ cardlac rhyLhm changes carrles a warnlng for Lhe rlsk
of sudden cardlac deaLh
O b/c of adverse effecLs use of Lhese agenLs has decreased
ChapLer 23 LmeLlcs and AnLlemeLlcs 4


-@I,@ICS conLlnued

rok|net|c gents
O ex meLoclopramlde (8eglan)
O block dopamlne buL also sLlmulaLe aceLylchollne Lo lncrease gasLrlc empLylng
O used as a premedlcaLlon and an ad[uncL Lo anLlneoplasLlc Lherapy Lo prevenL nausea assoclaLed
wlLh cancer Lx

Seroton|n8|ock|ng gents (Seroton|n ntagon|sts)
O block seroLonln recepLors ln Lhe gasLrolnLesLlnal LracL and Lhe cenLral nervous sysLem
O selecLlvely anLagonlze 3hydroxyLryLamlne3 recepLors Lhus prevenLlng Lhe Lransmlsslon of
afferenL vlsceral and chemorecepLor Lrlggers LhaL cause n/v
O mosL commonly used agenLs Lo prevenL and LreaL n/v assoclaLed w/ chemoLherapy
O lndlcaLed for Lx of nausea assoclaLed w/ mlgralne headaches gasLroenLerlLls posLoperaLlve n/v

O Lhe flrsL seroLonln blocklng anLagonlsLs developed was ondanseLron (Zofran)
4 lnlLlal approval was for Lhe Lx of chemoLherapy relaLed n/v

O addlLlons of seroLonln blocklng agenLs lnclude
4 granlseLron (kyLrll)
4 dolaseLron mesylaLe (AnzemeL)
4 palonoseLron PCL (Aloxl)
4 wlLh Lhese addlLlons LreaLmenL has expanded Lo Lhe LreaLmenL of oLher causes of n/v

O ranlseLron and dolaseLron mesylaLe avallable ln oral / ln[ecLable preparaLlons
O ndanseLron mosL commonly used ln prophylaxls LreaLmenL of chemoLherapy relaLed n/v
4 admlnlsLered I before chemoLherapy

O parentera| pa|onosetron nCL
4 Lhls agenL was developed Lo LreaL delayed nausea and vomlLlng assoclaLed w/
anLlneoplasLlcs such as clsplaLln and doxorublcln
4 nausea and vomlLlng occurred 24 hours or longer afLer Lhe lnfuslon of Lhese drugs
4 Lhe advanLage of uslng Lhls agenL over oLher seroLonln anLagonlsLs half llfe and duraLlon of
acLlon are longer
4 Adverse effecLs
use w/ cauLlon ln cardlac cllenLs w/ conducLlon abnormallLles
consLlpaLlon
headache
hypersenslLlvlLy reacLlons
4 should noL be mlxed wlLh any oLher drugs ln an I llne
4 I llne should be flushed wlLh 09 nS before and afLer Lhe 30 second or longer
admlnlsLraLlon of palonoseLron
4 llke ondanseLron palonoseLron should be admlnlsLered 30 mln before Lhe parenLeral
admlnlsLraLlon of emeLogenlc anLlneoplasLlc agenLs


ChapLer 23 LmeLlcs and AnLlemeLlcs 3

-@I,@ICS conLlnued

prep|tant (mend)
O ls a subsLance /neuroklnln1 recepLor anLagonlsL
O used ln con[uncLlon w/ seroLonln anLagonlsLs and a corLlcosLerold for Lhe Lx of chemoLherapy
relaLed delayed n/v



e||ow pages
Safe nurslng pracLlce
LmeLlcs O ldenLlfy Lhe Loxlc subsLances lngesLed and call a polson conLrol cenLer
for lnformaLlon
O emet|cs are not adm|n|stered to persons who have swa||owed
corros|ve substances or o||s or to those who are unconsc|ous
O u n1 IL 1 nLS1Lu L (ex peLroleum producLs furnlLure pollsh eLc)
b/c vomlLlng oll could resulL ln asplraLlon of Lhe olly subsLance lnLo
Lhe lungs
O u n1 IL 1 nLS1Lu C88SIL Su8S1AnCLS (ex lye) b/c
vomlLlng would rapldly lead Lo desLrucLlon of even more Llssue wlLh
Lhe subsLance comlng lnLo conLacL wlLh Lhe sLomach esophagus
LhroaL mouLh llps

AnLlemeLlcs O Lhe nurse should anLlclpaLe clrcumsLances LhaL may lnduce nausea
and vomlLlng and work collaboraLlvely wlLh Lhe healLh care provlder
Lo LreaL Lhese cllenLs proacLlvely
O early lnLervenLlons Lo conLrol surglcal paln can prevenL paln
assoclaLed n/v
O If vom|t|ng occurs the nurse's pr|or|ty |s to prevent asp|rat|on by
pos|t|on|ng the c||ent |n the s|de |y|ng pos|t|on|ng
O anLlclpaLe nausea and vomlLlng ln cllenLs recelvlng emeLogenlc
anLlneoplasLlc agenLs and premedlcaLe as prescrlbed
O assess cllenLs recelvlng anLlhlsLamlne and anLlchollnerglc anLlemeLlcs
for urlnary reLenLlon narrowangle glaucoma and consLlpaLlon
O monlLor cllenLs requlrlng anLlemeLlc Lherapy for fluld and elecLrolyLe
lmbalances
O monlLor cllenLs recelvlng palonoseLron PCl for changes ln C1 lnLerval
O alonoseLron should noL be mlxed wlLh any oLher drug ln Lhe I llne
and Lhe llne should be flushed wlLh 09 nS before and afLer
palonoseLron admlnlsLraLlon




ChapLer 23 LmeLlcs and AnLlemeLlcs 6

met|cs

O subsLances LhaL lnduce vomlLlng
O mosL lmporLanL nurslng measures assoclaLed wlLh Lhe use of emeLlcs concern flndlng ouL whaL
Loxlc subsLance has been lngesLed malnLalnlng a paLenL alrway and effecLlve breaLhlng paLLern
and conLacLlng a polson conLrol cenLer for more lnfo
O rlsk for asplraLlon ls hlgh when pL ls vomlLlng proLecL pL from rlsk


nt|emet|cs
O used Lo relleve nausea and suppress vomlLlng
O n/v can resulL from unconLrolled paln from surglcal procedures
O early lnLervenLlons Lo conLrol paln can prevenL n/v
O obLalnlng a nurslng hlsLory before surgery relaLed Lo any pasL nausea experlences wlLh general
anesLhesla should be shared wlLh Lhe anesLheslologlsL and be consldered ln Lhe selecLlon of
anesLheLlc agenLs
O closely monlLor pL for gagglng frequenL swallowlng resulLlng from lncreased sallva producLlon
assoclaLed wlLh nausea allows Lhe nurse Lo collaboraLe wlLh Lhe healLh care provlders Lo obLaln
approprlaLe medlcaLlon Lo LreaL Lhese sympLoms of nausea and prevenL vomlLlng
O mosL common adverse effecL assoclaLed wlLh Lhe use of anLlneoplasLlcs Lo LreaL cancer ls n/v
4 nurse should have and educaLed undersLandlng of anLlneoplasLlcs Lhelr acLlons ad Lhelr
adverse effecLs and anLlclpaLe Lhe need Lo premedlcaLe pLs before admlnlsLerlng
anLlneoplasLlcs
O pLs experlenclng n/v musL be monlLored for lnLake and ouLpuL and have serum chemlsLrles
monlLored Lo deLecL fluld and elecLrolyLe lmbalances
O anLlhlsLamlne and anLlchollnerglc anLlemeLlcs can cause urlnary reLenLlon and lncreased
lnLraocular pressure so Lhey should noL be used or used wlLh cauLlon ln cllenLs wlLh benlgn
prosLaLlc hyperLrophy (urlnary LracL obsLrucLlon) or narrow angle glaucoma
O use wlLh cauLlon ln cllenLs wlLh asLhma or gasLrolnLesLlnal obsLrucLlon b/c anLlchollnerglc effecLs
of Lhese agenLs may cause exacerbaLlon of asLhma or lnLenslfy Lhe gasLrolnLesLlnal obsLrucLlon
O monlLor for drowslness and advlse cllenL Lo change poslLlons slowly as Lhese agenLs can cause
some CnS depresslon
O consLlpaLlon posslble adverse effecL
O preferred rouLe of admlnlsLraLlon for neurolepLlc agenLs ls oral wlLh Lhe excepLlon of
scopolamlne applled Lransdermally
O Lo prevenL chemoLherapy relaLed nausea and vomlLlng parenLeral admlnlsLraLlon of seroLonln
anLagonlsLs ls preferred admlnlsLer 30 mln before Lhe admlnlsLraLlon of anLlneoplasLlc agenLs
O ln chlldren ondanseLron ls admlnlsLered before chemoLherapy conLlnue ln small doses q4h
durlng and for 24 hours afLer chemoLherapy
O alonoseLron should be used wlLh cauLlon ln cllenLs wlLh conducLlve dlsorders of Lhe hearL
relaLed Lo prolonged C1 lnLerval alonoseLron can prolong C1 lnLerval
O female cllenLs uslng oral conLracepLlon should be advlsed LhaL whlle Laklng apreplLanL alLernaLe
meLhods of conLracepLlon should be used
O cllenLs Laklng apreplLanL should be monlLored closely for coagulaLlon problems especlally Lhe
nLernaLlonal normallzed 8aLlo durlng Lhe 2 weeks afLer Lhe lnlLlaLlon of apreplLanL Lherapy

ChapLer 23 LmeLlcs and AnLlemeLlcs 7

b[ect|ves

1 uescrlbe how and when lpecac syrup ls used ln Lhe emergency LreaLmenL of polsonlng

O seldom used ln chlldren under 1 b/c of rlsk of asplraLlon lf prescrlbed glven 3 10 mL
wlLh Z 1 glass of waLer
O ln older chlldren glven 13 mL wlLh 1 2 glasses of waLer
O ln adulLs glven 13 30 mL wlLh 3 4 glasses of waLer
O ln any case dosage may be repeaLed once lf vomlLlng does noL occur wlLhln 20 mln
O lpecac should noL be glven wlLh acLlvaLed charcoal

2 ulscuss Lhe common causes of n/v

O caused by
4 lnLerrupLlons ln Lhe balanclng sysLems of Lhe ear (moLlon slckness)
4 hormonal changes assoclaLed w/ early pregnancy (mornlng slckness)
4 lnLense paln
4 exposure Lo chemlcal Loxlns (analgeslcs anesLheLlcs anLlneoplasLlcs anLlmlcroblals)
4 emoLlonal sLress (fear and anxleLy)
4 gallbladder dlsease
4 food polsonlng
4 hyperacldlLy
4 condlLlons LhaL lmpalr gasLrolnLesLlnal moLlllLy
4 vlruses
4 odors slghLs LasLes LhoughLs

3 ulscuss Lhe acLlon of seroLonln blocklng agenLs n Lhe LreaLmenL of n/v

O 1hese agenLs block seroLonln recepLors n Lhe gasLrolnLesLlnal LracL and Lhe CnS 1hey
selecLlvely anLagonlze 3hydroxyLryLamlne3 recepLors Lhus prevenLlng Lhe Lransmlsslon
of afferenL vlsceral and chemorecepLor Lrlggers LhaL cause n/v