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SAIT ACP pharmacology (2
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SAIT ACP pharmacology (2
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SAIT ACP pharmacologyAntiemetic drugs (4) - ANS-Ondasteron
Dimenhydrinate
Metoclopramide
Diphenhydramine
Metoclopramide (Maxeran) classification (2) - ANS-Antiemetic
modifier of upper GI tract motility
Metoclopramide (Maxeran) Actions (5) - ANS-increases pressure in lower esophageal sphincter
increasing peristaltic movements in the esophagus, stomach, and small intestine
increases gastric emptying
relieves N/V
Antagonizes central and peripheral dopamine receptors, raising the threshold of activity in the
chemoreceptor zone- antiemetic effects
Used to counteract the gastric states and nausea associated with migraine
Metoclopramide (Maxeran) Indications - ANS-N/V
Headache suggestive of being vascular in origin (migraine)
Metoclopramide (Maxeran) Contraindications (5) - ANS-Hypersensitivity
GI obstruction
GI bleed
Seizure disorder
Concurrent use with other agents likely to increase extrapyramidal reactions
Metoclopramide (Maxeran) N/V dose (3) - ANS-10mg diluted in 50mL NS and infuse over 5
(five) mins NO REPEAT
or 10mg IM NO REPEAT
,(10mg IM/IV q 8-12 hrs, prn)*
Metoclopramide (Maxeran) HA dose (2) - ANS-10mg diltued in 50mL NS and infuse over 15
(fifteen) mins NO REPEAT
or 10mg IM NO REPEAT
Metoclopramide (Maxeran) pharmacokinetics - ANS-Half life: 3-5 hrs
Metoclopramide (Maxeran) Considerations (4) - ANS-Maxeran can cause extrapyramidal
symptoms if administered to quickly:
A) Dyskinesia- repetitive, involuntary body/facial movements
B) Akathisia- extreme form of restlessness
C) Dystonia- very strong muscle contractions
Use with caution in pts with HTN, depression, parkinson's, elders (risk of dyskinesia), breast CA
Metoclopramide (Maxeran) Adverse effects (4) - ANS-Drowsiness
dizziness
seizures
tachydysrhythmias
Dimenhydrinate (Gravol) Classification (2) - ANS-Antiemetic
Antihistamine
Dimenhydrinate (Gravol) Actions (4) - ANS-Depressant action on hyper stimulated labyrinthine
functions and diminishes vestibular function
Sedative effects due to inhibition of histamine and blockade of central histaminergic receptors
central inhibition of acetylcholine
H1 receptor antagonist
Dimenhydrinate (Gravol) Indications (5) - ANS-Prevention and treatment of N/V associated with:
motion sickness
radiation sickness
Meniere's disease
, Labryinthine disturbances
Post-operative vomiting
Dimenhydrinate (Gravol) Contraindications (3) - ANS-Known hypersensitivity to
dimenhydramine and dimenhydrinate
Narrow angle glaucoma
ETOH
Dimenhydrinate (Gravol) N/V Dose (2) - ANS-50mg SIVP/IM q 4hrs
>65: 25mg SIVP/IM q 15 mins, max 50mg
(50-100mg IV/IM q 4-6hrs prn, max 400mg/day)*
Dimenhydrinate (Gravol) Pharmacokinetics (3) - ANS-PO onset 15-30mins
IV onset immediate
Both last 3-6 hrs
Dimenhydrinate (Gravol) considerations (5) - ANS-5mg/mL over 2-4 mins
Geriatrics may be more sensitive
Tends to irritate vein on administration
Can cause seizures
Not recommended in neonates
Dimenhydrinate (Gravol) Adverse effects (3) - ANS-Drowsiness
sedative effect
dry mouth/throat
Ondasteron (Zofran) Classification - ANS-Antiemetic
Ondasteron (Zofran) Actions (2) - ANS-Is an 5-HT3 receptor antagonist
Antiemetic effects chiefly derive from a blockade of serotonin vagal afferent nerve endings in the
GI tract with some minor antagonism of medullary receptors
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