{"id":375,"date":"2019-11-04T23:54:44","date_gmt":"2019-11-05T04:54:44","guid":{"rendered":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/7-7-antiemetic\/"},"modified":"2023-08-15T14:20:17","modified_gmt":"2023-08-15T18:20:17","slug":"7-7-antiemetic","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/7-7-antiemetic\/","title":{"raw":"7.7 Antiemetics","rendered":"7.7 Antiemetics"},"content":{"raw":"Treatment of nausea and vomiting should be tailored to the cause. There are several medications that work on different neuroreceptors that, when used, can treat nausea and vomiting. For severe cases of vomiting, intravenous fluids may also be needed to treat the accompanying dehydration. [footnote]MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2019 October 23]. <em>Nausea and vomiting;<\/em> [updated 2019 February 7; reviewed 2016 March 17; cited 2019 October 27]. <a href=\"https:\/\/medlineplus.gov\/nauseaandvomiting.html\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/nauseaandvomiting.html<\/a>.[\/footnote],[footnote]Bashashati, M. &amp; McCallum, R. (2014). Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. <em>European Journal of Pharmacology, 772<\/em>, p 79.[\/footnote]\r\n\r\nTable 7.7a compares the neurotransmitters involved in the nausea and vomiting process, classes of antiemetic medication targeting these neurotransmitters, prototype antiemetic medications, and associated mechanisms of action.[footnote]Bashashati, M. and McCallum, R. (2014). Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. <em>European Journal of Pharmacology, 772<\/em>, p 79.[\/footnote] [footnote]RNPedia. (2021). https:\/\/www.rnpedia.com[\/footnote][footnote]OpenMD.Com at openmd.com[\/footnote][footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral[\/footnote] Each medication class is also discussed in more detail later in this section.\r\n<table class=\"grid\" style=\"width: 100%;\"><caption>Table 7.7a Neurotransmitters and Associated Medications Used to Treat Nausea and Vomiting<\/caption>\r\n<tbody>\r\n<tr style=\"height: 36px;\">\r\n<th scope=\"col\">Neurotransmitter<\/th>\r\n<th scope=\"col\">Medication Class<\/th>\r\n<th scope=\"col\">Antiemetic Drug<\/th>\r\n<th scope=\"col\">Mechanism of Action<\/th>\r\n<\/tr>\r\n<tr style=\"height: 73px;\">\r\n<th scope=\"row\">Acetylcholine (M1)<\/th>\r\n<td>Anticholinergics<\/td>\r\n<td>scopolamine<\/td>\r\n<td>Blocks ACh receptors in vestibular system<\/td>\r\n<\/tr>\r\n<tr style=\"height: 129px;\">\r\n<th scope=\"row\">Histamine (H1)<\/th>\r\n<td>Antihistamines<\/td>\r\n<td>meclizine<\/td>\r\n<td>Blocks H1 receptors and thus blocks ACh in vestibular system<\/td>\r\n<\/tr>\r\n<tr style=\"height: 92px;\">\r\n<th scope=\"row\">Dopamine (DA2)<\/th>\r\n<td>Dopamine antagonists<\/td>\r\n<td>prochlorperazine<\/td>\r\n<td>Blocks dopamine in CTZ and may block ACh<\/td>\r\n<\/tr>\r\n<tr style=\"height: 110px;\">\r\n<th scope=\"row\">Dopamine and ACh (DA2 and M1)<\/th>\r\n<td>Prokinetics<\/td>\r\n<td>metoclopramide<\/td>\r\n<td>Blocks dopamine in CTZ and stimulates ACh in GI tract<\/td>\r\n<\/tr>\r\n<tr style=\"height: 92px;\">\r\n<th scope=\"row\">Serotonin (5HT)<\/th>\r\n<td>Serotonin antagonists<\/td>\r\n<td>ondansetron<\/td>\r\n<td>Blocks serotonin in GI tract, CTZ, and VC<\/td>\r\n<\/tr>\r\n<tr style=\"height: 73px;\">\r\n<th scope=\"row\">Substance P (NK1)<\/th>\r\n<td>Neurokinin antagonists<\/td>\r\n<td>aprepitant<\/td>\r\n<td>Inhibits substance P neurokinin receptors<\/td>\r\n<\/tr>\r\n<tr class=\"a-R\" style=\"height: 147px;\">\r\n<th scope=\"row\">Cannabinoid (CB1)<\/th>\r\n<td>Tetrahydrocannabinols (THC)<\/td>\r\n<td>dronabinol or medical marijuana<\/td>\r\n<td>Activated CB1 receptor leading to inhibitory effects on cerebral cortex<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h1>Anticholinergics<\/h1>\r\nScopolamine is an example of an anticholinergic medication that is often used to treat motion sickness or nausea and vomiting associated with surgical recovery from anesthesia and\/or opiate analgesia.\r\n<h2>Mechanism of Action<\/h2>\r\nAnticholinergics block ACh receptors in the vestibular center and within the brain to prevent nausea-inducing stimuli to the Chemoreceptor Trigger Zone (CTZ) and the Vomiting Center (VC). They also dry GI secretions and reduce smooth muscle spasms.\r\n<h2>Specific Administration Considerations<\/h2>\r\nThe scopolamine transdermal patch (see Figure 7.7a)[footnote]\"<a href=\"https:\/\/www.flickr.com\/photos\/andreasnilsson1976\/2551446785\" rel=\"noopener noreferrer\">Scopoderm 278:365<\/a>\" by <a href=\"https:\/\/www.flickr.com\/photos\/andreasnilsson1976\/\" rel=\"noopener noreferrer\">Andreas Nilsson<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/2.0\/\" rel=\"noopener noreferrer\">CC BY-NC-ND 2.0<\/a>[\/footnote] is designed for continuous release of scopolamine following the application to an area of intact skin on the head, behind the ear. The system is formulated to deliver approximately 1 mg of scopolamine to the systemic circulation over 3 days. It is contraindicated in clients with glaucoma. It has been reported to exacerbate psychosis, induce seizures, and cause drowsiness, confusion, and sedation. Due to its anticholinergic properties, scopolamine can decrease gastrointestinal motility and cause urinary retention. Nurses should perform more frequent monitoring during treatment with Transderm Sc\u014dp and discontinue Transderm Sc\u014dp in clients who develop difficulty in urination. Transderm Sc\u014dp contains an aluminized membrane; skin burns have been reported at the application site in clients wearing an aluminized transdermal system during an MRI scan. Remove Transderm Sc\u014dp before undergoing an MRI.\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"347\"]<img title=\"&quot;Scopoderm 278:365&quot; by Andreas Nilsson is licensed under CC BY-NC-ND 2.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2019\/11\/image2-2.png\" alt=\"A person with a with transdermal patch behind their right ear.\" width=\"347\" height=\"521\" \/> Figure 7.7a Scopolamine Transdermal Patch[\/caption]\r\n\r\nApplication instructions:\r\n<ul>\r\n \t<li>Only wear one transdermal system at any time.<\/li>\r\n \t<li>Do not cut the transdermal system.<\/li>\r\n \t<li>Apply the transdermal system to the skin in the postauricular area (hairless area behind one ear).<\/li>\r\n \t<li>After the transdermal system is applied on the dry skin behind the ear, wash hands thoroughly with soap and water and dry hands.<\/li>\r\n \t<li>If the transdermal system becomes displaced, discard the transdermal system, and apply a new transdermal system on the hairless area behind the other ear.<\/li>\r\n \t<li>For surgeries other than cesarean section, apply one Transderm Sc\u014dp transdermal system the evening before a scheduled surgery. Remove the transdermal system 24 hours following surgery.<\/li>\r\n<\/ul>\r\n<h2>Patient Teaching &amp; Education<\/h2>\r\nTransderm Sc\u014dp may impair the mental and\/or physical abilities required for the performance of hazardous tasks such as driving a motor vehicle, operating machinery, or participating in underwater sports. Concomitant use of other drugs (e.g., alcohol, sedatives, hypnotics, opiates, and anxiolytics) that cause central nervous system (CNS) adverse reactions, or that have anticholinergic properties, may increase this impairment. Inform clients not to operate motor vehicles or other dangerous machinery or participate in underwater sports until they are reasonably certain that Transderm Sc\u014dp does not affect them adversely. Scopolamine can cause temporary dilation of the pupils resulting in blurred vision if it comes in contact with the eyes. Advise clients to wash their hands thoroughly with soap and water and dry their hands immediately after handling the transdermal system. Upon removal, fold the used transdermal system in half with the sticky side together, and discard in household trash in a manner that prevents accidental contact or ingestion by children, pets, or others.[footnote]This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>. [\/footnote]\r\n<h1>Antihistamines<\/h1>\r\nMeclizine is an example of an antihistamine that is often used to treat motion sickness.\r\n<h2>Mechanism of Action<\/h2>\r\nAntihistamines block H1 receptors in the vestibular center and may also block acetylcholine (ACh).\r\n<h2>Specific Administration Considerations<\/h2>\r\nAntihistamines are contraindicated in clients with glaucoma or an enlarged prostate gland. Dosage should be started one hour before travel begins.\r\n<h2>Patient Teaching &amp; Education<\/h2>\r\n<ul>\r\n \t<li>Do not exceed recommended dosage.<\/li>\r\n \t<li>Be advised that drowsiness may occur.<\/li>\r\n \t<li>Avoid alcohol, sedatives, and tranquilizers, which may increase drowsiness.<\/li>\r\n \t<li>Avoid alcoholic drinks.<\/li>\r\n \t<li>Be careful when driving a motor vehicle or operating machinery.[footnote]This work is a derivative of <a style=\"text-align: initial;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a><span style=\"text-align: initial;\"> by <\/span><a style=\"text-align: initial;\" href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a><span style=\"text-align: initial;\"> in the <\/span><a style=\"text-align: initial;\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a><span style=\"text-align: initial;\">. [\/footnote]<\/span><\/li>\r\n<\/ul>\r\n<h1>Dopamine Antagonists<\/h1>\r\nProchlorperazine is an example of a dopamine antagonist used to treat nausea and vomiting. It can also be used as an antipsychotic medication.\r\n<h2>Mechanism of Action<\/h2>\r\nProchlorperazine blocks dopamine in the Chemoreceptor Trigger Zone (CTZ). It also calms the central nervous system and may also block acetylcholine.\r\n<h2>Specific Administration Considerations<\/h2>\r\nProchlorperazine can be administered orally, intramuscularly, rectally or intravenously. It is contraindicated in children under age 2 or under 20 pounds. Severe side effects have occurred when used to treat psychosis.\r\n<h2>Patient Teaching &amp; Education<\/h2>\r\nClients should be instructed to take medications as prescribed.\u00a0 They should avoid alcohol and other CNS depressants. Clients may experience increased photosensitivity and extreme temperatures should be avoided. Clients should be advised that urine may turn pinkish to reddish-brown.[footnote]uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\" rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a>[\/footnote]\r\n<h1>Prokinetics<\/h1>\r\nMetoclopramide is an example of a [pb_glossary id=\"732\"]<strong>prokinetic<\/strong>[\/pb_glossary] medication (see Figure 7.7b).[footnote]\"<a href=\"https:\/\/www.flickr.com\/photos\/104346167@N06\/36640425216\" rel=\"noopener noreferrer\">Metoclopramide<\/a>\" by <a href=\"https:\/\/www.flickr.com\/photos\/104346167@N06\/\" rel=\"noopener noreferrer\">John Campbell<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/cc0\/\" rel=\"noopener noreferrer\">CC0<\/a>[\/footnote]\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"601\"]<img title=\"&quot;Metoclopramide&quot; by John Campbell is licensed under CC0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image4-2-1.png\" alt=\"Photo of metoclopramide vials, a prokinetic\" width=\"601\" height=\"401\" \/> Figure 7.7b Prokinetics[\/caption]\r\n<h2>Mechanism of Action<\/h2>\r\nMetoclopramide blocks dopamine and may also sensitize tissues to acetylcholine. It is used to promote peristalsis to empty the gastrointestinal tract and thus reduce nausea.\r\n<h2>Specific Administration Considerations<\/h2>\r\nMetoclopramide can be administered orally, intramuscularly, and intravenously. The onset of pharmacological action of metoclopramide is 1 to 3 minutes following an intravenous dose, 10 to 15 minutes following intramuscular administration, and 30 to 60 minutes following an oral dose. Pharmacological effects persist for 1 to 2 hours.\r\n\r\nMetoclopramide should not be used whenever stimulation of gastrointestinal motility might be dangerous (e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation). Metoclopramide is contraindicated in clients with pheochromocytoma because the drug may cause a hypertensive crisis. Metoclopramide should not be used in epileptics or clients receiving other drugs that are likely to cause extrapyramidal reactions because the frequency and severity of seizures or extrapyramidal reactions may be increased. Rare reports of neuromalignant syndrome have occurred.\r\n<h2>Patient Teaching &amp; Education<\/h2>\r\nTeach clients to immediately inform the healthcare provider if they experience new feelings of depression or abnormal muscle movements they cannot control such as:\r\n<ul>\r\n \t<li>lip-smacking, chewing, or puckering of the mouth<\/li>\r\n \t<li>frowning or scowling<\/li>\r\n \t<li>sticking out the tongue<\/li>\r\n \t<li>blinking and moving the eyes<\/li>\r\n \t<li>shaking of the arms and legs[footnote]This work is a derivative of <a style=\"text-align: initial;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a><span style=\"text-align: initial;\"> by <\/span><a style=\"text-align: initial;\" href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a><span style=\"text-align: initial;\"> in the <\/span><a style=\"text-align: initial;\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a><span style=\"text-align: initial;\">. [\/footnote]<\/span><\/li>\r\n<\/ul>\r\n<h1>Serotonin Antagonists<\/h1>\r\nOndansetron is an example of a serotonin (5HT) antagonist often used to treat severe nausea and vomiting associated with chemotherapy, postoperative nausea and vomiting, and hyperemesis during pregnancy. (See Figure 7.7c for an image of odansetron blocking the 5-HT<sub>3<\/sub> receptor.[footnote]\"<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Eichelbaum2.jpg\" rel=\"noopener noreferrer\">Eichelbaum2.jpg<\/a>\" by Michel Eichelbaum is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/de\/deed.en\" rel=\"noopener noreferrer\">CC BY-SA 3.0 DE<\/a>[\/footnote])\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"557\"]<img title=\"&quot;Eichelbaum2.jpg&quot; by Michel Eichelbaum is licensed under CC BY-SA 3.0 DE\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image5.jpg\" alt=\"Illustration of Ondansetron blocking serotonin receptors.\" width=\"557\" height=\"414\" \/> Figure 7.7c Ondansetron blocking the 5-HT<sub>3<\/sub> receptor[\/caption]\r\n<h2>Mechanism of Action<\/h2>\r\nOndansetron blocks serotonin receptors in the GI tract, the chemoreceptor trigger zone (CTZ), and the vomiting center (VC). See Figures 7.7d and 7.7e for images of the injectable and oral formulations of ondansetron.[footnote]\"<a href=\"https:\/\/en.wikipedia.org\/wiki\/File:000817lg_Zofran_8_MG_Oral_Tablet.jpg\" rel=\"noopener noreferrer\">000817lg Zofran 8 MG Oral Tablet.jpg<\/a>\" by NLM is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/cc0\/\" rel=\"noopener noreferrer\">CC0<\/a>[\/footnote]<span style=\"font-size: 16px;\">,<\/span>[footnote]\"<a href=\"http:\/\/flickr.com\/photos\/intropin\/4499127380\" rel=\"noopener noreferrer\">Ondansetron (1<\/a>)\" by <a href=\"https:\/\/www.flickr.com\/photos\/intropin\/\" rel=\"noopener noreferrer\">M<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/\" rel=\"noopener noreferrer\">CC BY-NC 2.0<\/a>[\/footnote]\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"313\"]<img title=\"&quot;Ondansetron (1)&quot; by M is licensed under CC BY-NC 2.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image6-2-1.png\" alt=\"Photo of bottle of Zofran injectable.\" width=\"313\" height=\"418\" \/> Figure 7.7d Ondansetron in injectable form[\/caption]\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"436\"]<img style=\"color: #373d3f; font-weight: bold; font-size: 1.125em;\" title=\"&quot;000817lg Zofran 8 MG Oral Tablet.jpg&quot; by NLM is licensed under CC0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image7-2-1.png\" alt=\"Photo of Zofran tablets\" width=\"436\" height=\"311\" \/> Figure 7.7e Ondansetron in tablet form[\/caption]\r\n<h2>Specific Administration Considerations<\/h2>\r\nOndansetron is available as an orally disintegrating tablet and as an injectable for those clients too nauseated to tolerate oral medication. It is contraindicated with apomorphine. <strong>[pb_glossary id=\"705\"]Serotonin syndrome[\/pb_glossary]<\/strong> can occur if administered concurrently with other serotonin antagonists or selective serotonin reuptake inhibitors. Ondansetron can cause headaches, drowsiness, constipation, fever, and diarrhea. A rare but serious adverse effect of ondansetron is QT prolongation that can cause an abnormal cardiac rhythm.\r\n<h2>Patient Teaching &amp; Education<\/h2>\r\nTeach clients to immediately inform their healthcare provider if they experience a change in heart rate, lightheadedness, or feel faint or have any signs and symptoms of hypersensitivity reactions such as fever, chills, rash, or breathing problems.[footnote]This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>. [\/footnote]\r\n<h1>Neurokinin Receptor Antagonists<\/h1>\r\nAprepitant is an example of a neurokinin antagonist used to prevent nausea and vomiting associated with chemotherapy and surgery.\r\n<h2>Mechanism of Action<\/h2>\r\nAprepitant inhibits substance-P neurokinin receptors in the brainstem.\r\n<h2>Nursing Considerations<\/h2>\r\nAprepitant is usually administered concurrently with dexamethasone (a corticosteroid) and ondansetron. It can be administered orally or intravenously. It has clinically significant CYP3A4 drug interactions with medications such as pimozide, diltiazem, and rifampin, and can decrease INR levels when taken concurrently with warfarin. It can also reduce the effectiveness of oral contraceptives.\r\n<h2>Patient Teaching &amp; Education<\/h2>\r\nTeach clients taking warfarin that they will need to monitor their INR levels more closely, which may require adjustment of the warfarin dosage while taking aprepitant. Teach clients using an oral contraceptive to use backup birth control.[footnote]This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>. \u00a0[\/footnote]\r\n<h1>Tetrahydrocannabinoids (THC)<\/h1>\r\nDronabinol or medical marijuana is an example of a <strong>[pb_glossary id=\"736\"]THC[\/pb_glossary]<\/strong> medication used to treat nausea in clients with cancer or AIDS (see Figures 7.7f and 7.7g).[footnote]\"<a href=\"https:\/\/www.flickr.com\/photos\/115645852@N04\/32335066121\" rel=\"noopener noreferrer\">Marinol - Dronabinol<\/a>\" by <a href=\"https:\/\/www.flickr.com\/photos\/115645852@N04\/\" rel=\"noopener noreferrer\">Steffen Geyer<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/\" rel=\"noopener noreferrer\">CC BY-NC 2.0<\/a> &amp; 7.21\"<a href=\"https:\/\/www.publicdomainpictures.net\/en\/view-image.php?image=246405&amp;picture=medical-marijuana\" rel=\"noopener noreferrer\">Medical Marijuana<\/a>\" by <a href=\"https:\/\/www.publicdomainpictures.net\/en\/browse-author.php?a=81846\" rel=\"noopener noreferrer\">Circe Denyer<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/cc0\/\" rel=\"noopener noreferrer\">CC0<\/a>[\/footnote]\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"345\"]<img title=\"&quot;Marinol - Dronabinol&quot; by Steffen Geyer is licensed under CC BY-NC 2.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image8-1-1.png\" alt=\"Photo of Marinol capules bottle.\" width=\"345\" height=\"517\" \/> Figure 7.7f Dronabinol, a THC medication[\/caption]\r\n\r\n&nbsp;\r\n\r\n[caption id=\"\" align=\"aligncenter\" width=\"610\"]<img title=\"&quot;Medical Marijuana&quot; by Circe Denyer is licensed under CC0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image9-1.png\" alt=\"Photo of medical marijuana in prescription bottle\" width=\"610\" height=\"457\" \/> Figure 7.7g Medical Marijuana[\/caption]\r\n<h2>Mechanism of Action<\/h2>\r\nTHC has inhibitory effects in the cerebral cortex causing an alteration in mood and the body's perception of its surroundings, which may relieve nausea and vomiting, as well as stimulate the appetite.\r\n<h2>Specific Administration Considerations<\/h2>\r\nTHC will cause a dose-related \"high\" (easy laughing, elation, and heightened awareness). It is abusable and, thus, is a controlled substance and scheduled medication. THC should be used cautiously in elderly clients because they may be more sensitive to the neurological, psychoactive, and postural hypotensive effects of the drug. In general, dose selection for an elderly client should be cautious, usually starting at the low end of the dosing range.\r\n<h2>Patient Teaching &amp; Education<\/h2>\r\nClients should not drive, operate machinery, or engage in any hazardous activity when using THC. Keep out of reach of children and pets.[footnote]This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>. \u00a0[\/footnote]\r\n<h1>Herbal and Vitamin Supplements<\/h1>\r\nGinger has been used in traditional Indian and Chinese medicine as an antiemetic. Although its mechanism of action is not completely understood, ginger is thought to antagonize the 5HT and cholinergic receptors and may have direct effect on the gastrointestinal tract. Although ginger can cause reflux and heartburn and may potentially cause bleeding because of its anticoagulant effects, dosages of up to 2 g per day in divided doses of 250 mg are considered safe, even in pregnant women. Pyridoxine (vitamin B6) has also been recommended for treating nausea and vomiting in pregnancy. Typical dosages of pyridoxine, 10 to 25 mg every eight hours, cause minimal adverse effects. [footnote]Flake, Z., Linn, B., &amp; Hornecker, J. (2015). Practical selection of antiemetics in the ambulatory setting. <em>American Family Physician, 91<\/em>(5): pp 293-296.[\/footnote]\r\n<h1>Antiemetics Medication Grid<\/h1>\r\nNow let\u2019s take a closer look at the medication grids comparing medications used to treat nausea and vomiting, in Table 7.7a [footnote]This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>. [\/footnote].\r\n\r\nMedication cards like this are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Prototype or generic medication examples are also hyperlinked to a free resource at <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\">Daily Med<\/a>. On the home page, enter the drug name in the search bar to read more about the medication.\r\n\r\n<span style=\"text-align: initial; font-size: 14pt;\">Table 7.7 Comparing Medications Used to Treat Nausea and Vomiting [footnote] This work is a derivative of\u00a0 <\/span><a style=\"text-align: initial;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener\">Daily Med <\/a><span style=\"text-align: initial;\">by\u00a0<\/span><a style=\"text-align: initial;\" href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener\">U.S. National Library of Medicine<\/a><span style=\"text-align: initial;\">\u00a0in the\u00a0<\/span><a style=\"text-align: initial;\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener\">public domain<\/a><span style=\"text-align: initial;\">. [\/footnote][footnote]RNPedia. (2021). https:\/\/www.rnpedia.com[\/footnote][footnote]OpenMD.Com at openmd.com[\/footnote][footnote]uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral[\/footnote]<\/span><span style=\"font-size: 1em; text-align: initial;\">\u00a0<\/span><a class=\"rId19\" style=\"font-size: 1em; text-align: initial;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=b877a694-a1d0-4280-937a-a06820b12a88\" rel=\"noopener noreferrer\">scopolamine\u00a0<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId20\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=8b3c9283-b618-4d57-9f15-7cf73e8737f5\" rel=\"noopener noreferrer\">meclizine<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId21\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=5e771ba7-983f-49b4-a1f2-0f335b637433\" rel=\"noopener noreferrer\">prochlorperazine<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId22\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=50a3cf38-66dc-4fa5-8a45-adf959c987ab\" rel=\"noopener noreferrer\">metoclopramide<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId23\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=e0050959-c14c-41b6-9a92-fadc5f6feff3\" rel=\"noopener noreferrer\">ondansetron<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId24\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=d72e0e10-4557-41b0-b65d-d395468cad19\" rel=\"noopener noreferrer\">aprepitant<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId25\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=1f1af798-17d5-47d0-b129-21d4aa1eb125\" rel=\"noopener noreferrer\">dronabinol<\/a><span style=\"text-align: initial; font-size: 14pt;\"> or medical marijuana<\/span>\r\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"0\"><caption><span style=\"text-align: initial; font-size: 14pt;\">Table 7.7 Comparing Medications Used to Treat Nausea and Vomiting<\/span><\/caption>\r\n<tbody>\r\n<tr>\r\n<th style=\"width: 10.0287%;\" scope=\"col\">Class<\/th>\r\n<th style=\"width: 9.16906%;\" scope=\"col\">Generic Prototype (Brand)<\/th>\r\n<th style=\"width: 3.9799%;\" scope=\"col\">Mechanism<\/th>\r\n<th style=\"width: 18.6653%;\" scope=\"col\">Indication &amp; Therapeutic Effect<\/th>\r\n<th style=\"width: 12.2294%;\" scope=\"col\">Contraindications<\/th>\r\n<th style=\"width: 16.6914%;\" scope=\"col\">Side Effects<\/th>\r\n<th style=\"width: 21.6621%;\" scope=\"col\">Administration and Nursing Considerations<\/th>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 10.0287%;\" scope=\"row\">Anticholinergic<\/th>\r\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=163accb7-45e6-4d97-844d-72b606677008\">Scopolamine<\/a>\r\n<p class=\"small\">(Hyoscine)<\/p>\r\n<p class=\"small\">(Transderm)<\/p>\r\n<\/td>\r\n<td style=\"width: 3.9799%;\">Inhibits postganglionic muscarinic receptor sites, and acts on smooth muscles that respond to acetylcholine<\/td>\r\n<td style=\"width: 18.6653%;\">Prevent or reduce N\/V associated with motion sickness or surgery\r\n\r\n&nbsp;<\/td>\r\n<td style=\"width: 12.2294%;\">Contraindicated in clients with glaucoma<\/td>\r\n<td style=\"width: 16.6914%;\">anticholinergic effects\r\n\r\nStop if it exacerbates psychosis or causes seizures, cognitive impairment<\/td>\r\n<td style=\"width: 21.6621%;\">Apply to hairless skin behind ear for 3 days or the night before surgery and remove 24 hours later\r\n\r\nDo not cut patch\r\n\r\nAfter application, thoroughly wash and dry handsRemove before an MRI<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 10.0287%;\" scope=\"row\">Dopamine antagonist<\/th>\r\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=baf59816-7577-4652-b065-fb6de9e54569\">prochlorperazine<\/a>\r\n<p class=\"\u201dsmall\u201d\">(Stemetil)<\/p>\r\n<\/td>\r\n<td style=\"width: 3.9799%;\">Depresses action on the chemo-receptor trigger zone.<\/td>\r\n<td style=\"width: 18.6653%;\">Control N\/V associated with surgery\r\n\r\n&nbsp;<\/td>\r\n<td style=\"width: 12.2294%;\">Use of other CNS depressants\r\n\r\nDementia-related psychosis<\/td>\r\n<td style=\"width: 16.6914%;\">Drowsiness, dizziness, amenorrhea, blurred vision, skin reactions, low\u00a0 Tardive dyskinesia, NMS\r\n\r\n&nbsp;<\/td>\r\n<td style=\"width: 21.6621%;\">Can be administered PO, IM, PR, or IV\r\n\r\nNot suitable for children under the age of 2<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 10.0287%;\" scope=\"row\">Prokinetic<\/th>\r\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=59abd52d-8172-44a3-baa2-fe1fe20f78c0\">metoclopramide<\/a>\r\n<p class=\"small\">(Maxeran)<\/p>\r\n<\/td>\r\n<td style=\"width: 3.9799%;\">Stimulates upper GI tract\r\n\r\nAntagonizes dopamine receptors<\/td>\r\n<td style=\"width: 18.6653%;\">GERD\r\n\r\nN\/V associated with surgery or chemo-therapy<\/td>\r\n<td style=\"width: 12.2294%;\">GI hemorrhage\r\n\r\nGI obstruction\r\n\r\nGI perforation\r\nHistory of seizures<\/td>\r\n<td style=\"width: 16.6914%;\">Restlessness, drowsiness, fatigue, depression, and suicide ideation.\r\n\r\nTardive dyskinesia, NMS<\/td>\r\n<td style=\"width: 21.6621%;\">Can be administered PO, IM, and IV\r\n\r\nOnset: 1 to 3 mins for IV dose, 10 to 15 mins for IM admin, and 30 to 60 mins for oral dose<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 10.0287%;\" scope=\"row\">Serotonin antagonist<\/th>\r\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=be5930d2-0008-4e61-9715-684c29a9c613\">ondansetron<\/a>\r\n<p class=\"small\">(Zofran)<\/p>\r\n<\/td>\r\n<td style=\"width: 3.9799%;\">Selective 5-HT3 receptor antagonist.<\/td>\r\n<td style=\"width: 18.6653%;\">Prevention or treatment of severe N\/V associated with surgery, chemo-therapy, or hyperemesis in pregnancy<\/td>\r\n<td style=\"width: 12.2294%;\">Hypersensitivity<\/td>\r\n<td style=\"width: 16.6914%;\">Headache, drowsiness, constipation, fever, and diarrhea\r\n\r\nMay prolong QT\r\nserotonin syndrome if given concurrently with serotonin antagonists or SSRIs<\/td>\r\n<td style=\"width: 21.6621%;\">Can be administered as oral disintegrating tablet, PO, or IV<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 10.0287%;\" scope=\"row\">Neurokinin receptor antagonist<\/th>\r\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=af9b6086-4bf2-472c-8740-4134eaaebace\">aprepitant<\/a>\r\n<p class=\"small\">(Emend)<\/p>\r\n<\/td>\r\n<td style=\"width: 3.9799%;\">selective high-affinity antagonist of human substance P\/neurokinin 1 (NK1) receptor<\/td>\r\n<td style=\"width: 18.6653%;\">Prevention of nausea and vomiting associated with chemo-therapy and surgery<\/td>\r\n<td style=\"width: 12.2294%;\">Clients on pimozide<\/td>\r\n<td style=\"width: 16.6914%;\">Hypersensitivity reaction, such as hives, rash. and itching; skin peeling or sores; or difficulty in breathing or swallowing<\/td>\r\n<td style=\"width: 21.6621%;\">Can be administered PO or IV\r\n\r\nIf on warfarin, increase INR monitoring\r\n\r\nIf on oral contraceptives, use backup birth control<\/td>\r\n<\/tr>\r\n<tr>\r\n<th style=\"width: 10.0287%;\" scope=\"row\">THC<\/th>\r\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=a0409d82-a61e-4b9e-8717-ced299ccedb2\">dronabinol<\/a> or medical marijuana<\/td>\r\n<td style=\"width: 3.9799%;\">central sympathomimetic activity<\/td>\r\n<td style=\"width: 18.6653%;\">For treatment of N\/V associated with cancer chemo-therapy when other treatment fails<\/td>\r\n<td style=\"width: 12.2294%;\">Hypersensitivity to sesame oil.<\/td>\r\n<td style=\"width: 16.6914%;\">Neuropsychiatric Adverse Reactions, <span style=\"font-family: inherit; font-size: inherit;\">Hemodynamic Instability Seizures, <\/span><span style=\"font-family: inherit; font-size: inherit;\">Paradoxical Nausea, Vomiting, and Abdominal Pain<\/span><\/td>\r\n<td style=\"width: 21.6621%;\">Administered PO\r\n\r\nDosage may be escalated based on initial results\r\nUse cautiously in elderly client<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"textbox textbox--key-takeaways\"><header class=\"textbox__header\">Clinical Reasoning and Decision-Making Activity 7.7<img class=\"alignright wp-image-50\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of lightbulb in a circle\" width=\"200\" height=\"200\" \/><\/header>\r\n<div class=\"textbox__content\">\r\n\r\nA nurse is caring for a client who underwent surgery earlier today and is experiencing nausea and vomiting. The original post-op orders included prochlorperazine, but the client continues to experience vomiting despite receiving this medication. The nurse calls the provider and receives a new order for ondansetron orally dissolving tablets, 8 mg three times daily as needed.\r\n<ol>\r\n \t<li>How will the nurse assess for symptoms of dehydration?<\/li>\r\n \t<li>When administering the medication, the client states, \"This tastes terrible! Why can't I have a normal pill to swallow?\" What is the nurse's best response?<\/li>\r\n \t<li>What other measures should the nurse teach the clients to reduce feelings of nausea and avoid dehydration?<\/li>\r\n<\/ol>\r\nNote: Answers to the Critical Thinking activities can be found in the \"<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-7\/\">Answer Key<\/a>\" sections at the end of the book.\r\n\r\n<\/div>\r\n<\/div>\r\n&nbsp;","rendered":"<p>Treatment of nausea and vomiting should be tailored to the cause. There are several medications that work on different neuroreceptors that, when used, can treat nausea and vomiting. For severe cases of vomiting, intravenous fluids may also be needed to treat the accompanying dehydration. <a class=\"footnote\" title=\"MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2019 October 23]. Nausea and vomiting; [updated 2019 February 7; reviewed 2016 March 17; cited 2019 October 27]. https:\/\/medlineplus.gov\/nauseaandvomiting.html.\" id=\"return-footnote-375-1\" href=\"#footnote-375-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a>,<a class=\"footnote\" title=\"Bashashati, M. &amp; McCallum, R. (2014). Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. European Journal of Pharmacology, 772, p 79.\" id=\"return-footnote-375-2\" href=\"#footnote-375-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<p>Table 7.7a compares the neurotransmitters involved in the nausea and vomiting process, classes of antiemetic medication targeting these neurotransmitters, prototype antiemetic medications, and associated mechanisms of action.<a class=\"footnote\" title=\"Bashashati, M. and McCallum, R. (2014). Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. European Journal of Pharmacology, 772, p 79.\" id=\"return-footnote-375-3\" href=\"#footnote-375-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a> <a class=\"footnote\" title=\"RNPedia. (2021). https:\/\/www.rnpedia.com\" id=\"return-footnote-375-4\" href=\"#footnote-375-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><a class=\"footnote\" title=\"OpenMD.Com at openmd.com\" id=\"return-footnote-375-5\" href=\"#footnote-375-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><a class=\"footnote\" title=\"uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral\" id=\"return-footnote-375-6\" href=\"#footnote-375-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a> Each medication class is also discussed in more detail later in this section.<\/p>\n<table class=\"grid\" style=\"width: 100%;\">\n<caption>Table 7.7a Neurotransmitters and Associated Medications Used to Treat Nausea and Vomiting<\/caption>\n<tbody>\n<tr style=\"height: 36px;\">\n<th scope=\"col\">Neurotransmitter<\/th>\n<th scope=\"col\">Medication Class<\/th>\n<th scope=\"col\">Antiemetic Drug<\/th>\n<th scope=\"col\">Mechanism of Action<\/th>\n<\/tr>\n<tr style=\"height: 73px;\">\n<th scope=\"row\">Acetylcholine (M1)<\/th>\n<td>Anticholinergics<\/td>\n<td>scopolamine<\/td>\n<td>Blocks ACh receptors in vestibular system<\/td>\n<\/tr>\n<tr style=\"height: 129px;\">\n<th scope=\"row\">Histamine (H1)<\/th>\n<td>Antihistamines<\/td>\n<td>meclizine<\/td>\n<td>Blocks H1 receptors and thus blocks ACh in vestibular system<\/td>\n<\/tr>\n<tr style=\"height: 92px;\">\n<th scope=\"row\">Dopamine (DA2)<\/th>\n<td>Dopamine antagonists<\/td>\n<td>prochlorperazine<\/td>\n<td>Blocks dopamine in CTZ and may block ACh<\/td>\n<\/tr>\n<tr style=\"height: 110px;\">\n<th scope=\"row\">Dopamine and ACh (DA2 and M1)<\/th>\n<td>Prokinetics<\/td>\n<td>metoclopramide<\/td>\n<td>Blocks dopamine in CTZ and stimulates ACh in GI tract<\/td>\n<\/tr>\n<tr style=\"height: 92px;\">\n<th scope=\"row\">Serotonin (5HT)<\/th>\n<td>Serotonin antagonists<\/td>\n<td>ondansetron<\/td>\n<td>Blocks serotonin in GI tract, CTZ, and VC<\/td>\n<\/tr>\n<tr style=\"height: 73px;\">\n<th scope=\"row\">Substance P (NK1)<\/th>\n<td>Neurokinin antagonists<\/td>\n<td>aprepitant<\/td>\n<td>Inhibits substance P neurokinin receptors<\/td>\n<\/tr>\n<tr class=\"a-R\" style=\"height: 147px;\">\n<th scope=\"row\">Cannabinoid (CB1)<\/th>\n<td>Tetrahydrocannabinols (THC)<\/td>\n<td>dronabinol or medical marijuana<\/td>\n<td>Activated CB1 receptor leading to inhibitory effects on cerebral cortex<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h1>Anticholinergics<\/h1>\n<p>Scopolamine is an example of an anticholinergic medication that is often used to treat motion sickness or nausea and vomiting associated with surgical recovery from anesthesia and\/or opiate analgesia.<\/p>\n<h2>Mechanism of Action<\/h2>\n<p>Anticholinergics block ACh receptors in the vestibular center and within the brain to prevent nausea-inducing stimuli to the Chemoreceptor Trigger Zone (CTZ) and the Vomiting Center (VC). They also dry GI secretions and reduce smooth muscle spasms.<\/p>\n<h2>Specific Administration Considerations<\/h2>\n<p>The scopolamine transdermal patch (see Figure 7.7a)<a class=\"footnote\" title=\"&quot;Scopoderm 278:365&quot; by Andreas Nilsson is licensed under CC BY-NC-ND 2.0\" id=\"return-footnote-375-7\" href=\"#footnote-375-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a> is designed for continuous release of scopolamine following the application to an area of intact skin on the head, behind the ear. The system is formulated to deliver approximately 1 mg of scopolamine to the systemic circulation over 3 days. It is contraindicated in clients with glaucoma. It has been reported to exacerbate psychosis, induce seizures, and cause drowsiness, confusion, and sedation. Due to its anticholinergic properties, scopolamine can decrease gastrointestinal motility and cause urinary retention. Nurses should perform more frequent monitoring during treatment with Transderm Sc\u014dp and discontinue Transderm Sc\u014dp in clients who develop difficulty in urination. Transderm Sc\u014dp contains an aluminized membrane; skin burns have been reported at the application site in clients wearing an aluminized transdermal system during an MRI scan. Remove Transderm Sc\u014dp before undergoing an MRI.<\/p>\n<figure style=\"width: 347px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" title=\"&quot;Scopoderm 278:365&quot; by Andreas Nilsson is licensed under CC BY-NC-ND 2.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2019\/11\/image2-2.png\" alt=\"A person with a with transdermal patch behind their right ear.\" width=\"347\" height=\"521\" \/><figcaption class=\"wp-caption-text\">Figure 7.7a Scopolamine Transdermal Patch<\/figcaption><\/figure>\n<p>Application instructions:<\/p>\n<ul>\n<li>Only wear one transdermal system at any time.<\/li>\n<li>Do not cut the transdermal system.<\/li>\n<li>Apply the transdermal system to the skin in the postauricular area (hairless area behind one ear).<\/li>\n<li>After the transdermal system is applied on the dry skin behind the ear, wash hands thoroughly with soap and water and dry hands.<\/li>\n<li>If the transdermal system becomes displaced, discard the transdermal system, and apply a new transdermal system on the hairless area behind the other ear.<\/li>\n<li>For surgeries other than cesarean section, apply one Transderm Sc\u014dp transdermal system the evening before a scheduled surgery. Remove the transdermal system 24 hours following surgery.<\/li>\n<\/ul>\n<h2>Patient Teaching &amp; Education<\/h2>\n<p>Transderm Sc\u014dp may impair the mental and\/or physical abilities required for the performance of hazardous tasks such as driving a motor vehicle, operating machinery, or participating in underwater sports. Concomitant use of other drugs (e.g., alcohol, sedatives, hypnotics, opiates, and anxiolytics) that cause central nervous system (CNS) adverse reactions, or that have anticholinergic properties, may increase this impairment. Inform clients not to operate motor vehicles or other dangerous machinery or participate in underwater sports until they are reasonably certain that Transderm Sc\u014dp does not affect them adversely. Scopolamine can cause temporary dilation of the pupils resulting in blurred vision if it comes in contact with the eyes. Advise clients to wash their hands thoroughly with soap and water and dry their hands immediately after handling the transdermal system. Upon removal, fold the used transdermal system in half with the sticky side together, and discard in household trash in a manner that prevents accidental contact or ingestion by children, pets, or others.<a class=\"footnote\" title=\"This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain.\" id=\"return-footnote-375-8\" href=\"#footnote-375-8\" aria-label=\"Footnote 8\"><sup class=\"footnote\">[8]<\/sup><\/a><\/p>\n<h1>Antihistamines<\/h1>\n<p>Meclizine is an example of an antihistamine that is often used to treat motion sickness.<\/p>\n<h2>Mechanism of Action<\/h2>\n<p>Antihistamines block H1 receptors in the vestibular center and may also block acetylcholine (ACh).<\/p>\n<h2>Specific Administration Considerations<\/h2>\n<p>Antihistamines are contraindicated in clients with glaucoma or an enlarged prostate gland. Dosage should be started one hour before travel begins.<\/p>\n<h2>Patient Teaching &amp; Education<\/h2>\n<ul>\n<li>Do not exceed recommended dosage.<\/li>\n<li>Be advised that drowsiness may occur.<\/li>\n<li>Avoid alcohol, sedatives, and tranquilizers, which may increase drowsiness.<\/li>\n<li>Avoid alcoholic drinks.<\/li>\n<li>Be careful when driving a motor vehicle or operating machinery.<a class=\"footnote\" title=\"This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain.\" id=\"return-footnote-375-9\" href=\"#footnote-375-9\" aria-label=\"Footnote 9\"><sup class=\"footnote\">[9]<\/sup><\/a><\/span><\/li>\n<\/ul>\n<h1>Dopamine Antagonists<\/h1>\n<p>Prochlorperazine is an example of a dopamine antagonist used to treat nausea and vomiting. It can also be used as an antipsychotic medication.<\/p>\n<h2>Mechanism of Action<\/h2>\n<p>Prochlorperazine blocks dopamine in the Chemoreceptor Trigger Zone (CTZ). It also calms the central nervous system and may also block acetylcholine.<\/p>\n<h2>Specific Administration Considerations<\/h2>\n<p>Prochlorperazine can be administered orally, intramuscularly, rectally or intravenously. It is contraindicated in children under age 2 or under 20 pounds. Severe side effects have occurred when used to treat psychosis.<\/p>\n<h2>Patient Teaching &amp; Education<\/h2>\n<p>Clients should be instructed to take medications as prescribed.\u00a0 They should avoid alcohol and other CNS depressants. Clients may experience increased photosensitivity and extreme temperatures should be avoided. Clients should be advised that urine may turn pinkish to reddish-brown.<a class=\"footnote\" title=\"uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral\" id=\"return-footnote-375-10\" href=\"#footnote-375-10\" aria-label=\"Footnote 10\"><sup class=\"footnote\">[10]<\/sup><\/a><\/p>\n<h1>Prokinetics<\/h1>\n<p>Metoclopramide is an example of a <a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_375_732\"><strong>prokinetic<\/strong><\/a> medication (see Figure 7.7b).<a class=\"footnote\" title=\"&quot;Metoclopramide&quot; by John Campbell is licensed under CC0\" id=\"return-footnote-375-11\" href=\"#footnote-375-11\" aria-label=\"Footnote 11\"><sup class=\"footnote\">[11]<\/sup><\/a><\/p>\n<figure style=\"width: 601px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" title=\"&quot;Metoclopramide&quot; by John Campbell is licensed under CC0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image4-2-1.png\" alt=\"Photo of metoclopramide vials, a prokinetic\" width=\"601\" height=\"401\" \/><figcaption class=\"wp-caption-text\">Figure 7.7b Prokinetics<\/figcaption><\/figure>\n<h2>Mechanism of Action<\/h2>\n<p>Metoclopramide blocks dopamine and may also sensitize tissues to acetylcholine. It is used to promote peristalsis to empty the gastrointestinal tract and thus reduce nausea.<\/p>\n<h2>Specific Administration Considerations<\/h2>\n<p>Metoclopramide can be administered orally, intramuscularly, and intravenously. The onset of pharmacological action of metoclopramide is 1 to 3 minutes following an intravenous dose, 10 to 15 minutes following intramuscular administration, and 30 to 60 minutes following an oral dose. Pharmacological effects persist for 1 to 2 hours.<\/p>\n<p>Metoclopramide should not be used whenever stimulation of gastrointestinal motility might be dangerous (e.g., in the presence of gastrointestinal hemorrhage, mechanical obstruction, or perforation). Metoclopramide is contraindicated in clients with pheochromocytoma because the drug may cause a hypertensive crisis. Metoclopramide should not be used in epileptics or clients receiving other drugs that are likely to cause extrapyramidal reactions because the frequency and severity of seizures or extrapyramidal reactions may be increased. Rare reports of neuromalignant syndrome have occurred.<\/p>\n<h2>Patient Teaching &amp; Education<\/h2>\n<p>Teach clients to immediately inform the healthcare provider if they experience new feelings of depression or abnormal muscle movements they cannot control such as:<\/p>\n<ul>\n<li>lip-smacking, chewing, or puckering of the mouth<\/li>\n<li>frowning or scowling<\/li>\n<li>sticking out the tongue<\/li>\n<li>blinking and moving the eyes<\/li>\n<li>shaking of the arms and legs<a class=\"footnote\" title=\"This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain.\" id=\"return-footnote-375-12\" href=\"#footnote-375-12\" aria-label=\"Footnote 12\"><sup class=\"footnote\">[12]<\/sup><\/a><\/span><\/li>\n<\/ul>\n<h1>Serotonin Antagonists<\/h1>\n<p>Ondansetron is an example of a serotonin (5HT) antagonist often used to treat severe nausea and vomiting associated with chemotherapy, postoperative nausea and vomiting, and hyperemesis during pregnancy. (See Figure 7.7c for an image of odansetron blocking the 5-HT<sub>3<\/sub> receptor.<a class=\"footnote\" title=\"&quot;Eichelbaum2.jpg&quot; by Michel Eichelbaum is licensed under CC BY-SA 3.0 DE\" id=\"return-footnote-375-13\" href=\"#footnote-375-13\" aria-label=\"Footnote 13\"><sup class=\"footnote\">[13]<\/sup><\/a>)<\/p>\n<figure style=\"width: 557px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" title=\"&quot;Eichelbaum2.jpg&quot; by Michel Eichelbaum is licensed under CC BY-SA 3.0 DE\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image5.jpg\" alt=\"Illustration of Ondansetron blocking serotonin receptors.\" width=\"557\" height=\"414\" \/><figcaption class=\"wp-caption-text\">Figure 7.7c Ondansetron blocking the 5-HT<sub>3<\/sub> receptor<\/figcaption><\/figure>\n<h2>Mechanism of Action<\/h2>\n<p>Ondansetron blocks serotonin receptors in the GI tract, the chemoreceptor trigger zone (CTZ), and the vomiting center (VC). See Figures 7.7d and 7.7e for images of the injectable and oral formulations of ondansetron.<a class=\"footnote\" title=\"&quot;000817lg Zofran 8 MG Oral Tablet.jpg&quot; by NLM is licensed under CC0\" id=\"return-footnote-375-14\" href=\"#footnote-375-14\" aria-label=\"Footnote 14\"><sup class=\"footnote\">[14]<\/sup><\/a><span style=\"font-size: 16px;\">,<\/span><a class=\"footnote\" title=\"&quot;Ondansetron (1)&quot; by M is licensed under CC BY-NC 2.0\" id=\"return-footnote-375-15\" href=\"#footnote-375-15\" aria-label=\"Footnote 15\"><sup class=\"footnote\">[15]<\/sup><\/a><\/p>\n<figure style=\"width: 313px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" title=\"&quot;Ondansetron (1)&quot; by M is licensed under CC BY-NC 2.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image6-2-1.png\" alt=\"Photo of bottle of Zofran injectable.\" width=\"313\" height=\"418\" \/><figcaption class=\"wp-caption-text\">Figure 7.7d Ondansetron in injectable form<\/figcaption><\/figure>\n<figure style=\"width: 436px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" style=\"color: #373d3f; font-weight: bold; font-size: 1.125em;\" title=\"&quot;000817lg Zofran 8 MG Oral Tablet.jpg&quot; by NLM is licensed under CC0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image7-2-1.png\" alt=\"Photo of Zofran tablets\" width=\"436\" height=\"311\" \/><figcaption class=\"wp-caption-text\">Figure 7.7e Ondansetron in tablet form<\/figcaption><\/figure>\n<h2>Specific Administration Considerations<\/h2>\n<p>Ondansetron is available as an orally disintegrating tablet and as an injectable for those clients too nauseated to tolerate oral medication. It is contraindicated with apomorphine. <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_375_705\">Serotonin syndrome<\/a><\/strong> can occur if administered concurrently with other serotonin antagonists or selective serotonin reuptake inhibitors. Ondansetron can cause headaches, drowsiness, constipation, fever, and diarrhea. A rare but serious adverse effect of ondansetron is QT prolongation that can cause an abnormal cardiac rhythm.<\/p>\n<h2>Patient Teaching &amp; Education<\/h2>\n<p>Teach clients to immediately inform their healthcare provider if they experience a change in heart rate, lightheadedness, or feel faint or have any signs and symptoms of hypersensitivity reactions such as fever, chills, rash, or breathing problems.<a class=\"footnote\" title=\"This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain.\" id=\"return-footnote-375-16\" href=\"#footnote-375-16\" aria-label=\"Footnote 16\"><sup class=\"footnote\">[16]<\/sup><\/a><\/p>\n<h1>Neurokinin Receptor Antagonists<\/h1>\n<p>Aprepitant is an example of a neurokinin antagonist used to prevent nausea and vomiting associated with chemotherapy and surgery.<\/p>\n<h2>Mechanism of Action<\/h2>\n<p>Aprepitant inhibits substance-P neurokinin receptors in the brainstem.<\/p>\n<h2>Nursing Considerations<\/h2>\n<p>Aprepitant is usually administered concurrently with dexamethasone (a corticosteroid) and ondansetron. It can be administered orally or intravenously. It has clinically significant CYP3A4 drug interactions with medications such as pimozide, diltiazem, and rifampin, and can decrease INR levels when taken concurrently with warfarin. It can also reduce the effectiveness of oral contraceptives.<\/p>\n<h2>Patient Teaching &amp; Education<\/h2>\n<p>Teach clients taking warfarin that they will need to monitor their INR levels more closely, which may require adjustment of the warfarin dosage while taking aprepitant. Teach clients using an oral contraceptive to use backup birth control.<a class=\"footnote\" title=\"This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain. \u00a0\" id=\"return-footnote-375-17\" href=\"#footnote-375-17\" aria-label=\"Footnote 17\"><sup class=\"footnote\">[17]<\/sup><\/a><\/p>\n<h1>Tetrahydrocannabinoids (THC)<\/h1>\n<p>Dronabinol or medical marijuana is an example of a <strong><a class=\"glossary-term\" aria-haspopup=\"dialog\" aria-describedby=\"definition\" href=\"#term_375_736\">THC<\/a><\/strong> medication used to treat nausea in clients with cancer or AIDS (see Figures 7.7f and 7.7g).<a class=\"footnote\" title=\"&quot;Marinol - Dronabinol&quot; by Steffen Geyer is licensed under CC BY-NC 2.0 &amp; 7.21&quot;Medical Marijuana&quot; by Circe Denyer is licensed under CC0\" id=\"return-footnote-375-18\" href=\"#footnote-375-18\" aria-label=\"Footnote 18\"><sup class=\"footnote\">[18]<\/sup><\/a><\/p>\n<figure style=\"width: 345px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" title=\"&quot;Marinol - Dronabinol&quot; by Steffen Geyer is licensed under CC BY-NC 2.0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image8-1-1.png\" alt=\"Photo of Marinol capules bottle.\" width=\"345\" height=\"517\" \/><figcaption class=\"wp-caption-text\">Figure 7.7f Dronabinol, a THC medication<\/figcaption><\/figure>\n<p>&nbsp;<\/p>\n<figure style=\"width: 610px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" title=\"&quot;Medical Marijuana&quot; by Circe Denyer is licensed under CC0\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2022\/05\/image9-1.png\" alt=\"Photo of medical marijuana in prescription bottle\" width=\"610\" height=\"457\" \/><figcaption class=\"wp-caption-text\">Figure 7.7g Medical Marijuana<\/figcaption><\/figure>\n<h2>Mechanism of Action<\/h2>\n<p>THC has inhibitory effects in the cerebral cortex causing an alteration in mood and the body&#8217;s perception of its surroundings, which may relieve nausea and vomiting, as well as stimulate the appetite.<\/p>\n<h2>Specific Administration Considerations<\/h2>\n<p>THC will cause a dose-related &#8220;high&#8221; (easy laughing, elation, and heightened awareness). It is abusable and, thus, is a controlled substance and scheduled medication. THC should be used cautiously in elderly clients because they may be more sensitive to the neurological, psychoactive, and postural hypotensive effects of the drug. In general, dose selection for an elderly client should be cautious, usually starting at the low end of the dosing range.<\/p>\n<h2>Patient Teaching &amp; Education<\/h2>\n<p>Clients should not drive, operate machinery, or engage in any hazardous activity when using THC. Keep out of reach of children and pets.<a class=\"footnote\" title=\"This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain. \u00a0\" id=\"return-footnote-375-19\" href=\"#footnote-375-19\" aria-label=\"Footnote 19\"><sup class=\"footnote\">[19]<\/sup><\/a><\/p>\n<h1>Herbal and Vitamin Supplements<\/h1>\n<p>Ginger has been used in traditional Indian and Chinese medicine as an antiemetic. Although its mechanism of action is not completely understood, ginger is thought to antagonize the 5HT and cholinergic receptors and may have direct effect on the gastrointestinal tract. Although ginger can cause reflux and heartburn and may potentially cause bleeding because of its anticoagulant effects, dosages of up to 2 g per day in divided doses of 250 mg are considered safe, even in pregnant women. Pyridoxine (vitamin B6) has also been recommended for treating nausea and vomiting in pregnancy. Typical dosages of pyridoxine, 10 to 25 mg every eight hours, cause minimal adverse effects. <a class=\"footnote\" title=\"Flake, Z., Linn, B., &amp; Hornecker, J. (2015). Practical selection of antiemetics in the ambulatory setting. American Family Physician, 91(5): pp 293-296.\" id=\"return-footnote-375-20\" href=\"#footnote-375-20\" aria-label=\"Footnote 20\"><sup class=\"footnote\">[20]<\/sup><\/a><\/p>\n<h1>Antiemetics Medication Grid<\/h1>\n<p>Now let\u2019s take a closer look at the medication grids comparing medications used to treat nausea and vomiting, in Table 7.7a <a class=\"footnote\" title=\"This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain.\" id=\"return-footnote-375-21\" href=\"#footnote-375-21\" aria-label=\"Footnote 21\"><sup class=\"footnote\">[21]<\/sup><\/a>.<\/p>\n<p>Medication cards like this are intended to assist students to learn key points about each medication. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication. Basic information related to each class of medication is outlined below. Prototype or generic medication examples are also hyperlinked to a free resource at <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/index.cfm\">Daily Med<\/a>. On the home page, enter the drug name in the search bar to read more about the medication.<\/p>\n<p><span style=\"text-align: initial; font-size: 14pt;\">Table 7.7 Comparing Medications Used to Treat Nausea and Vomiting <a class=\"footnote\" title=\"This work is a derivative of\u00a0 Daily Med by\u00a0U.S. National Library of Medicine\u00a0in the\u00a0public domain.\" id=\"return-footnote-375-22\" href=\"#footnote-375-22\" aria-label=\"Footnote 22\"><sup class=\"footnote\">[22]<\/sup><\/a><a class=\"footnote\" title=\"RNPedia. (2021). https:\/\/www.rnpedia.com\" id=\"return-footnote-375-23\" href=\"#footnote-375-23\" aria-label=\"Footnote 23\"><sup class=\"footnote\">[23]<\/sup><\/a><a class=\"footnote\" title=\"OpenMD.Com at openmd.com\" id=\"return-footnote-375-24\" href=\"#footnote-375-24\" aria-label=\"Footnote 24\"><sup class=\"footnote\">[24]<\/sup><\/a><a class=\"footnote\" title=\"uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral\" id=\"return-footnote-375-25\" href=\"#footnote-375-25\" aria-label=\"Footnote 25\"><sup class=\"footnote\">[25]<\/sup><\/a><\/span><span style=\"font-size: 1em; text-align: initial;\">\u00a0<\/span><a class=\"rId19\" style=\"font-size: 1em; text-align: initial;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=b877a694-a1d0-4280-937a-a06820b12a88\" rel=\"noopener noreferrer\">scopolamine\u00a0<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId20\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=8b3c9283-b618-4d57-9f15-7cf73e8737f5\" rel=\"noopener noreferrer\">meclizine<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId21\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=5e771ba7-983f-49b4-a1f2-0f335b637433\" rel=\"noopener noreferrer\">prochlorperazine<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId22\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=50a3cf38-66dc-4fa5-8a45-adf959c987ab\" rel=\"noopener noreferrer\">metoclopramide<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId23\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=e0050959-c14c-41b6-9a92-fadc5f6feff3\" rel=\"noopener noreferrer\">ondansetron<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId24\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=d72e0e10-4557-41b0-b65d-d395468cad19\" rel=\"noopener noreferrer\">aprepitant<\/a><span style=\"text-align: initial; font-size: 14pt;\">, <\/span><a class=\"rId25\" style=\"text-align: initial; font-size: 14pt;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=1f1af798-17d5-47d0-b129-21d4aa1eb125\" rel=\"noopener noreferrer\">dronabinol<\/a><span style=\"text-align: initial; font-size: 14pt;\"> or medical marijuana<\/span><\/p>\n<table style=\"border-collapse: collapse; width: 100%;\">\n<caption><span style=\"text-align: initial; font-size: 14pt;\">Table 7.7 Comparing Medications Used to Treat Nausea and Vomiting<\/span><\/caption>\n<tbody>\n<tr>\n<th style=\"width: 10.0287%;\" scope=\"col\">Class<\/th>\n<th style=\"width: 9.16906%;\" scope=\"col\">Generic Prototype (Brand)<\/th>\n<th style=\"width: 3.9799%;\" scope=\"col\">Mechanism<\/th>\n<th style=\"width: 18.6653%;\" scope=\"col\">Indication &amp; Therapeutic Effect<\/th>\n<th style=\"width: 12.2294%;\" scope=\"col\">Contraindications<\/th>\n<th style=\"width: 16.6914%;\" scope=\"col\">Side Effects<\/th>\n<th style=\"width: 21.6621%;\" scope=\"col\">Administration and Nursing Considerations<\/th>\n<\/tr>\n<tr>\n<th style=\"width: 10.0287%;\" scope=\"row\">Anticholinergic<\/th>\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=163accb7-45e6-4d97-844d-72b606677008\">Scopolamine<\/a><\/p>\n<p class=\"small\">(Hyoscine)<\/p>\n<p class=\"small\">(Transderm)<\/p>\n<\/td>\n<td style=\"width: 3.9799%;\">Inhibits postganglionic muscarinic receptor sites, and acts on smooth muscles that respond to acetylcholine<\/td>\n<td style=\"width: 18.6653%;\">Prevent or reduce N\/V associated with motion sickness or surgery<\/p>\n<p>&nbsp;<\/td>\n<td style=\"width: 12.2294%;\">Contraindicated in clients with glaucoma<\/td>\n<td style=\"width: 16.6914%;\">anticholinergic effects<\/p>\n<p>Stop if it exacerbates psychosis or causes seizures, cognitive impairment<\/td>\n<td style=\"width: 21.6621%;\">Apply to hairless skin behind ear for 3 days or the night before surgery and remove 24 hours later<\/p>\n<p>Do not cut patch<\/p>\n<p>After application, thoroughly wash and dry handsRemove before an MRI<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 10.0287%;\" scope=\"row\">Dopamine antagonist<\/th>\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=baf59816-7577-4652-b065-fb6de9e54569\">prochlorperazine<\/a><\/p>\n<p class=\"\u201dsmall\u201d\">(Stemetil)<\/p>\n<\/td>\n<td style=\"width: 3.9799%;\">Depresses action on the chemo-receptor trigger zone.<\/td>\n<td style=\"width: 18.6653%;\">Control N\/V associated with surgery<\/p>\n<p>&nbsp;<\/td>\n<td style=\"width: 12.2294%;\">Use of other CNS depressants<\/p>\n<p>Dementia-related psychosis<\/td>\n<td style=\"width: 16.6914%;\">Drowsiness, dizziness, amenorrhea, blurred vision, skin reactions, low\u00a0 Tardive dyskinesia, NMS<\/p>\n<p>&nbsp;<\/td>\n<td style=\"width: 21.6621%;\">Can be administered PO, IM, PR, or IV<\/p>\n<p>Not suitable for children under the age of 2<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 10.0287%;\" scope=\"row\">Prokinetic<\/th>\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=59abd52d-8172-44a3-baa2-fe1fe20f78c0\">metoclopramide<\/a><\/p>\n<p class=\"small\">(Maxeran)<\/p>\n<\/td>\n<td style=\"width: 3.9799%;\">Stimulates upper GI tract<\/p>\n<p>Antagonizes dopamine receptors<\/td>\n<td style=\"width: 18.6653%;\">GERD<\/p>\n<p>N\/V associated with surgery or chemo-therapy<\/td>\n<td style=\"width: 12.2294%;\">GI hemorrhage<\/p>\n<p>GI obstruction<\/p>\n<p>GI perforation<br \/>\nHistory of seizures<\/td>\n<td style=\"width: 16.6914%;\">Restlessness, drowsiness, fatigue, depression, and suicide ideation.<\/p>\n<p>Tardive dyskinesia, NMS<\/td>\n<td style=\"width: 21.6621%;\">Can be administered PO, IM, and IV<\/p>\n<p>Onset: 1 to 3 mins for IV dose, 10 to 15 mins for IM admin, and 30 to 60 mins for oral dose<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 10.0287%;\" scope=\"row\">Serotonin antagonist<\/th>\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=be5930d2-0008-4e61-9715-684c29a9c613\">ondansetron<\/a><\/p>\n<p class=\"small\">(Zofran)<\/p>\n<\/td>\n<td style=\"width: 3.9799%;\">Selective 5-HT3 receptor antagonist.<\/td>\n<td style=\"width: 18.6653%;\">Prevention or treatment of severe N\/V associated with surgery, chemo-therapy, or hyperemesis in pregnancy<\/td>\n<td style=\"width: 12.2294%;\">Hypersensitivity<\/td>\n<td style=\"width: 16.6914%;\">Headache, drowsiness, constipation, fever, and diarrhea<\/p>\n<p>May prolong QT<br \/>\nserotonin syndrome if given concurrently with serotonin antagonists or SSRIs<\/td>\n<td style=\"width: 21.6621%;\">Can be administered as oral disintegrating tablet, PO, or IV<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 10.0287%;\" scope=\"row\">Neurokinin receptor antagonist<\/th>\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=af9b6086-4bf2-472c-8740-4134eaaebace\">aprepitant<\/a><\/p>\n<p class=\"small\">(Emend)<\/p>\n<\/td>\n<td style=\"width: 3.9799%;\">selective high-affinity antagonist of human substance P\/neurokinin 1 (NK1) receptor<\/td>\n<td style=\"width: 18.6653%;\">Prevention of nausea and vomiting associated with chemo-therapy and surgery<\/td>\n<td style=\"width: 12.2294%;\">Clients on pimozide<\/td>\n<td style=\"width: 16.6914%;\">Hypersensitivity reaction, such as hives, rash. and itching; skin peeling or sores; or difficulty in breathing or swallowing<\/td>\n<td style=\"width: 21.6621%;\">Can be administered PO or IV<\/p>\n<p>If on warfarin, increase INR monitoring<\/p>\n<p>If on oral contraceptives, use backup birth control<\/td>\n<\/tr>\n<tr>\n<th style=\"width: 10.0287%;\" scope=\"row\">THC<\/th>\n<td style=\"width: 9.16906%;\"><a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/drugInfo.cfm?setid=a0409d82-a61e-4b9e-8717-ced299ccedb2\">dronabinol<\/a> or medical marijuana<\/td>\n<td style=\"width: 3.9799%;\">central sympathomimetic activity<\/td>\n<td style=\"width: 18.6653%;\">For treatment of N\/V associated with cancer chemo-therapy when other treatment fails<\/td>\n<td style=\"width: 12.2294%;\">Hypersensitivity to sesame oil.<\/td>\n<td style=\"width: 16.6914%;\">Neuropsychiatric Adverse Reactions, <span style=\"font-family: inherit; font-size: inherit;\">Hemodynamic Instability Seizures, <\/span><span style=\"font-family: inherit; font-size: inherit;\">Paradoxical Nausea, Vomiting, and Abdominal Pain<\/span><\/td>\n<td style=\"width: 21.6621%;\">Administered PO<\/p>\n<p>Dosage may be escalated based on initial results<br \/>\nUse cautiously in elderly client<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"textbox textbox--key-takeaways\">\n<header class=\"textbox__header\">Clinical Reasoning and Decision-Making Activity 7.7<img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-50\" src=\"https:\/\/opentextbc.ca\/accessibilitytoolkit\/wp-content\/uploads\/sites\/397\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png\" alt=\"Image of lightbulb in a circle\" width=\"200\" height=\"200\" srcset=\"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-content\/uploads\/sites\/397\/2019\/09\/ORN-Icons_lightbulb-300x300-1.png 300w, https:\/\/opentextbc.ca\/nursingpharmacology\/wp-content\/uploads\/sites\/397\/2019\/09\/ORN-Icons_lightbulb-300x300-1-150x150.png 150w, https:\/\/opentextbc.ca\/nursingpharmacology\/wp-content\/uploads\/sites\/397\/2019\/09\/ORN-Icons_lightbulb-300x300-1-65x65.png 65w, https:\/\/opentextbc.ca\/nursingpharmacology\/wp-content\/uploads\/sites\/397\/2019\/09\/ORN-Icons_lightbulb-300x300-1-225x225.png 225w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><\/header>\n<div class=\"textbox__content\">\n<p>A nurse is caring for a client who underwent surgery earlier today and is experiencing nausea and vomiting. The original post-op orders included prochlorperazine, but the client continues to experience vomiting despite receiving this medication. The nurse calls the provider and receives a new order for ondansetron orally dissolving tablets, 8 mg three times daily as needed.<\/p>\n<ol>\n<li>How will the nurse assess for symptoms of dehydration?<\/li>\n<li>When administering the medication, the client states, &#8220;This tastes terrible! Why can&#8217;t I have a normal pill to swallow?&#8221; What is the nurse&#8217;s best response?<\/li>\n<li>What other measures should the nurse teach the clients to reduce feelings of nausea and avoid dehydration?<\/li>\n<\/ol>\n<p>Note: Answers to the Critical Thinking activities can be found in the &#8220;<a href=\"https:\/\/opentextbc.ca\/nursingpharmacology\/chapter\/chapter-7\/\">Answer Key<\/a>&#8221; sections at the end of the book.<\/p>\n<\/div>\n<\/div>\n<p>&nbsp;<\/p>\n<hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-375-1\">MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2019 October 23]. <em>Nausea and vomiting;<\/em> [updated 2019 February 7; reviewed 2016 March 17; cited 2019 October 27]. <a href=\"https:\/\/medlineplus.gov\/nauseaandvomiting.html\" rel=\"noopener noreferrer\">https:\/\/medlineplus.gov\/nauseaandvomiting.html<\/a>. <a href=\"#return-footnote-375-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-375-2\">Bashashati, M. &amp; McCallum, R. (2014). Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. <em>European Journal of Pharmacology, 772<\/em>, p 79. <a href=\"#return-footnote-375-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-375-3\">Bashashati, M. and McCallum, R. (2014). Neurochemical mechanisms and pharmacologic strategies in managing nausea and vomiting related to cyclic vomiting syndrome and other gastrointestinal disorders. <em>European Journal of Pharmacology, 772<\/em>, p 79. <a href=\"#return-footnote-375-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-375-4\">RNPedia. (2021). https:\/\/www.rnpedia.com <a href=\"#return-footnote-375-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-375-5\">OpenMD.Com at openmd.com <a href=\"#return-footnote-375-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-375-6\">uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral <a href=\"#return-footnote-375-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-375-7\">\"<a href=\"https:\/\/www.flickr.com\/photos\/andreasnilsson1976\/2551446785\" rel=\"noopener noreferrer\">Scopoderm 278:365<\/a>\" by <a href=\"https:\/\/www.flickr.com\/photos\/andreasnilsson1976\/\" rel=\"noopener noreferrer\">Andreas Nilsson<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/2.0\/\" rel=\"noopener noreferrer\">CC BY-NC-ND 2.0<\/a> <a href=\"#return-footnote-375-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><li id=\"footnote-375-8\">This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>.  <a href=\"#return-footnote-375-8\" class=\"return-footnote\" aria-label=\"Return to footnote 8\">&crarr;<\/a><\/li><li id=\"footnote-375-9\">This work is a derivative of <a style=\"text-align: initial;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a><span style=\"text-align: initial;\"> by <\/span><a style=\"text-align: initial;\" href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a><span style=\"text-align: initial;\"> in the <\/span><a style=\"text-align: initial;\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a><span style=\"text-align: initial;\">.  <a href=\"#return-footnote-375-9\" class=\"return-footnote\" aria-label=\"Return to footnote 9\">&crarr;<\/a><\/li><li id=\"footnote-375-10\">uCentral from Unbound Medicine. <a href=\"https:\/\/www.unboundmedicine.com\/ucentral\" rel=\"noopener noreferrer\">https:\/\/www.unboundmedicine.com\/ucentral<\/a> <a href=\"#return-footnote-375-10\" class=\"return-footnote\" aria-label=\"Return to footnote 10\">&crarr;<\/a><\/li><li id=\"footnote-375-11\">\"<a href=\"https:\/\/www.flickr.com\/photos\/104346167@N06\/36640425216\" rel=\"noopener noreferrer\">Metoclopramide<\/a>\" by <a href=\"https:\/\/www.flickr.com\/photos\/104346167@N06\/\" rel=\"noopener noreferrer\">John Campbell<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/cc0\/\" rel=\"noopener noreferrer\">CC0<\/a> <a href=\"#return-footnote-375-11\" class=\"return-footnote\" aria-label=\"Return to footnote 11\">&crarr;<\/a><\/li><li id=\"footnote-375-12\">This work is a derivative of <a style=\"text-align: initial;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a><span style=\"text-align: initial;\"> by <\/span><a style=\"text-align: initial;\" href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a><span style=\"text-align: initial;\"> in the <\/span><a style=\"text-align: initial;\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a><span style=\"text-align: initial;\">.  <a href=\"#return-footnote-375-12\" class=\"return-footnote\" aria-label=\"Return to footnote 12\">&crarr;<\/a><\/li><li id=\"footnote-375-13\">\"<a href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Eichelbaum2.jpg\" rel=\"noopener noreferrer\">Eichelbaum2.jpg<\/a>\" by Michel Eichelbaum is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/3.0\/de\/deed.en\" rel=\"noopener noreferrer\">CC BY-SA 3.0 DE<\/a> <a href=\"#return-footnote-375-13\" class=\"return-footnote\" aria-label=\"Return to footnote 13\">&crarr;<\/a><\/li><li id=\"footnote-375-14\">\"<a href=\"https:\/\/en.wikipedia.org\/wiki\/File:000817lg_Zofran_8_MG_Oral_Tablet.jpg\" rel=\"noopener noreferrer\">000817lg Zofran 8 MG Oral Tablet.jpg<\/a>\" by NLM is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/cc0\/\" rel=\"noopener noreferrer\">CC0<\/a> <a href=\"#return-footnote-375-14\" class=\"return-footnote\" aria-label=\"Return to footnote 14\">&crarr;<\/a><\/li><li id=\"footnote-375-15\">\"<a href=\"http:\/\/flickr.com\/photos\/intropin\/4499127380\" rel=\"noopener noreferrer\">Ondansetron (1<\/a>)\" by <a href=\"https:\/\/www.flickr.com\/photos\/intropin\/\" rel=\"noopener noreferrer\">M<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/\" rel=\"noopener noreferrer\">CC BY-NC 2.0<\/a> <a href=\"#return-footnote-375-15\" class=\"return-footnote\" aria-label=\"Return to footnote 15\">&crarr;<\/a><\/li><li id=\"footnote-375-16\">This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>.  <a href=\"#return-footnote-375-16\" class=\"return-footnote\" aria-label=\"Return to footnote 16\">&crarr;<\/a><\/li><li id=\"footnote-375-17\">This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>. \u00a0 <a href=\"#return-footnote-375-17\" class=\"return-footnote\" aria-label=\"Return to footnote 17\">&crarr;<\/a><\/li><li id=\"footnote-375-18\">\"<a href=\"https:\/\/www.flickr.com\/photos\/115645852@N04\/32335066121\" rel=\"noopener noreferrer\">Marinol - Dronabinol<\/a>\" by <a href=\"https:\/\/www.flickr.com\/photos\/115645852@N04\/\" rel=\"noopener noreferrer\">Steffen Geyer<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/licenses\/by-nc\/2.0\/\" rel=\"noopener noreferrer\">CC BY-NC 2.0<\/a> &amp; 7.21\"<a href=\"https:\/\/www.publicdomainpictures.net\/en\/view-image.php?image=246405&amp;picture=medical-marijuana\" rel=\"noopener noreferrer\">Medical Marijuana<\/a>\" by <a href=\"https:\/\/www.publicdomainpictures.net\/en\/browse-author.php?a=81846\" rel=\"noopener noreferrer\">Circe Denyer<\/a> is licensed under <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/cc0\/\" rel=\"noopener noreferrer\">CC0<\/a> <a href=\"#return-footnote-375-18\" class=\"return-footnote\" aria-label=\"Return to footnote 18\">&crarr;<\/a><\/li><li id=\"footnote-375-19\">This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>. \u00a0 <a href=\"#return-footnote-375-19\" class=\"return-footnote\" aria-label=\"Return to footnote 19\">&crarr;<\/a><\/li><li id=\"footnote-375-20\">Flake, Z., Linn, B., &amp; Hornecker, J. (2015). Practical selection of antiemetics in the ambulatory setting. <em>American Family Physician, 91<\/em>(5): pp 293-296. <a href=\"#return-footnote-375-20\" class=\"return-footnote\" aria-label=\"Return to footnote 20\">&crarr;<\/a><\/li><li id=\"footnote-375-21\">This work is a derivative of <a href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener noreferrer\">Daily Med<\/a> by <a href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener noreferrer\">U.S. National Library of Medicine<\/a> in the <a class=\"internal\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener noreferrer\">public domain<\/a>.  <a href=\"#return-footnote-375-21\" class=\"return-footnote\" aria-label=\"Return to footnote 21\">&crarr;<\/a><\/li><li id=\"footnote-375-22\"> This work is a derivative of\u00a0 <\/span><a style=\"text-align: initial;\" href=\"https:\/\/dailymed.nlm.nih.gov\/dailymed\/\" rel=\"noopener\">Daily Med <\/a><span style=\"text-align: initial;\">by\u00a0<\/span><a style=\"text-align: initial;\" href=\"https:\/\/www.nlm.nih.gov\/\" rel=\"noopener\">U.S. National Library of Medicine<\/a><span style=\"text-align: initial;\">\u00a0in the\u00a0<\/span><a style=\"text-align: initial;\" href=\"https:\/\/creativecommons.org\/share-your-work\/public-domain\/\" rel=\"noopener\">public domain<\/a><span style=\"text-align: initial;\">.  <a href=\"#return-footnote-375-22\" class=\"return-footnote\" aria-label=\"Return to footnote 22\">&crarr;<\/a><\/li><li id=\"footnote-375-23\">RNPedia. (2021). https:\/\/www.rnpedia.com <a href=\"#return-footnote-375-23\" class=\"return-footnote\" aria-label=\"Return to footnote 23\">&crarr;<\/a><\/li><li id=\"footnote-375-24\">OpenMD.Com at openmd.com <a href=\"#return-footnote-375-24\" class=\"return-footnote\" aria-label=\"Return to footnote 24\">&crarr;<\/a><\/li><li id=\"footnote-375-25\">uCentral from Unbound Medicine. https:\/\/www.unboundmedicine.com\/ucentral <a href=\"#return-footnote-375-25\" class=\"return-footnote\" aria-label=\"Return to footnote 25\">&crarr;<\/a><\/li><\/ol><\/div><div class=\"glossary\"><span class=\"screen-reader-text\" id=\"definition\">definition<\/span><template id=\"term_375_732\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_375_732\"><div tabindex=\"-1\"><p>Medications used to promote peristalsis to empty the gastrointestinal tract and reduce nausea.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_375_705\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_375_705\"><div tabindex=\"-1\"><p>Symptoms associated with serotonin syndrome may include the following combination of signs and symptoms: mental status changes (e.g., agitation, hallucinations, delirium, and coma), autonomic instability (e.g., tachycardia, labile blood pressure, dizziness, diaphoresis, flushing, hyperthermia), neuromuscular symptoms (e.g., tremor, rigidity, myoclonus, hyperreflexia, incoordination), seizures, with or without gastrointestinal symptoms (e.g., nausea, vomiting, diarrhea).<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><template id=\"term_375_736\"><div class=\"glossary__definition\" role=\"dialog\" data-id=\"term_375_736\"><div tabindex=\"-1\"><p>Tetrahydrocannabinoids found in marijuana.<\/p>\n<\/div><button><span aria-hidden=\"true\">&times;<\/span><span class=\"screen-reader-text\">Close definition<\/span><\/button><\/div><\/template><\/div>","protected":false},"author":90,"menu_order":7,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[50],"contributor":[],"license":[],"class_list":["post-375","chapter","type-chapter","status-publish","hentry","chapter-type-numberless"],"part":334,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/375","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/users\/90"}],"version-history":[{"count":25,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/375\/revisions"}],"predecessor-version":[{"id":1747,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/375\/revisions\/1747"}],"part":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/parts\/334"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapters\/375\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/media?parent=375"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/pressbooks\/v2\/chapter-type?post=375"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/contributor?post=375"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/nursingpharmacology\/wp-json\/wp\/v2\/license?post=375"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}