WHICH AM I?
I am a natural product used for nausea and vomiting, as well as motion sickness, morning sickness, seasickness, and general anesthesia. I am also said to have anti-inflammatory and pain-killing (analgesic) properties. Aside from eating the natural product raw or cooked, I can also be taken in
gum or lollipop form. Which drug am I?
GINGER ROOT
This class/type of medication, for which hydroxyzine (Vistaril) is a prototype and dimenhydrinate (Dramamine) is a later example, not only can be used for nausea and vomiting, and for treating motion sickness, but also is sometimes used as an anti-anxiety medication. What is the name of this general class of drugs?
ANTIHISTIMINES
(which are a sub-class of "anticholinergics")
One of the potential side effects of prochlorperazine (Compro) is to drop the blood pressure, an AR that could be made worse if the drug is taken in combination with an antihypertensive drug. Given this potential AR even when the drug is taken alone, what is a key part of patient teaching for this drug?
GET UP SLOWLY TO MINIMIZE ORTHOSTATIC HYPOTENSION (and the risk for falls!)
This is perhaps the #1 "first line" drug given in many health care settings for the acute treatment of nausea and vomiting. Its generic prototype name begins with an "o," and it's trade/brand name begins with a "Z."
ondansetron (ZOFRAN)
NOTE: KNOW THIS DRUG. You'll be seeing it a lot.
TRUE OR FALSE: You introduce one of the drugs in this unit that has the common anticholinergic effect of "dry mouth" in patients, and the patient tells you that if they experience dry mouth, they plan to suck on a sugar-free hard candy or chew some sugar-free gum. You consider your patient education effective for this client's management of this particular s/s, true or false?
TRUE
I am a drug commonly given in hospitals, for I am seen as a first choice drug for the treatment of severe nausea and vomiting from chemo, radiation therapy, and anesthesia. I work by blocking type 3 serotinin (5-HT3) receptors on vagal afferent neurons in the upper GI tract and in the CTZ, blocking the "I need to vomit" message from being received in the brain. Which drug am I?
ondansetron (ZOFRAN)
NOTE: This is our one serotonin receptor antagonist in this unit, although it is possible that the natural product "ginger root" also has a similar MOA
TRUE OR FALSE: Common anticholinergic "side effects" include constipation, urinary retention, and a dry mouth
TRUE
NOTE that the symptoms described here are part of the normal "rest and DIGEST" function of cholinergics that are blocked by drugs with anticholinergic effects
The prototype hydroxazine (Vistaril) can be used for motion sickness, to treat nausea and vomiting, and also as an anti-anxiety medication. Another potential use, mentioned in lecture, is connected to a common side effect of this drug and others in its class
INDUCING SLEEP
NOTE: This effect is common enough that part of the patient teaching for the drug is to avoid ETOH, opioids, and other CNS sedatives while taking this drug, for those would intensify its sedative effect. Also notice the PICTURE on the Pt Ed slide: a person falling asleep at the wheel of a car.
TRUE OR FALSE: The drug olanzapine (Zyprexa), which is a 2nd generation Atypical Antipsychotic medication mainly used to treat serious mental health conditions such as schizophrenia, also has the recommendation from the American Society of Clinical Oncology for use with cancer patients receiving chemotherapy to help prevent CINV.
TRUE
You have just introduced the scopolamine patch (Transderm) to your patient, and you know your patient education was effective when they repeat back to you that they need to keep the patch on for THIS MANY DAYS to avoid withdrawal ARs, even if they do not feel any symptoms after the first day.
THREE DAYS
I am a drug that is commonly given as a transdermal patch to treat motion sickness or n/v from radiation therapy, or to prevent n/v peri-operatively (i.e. around the time of surgery, often because of sedatives used for anesthesia). I work by inhibiting M1 muscarinic receptors, suppressing nerve transmission from the vestibular apparatus of the inner ear to the vomiting center in the brain. Which drug am I?
scopolamine patch (TRANSDERM)
NOTE: This is the only transdermal patch introduced prominently in this unit, so pay attention to that detail
With anticholinergic drugs, the "drying out" effect can mean that a person may become unable to produce sweat. Which two signs/symptoms follow from the inability to sweat?
(1) BODY OVERHEATS on exertion
(2) SKIN FLUSHES as more blood moves toward the surface of the skin in an attempt to cool the body
Name the terms for AT LEAST TWO acute signs/symptoms of a patient experiencing EPS, and briefly describe what they mean
(1) DYSTONIA: [often painful] muscle contractions causing repetitive movements or postures
(2) PARKINSONISM: slowed movements, tremors, and stiffness/rigidity
(3) AKATHISIA: difficulty remaining still, causing repetitive movements and/or pacing
I am in a class of drugs called "Prokinetic Agents" for I am given orally to help to increase movement in the GI tract (e.g. increased peristalsis in the esophagus) to suppress GERD, and to treat gastroparesis (i.e. food "stalling" in the stomach) in patients with DM. I can also be given IV to suppress post-op and chemo-induced n/v. I am even used off label to treat hiccups and migranes! Which drug am I?
metoclopramide (REGLAN)
You know your patient education was effective when after describing potential drug effects of ondansetron (Zofran) to a client, they describe back to you signs and symptoms of
_THIS SYNDROME_ that include confusion, agitation, anxiety, hallucinations, increased sweat production, tremors, and fever
SEROTONIN SYNDROME
I am a drug used to reduce post-operative nausea and vomiting related to anesthesia given in surgery, and also used to treat nausea/vomiting from chemotherapy and other toxins. I am not recommended for children < 2 y.o., nor for people who are pregnant or breastfeeding. I work by blocking the dopamine receptors in the CTZ to depress the vomiting reaction. Which drug am I?
prochlorperazine (COMPRO)
This is the only purely dopamine receptor antagonist drug that is included in this unit
How do anticholinergic drugs affect the heart, and specifically the rate at which the heart beats?
CAUSE RAPID HEART RATE
(thus increase risk for tachycardia)
NOTE: This seems somewhat paradoxical since many of these drugs often cause drowsiness, but other times in people they cause the opposite: hyper-alertness/ agitation / hyperactivity
List AT LEAST THREE signs/symptoms of the Adverse Reaction known as Serotonin Syndrome (which happens when a patient's serotonin levels get too high)
(1) CONFUSION
(2) AGITATION
(3) ANXIETY
(4) HALLUCINATIONS
(5) INCREASED SWEATING
(6) TREMORS
(7) FEVER
In addition to its use for chemo-induced nausea and vomiting (CINV), this drug, which has active ingredients similar to hemp and marijuana, is sometimes prescribed for appetite stimulation in patients who don't feel the urge to eat. What is the prototype name for this prescription cannabinoid?
dronabinol (MARINOL)
Your patient "teaches back" to you that they should be sure not to drink ETOH or take CNS depressants, they should get up slowly to minimize orthostatic hypotension, they should maintain good oral care due to risk for dry mouth, they should not take an antacid within 2 hours of this drug, they should drink plenty of fluids, and they should report to their provider if they experience any EPS. Which drug from this unit are they taking?
prochlorperazine (COMPRO)
I am in a class of drugs called Substance P/NK1 Antagonists. My MOA is to block substance P in the CNS, which prevents activation of the vomiting reflex. My main usage is in the oncology (cancer) unit, where I am given to a patient to help prevent chemotherapy-induced nausea and vomiting (CINV). I am effective but expensive, and with a narrow and specific use (and perhaps for this reason am "overview only"). Which drug am I?
aprepitant (EMEND)
List AT LEAST THREE anticholinergic effects that take place in the Central Nervous System (CNS)
(1) DROWSINESS
(2) DIZZINESS
(3) CONFUSION
(4) HALLUCINATIONS
Name the common antiemetic drug mentioned in the unit this past week that can increase the QT interval in an EKG, thus increasing the risk for potentially life-threatening heart dysrhythmias such as Ventricular-Tachycardia (V-Tach).
BONUS: Because of the above, how does that AR relate to patient education for this drug?
ondansetron (ZOFRAN)
BONUS: Notify your provider if you notice an IRREGULAR HEARTBEAT
+ Do not take with other drugs that can potentially prolong the QT interval, such as anti-dysrhythmics
This class of drugs is often given in combination with 5HT3 antagonists (like ondansetron) or with P/NK1 antagonists (like aprepitant) to increase the anti-emetic efficacy of those drugs
BONUS: Name at least one specific prototype from this category that is used in this combo fashion
CORTICOSTEROIDS
BONUS examples from your outline for this combo use:
dexamethasone
and
methylprednisolone
Despite your teaching your patient that they should keep their scopolamine patch (Transderm) on for three whole days, you realize that your patient education was nevertheless extremely effective when you hear them say to you, "But I should still remove it earlier than three days and notify my provider if I experience pain or reddening in my eyes when my pupils dilate, like when I come inside on a sunny day, right?" What serious medical condition that is potentially caused by the scopolamine patch do those symptoms describe?
ACUTE ANGLE CLOSURE GLAUCOMA