NAUSEA, VOMITING, AND DIARRHEA SUSAN AINSWORTH, MSN KEY TERMS • ANTIEMETICS • EMETIC • INTRACTABLE HICCOUGH • PHENOTHIAZINE • PHOTOSENSITIVITY • DIARRHEA • ANTIDIARRHEALS NAUSEA AND VOMITING • for some worse than pain • n and v are due to vestibular receptors in the inner ear • dizziness and vertigo • may need to induce vomiting • gastric lavage • photosensitivity REFLEX ACTION OF VOMITING • May not be beneficial to the pt body • May even be hazardous • Antiemetics may be used in these cases. GROUPS OF CENTRALLY ACTING ANTIEMETICS • • • • phenothiazine nonphenothiazines serotonin receptor blockers substance P receptor antagonists. PHENOTHIAZINES • • • • • Actions Indications Contraindications Caution Adverse Effects PHENOTHIAZINE ADVERSE EFFECTS AND DRUGDRUG INTERACTIONS • DROWSINESS, DRY MOUTH, DIZZINESS, WEAKNESS, H/S TREMORS • GYNECOMASTIA, PHOTOSENSITIVITY • USE SUNSCREEN AND PROTECTIVE GARMENTS • AVOID ETOH INTAKE AND SHOULD NOT BE USED WITH CNS DEPRESSANTS AS THE RESULT CAN BE ADDITIVE CNS DEPRESSION. NONPHENOTHIAZINE • Reglan only drug available at this time acts to reduce the responsiveness of the nerve cells in the CTZ to circulating chemicals that induce vomiting. 5-HT RECEPTORS BLOCKERS • Blocks receptors associated with nausea and vomiting in the CTZ locally • ondansetron (Zofran) • Aloxi • granisetron • Helpful in the tx of n and v associated with antineoplastic chemo and radiation therapy post op n and v MISCELLANEOUS GROUP • Marinol • Cesamet • Vistaril • Tigan SUBSTANCE P/NEUROKININ 1 RECEPTOR ANTAGONIST • Aprepitant (Emend) • Rolapitant (Verubi) EMETIC MEDICATION • Works the opposite of antiemetics • syrup of ipecac • no longer recommended but is still available • Do not recommend if working at poison control center. MECLIZINE • Cost effective • Works within 1 hour • Inner ear and vestibular problems • blocks CTZ INTRODUCTION TO DIARRHEA • • • • Diarrhea is the passage of too frequent stools Could be caused due to infection, toxins, anxiety and drugs Major cause of morbidity in developing countries Kills 5 million children in India per year DIARRHEA! • Why do we care? • Antidiarrheal agents activate opioid receptors and decrease motility • specific antidiarrheal agents could be an atx to treat a gi bacteria causing diarrhea • non-specific antidiarrheal agents such as Imodium. • contraindications • drug-drug interactions (ETOH and CNS depressants) • travelers diarrhea! ANTIDIARRHEALS! • SLOWS MOTILITY OF THE GI TRACT BY INHIBITING LOCAL REFLEXES THROUGH DIRECT ACTION ON THE MUSCLES OR THROUGH ACTION ON THE CNS (PEPTO BISMAL, IMODIUM, OPIUM DERIVATIVE) • USE WITH CAUTION IN PREGNANCY OR LACTATION • ADVERSE EFFECTS + N AND V , CONSTIPATION, ABDOMINAL DISCOMFORT TRAVELER’S DIARRHEA • Atx that treats e coli, the most common cause of travelers’ diarrhea • Destroys the causative agent; diarrhea will resolve • Prevention is the best medicine • Also used for cirrhosis of the liver IRRITABLE BOWEL SYNDROME (IBS) • • • • Common gi disorder More common in women underlying reason is stress related dysregulation of the autonomic nervous system NURSING CONSIDERATIONS FOR ANTIDIARRHEALS • ASSESS THE PT AND PERFORM A BASELINE EXAM • NURSING DIAGNOSIS • IMPLEMENTATION WITH THE RATIONALE • EVALUATE THE PATIENT POST MEDICATION ADMINISTRATION • DOCUMENT! THINGS TO REMEMBER • • • • • • Photosensitivity Cause of n and v Decrease CTZ Compazine for post op Syrup of Ipecac Traveler’s diarrhea drug of choice …AND A BIT MORE • Caution with antiemetics in pregnancy and lactation • Meclizine • Reglan
