Lecture on Nausea Medications and Related Drugs

Introduction

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Ondansetron (Zofran)

• Use: Treats nausea and vomiting.
• Mechanism: Blocks serotonin receptors to reduce nausea.
• *Key Points:
  • Risk of serotonin syndrome (high risk for injury).
  • Common side effects: headache, dizziness.
  • Priority side effect: Torsades de pointes (deadly heart rhythm).
  • Administration: Given before chemo and with pain medications to prevent nausea.
• *Quiz Notes:
  • ATI: Used to decrease nausea/vomiting from chemo.
  • HESI: Administer ondansetron during chemo if nausea/vomiting occurs; stop chemo and flush line first.

Metoclopramide (Reglan)

• Use: Treats nausea, vomiting, and delayed gastric emptying (gastroparesis).
• Mechanism: Accelerates gastric emptying by increasing intestinal motility.
• Key Points:
  • Contraindicated for GI bleeds (e.g., duodenal ulcers).
  • Side effects: Extrapyramidal symptoms, including tardive dyskinesia (especially in older adults).
  • Report immediately: Lip smacking, sucking lip motion, puffing cheeks, excess blinking, protruding/twisting tongue, and chewing movement.
  • Normal side effects: Sedation, fatigue, restlessness, headache, sleeplessness, dry mouth, constipation, diarrhea (do not hold for these).

Laxatives and Stool Softeners

• Key Point: Contraindicated for bowel obstruction (risk of death).
• Types:
  • Psyllium husk: Bulking fiber.
  • Magnesium hydroxide (Milk of Magnesia): Laxative and antacid.
  • Sodium docusate (Colace): Stool softener, increases water content in stool.
• Patient Teaching: Increase fluid intake, fiber, and walking to promote bowel movement.

Lactulose

• Use: Lowers ammonia levels, treats hepatic encephalopathy (cloudy brain).
• Mechanism: Laxative that promotes ammonia excretion via diarrhea.
• Key Points:
  • Indicators of effectiveness: 2-3 soft stools per day, decreased ammonia levels, improved cognition.
  • Common distractors: Doesn't affect urine ammonia levels, portal hypertension, or abdominal distension.

Sodium Polystyrene Sulfonate (Kayexalate)

• Use: Treats hyperkalemia (high potassium).
• Mechanism: Removes excess potassium via intestines.
• Administration: PO (most effective) or enema.
• Key Points:
  • Educate patients: Large intestine removes excess potassium, no contrast used, not for bedridden constipated clients, doesn't reduce intestinal bacteria.

Conclusion

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• Acknowledgement: Thanks to the team of experts.
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