Chapter 59

Emetic and Antiemetic Agents

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 Nausea and Vomiting

Most common and most uncomfortable complaint

Vomiting is a complex reflex reaction to various

stimuli

In some cases, it may be desired to induce vomiting

In many clinical conditions, the reflex reaction of

vomiting is not beneficial

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 Managing Nausea and Vomiting

Emetics
Cause vomiting
No longer recommended for at-home poison
control
Antiemetics
Decrease or prevent nausea and vomiting
Centrally acting or locally acting
Varying degrees of effectiveness
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Site of Action of Emetics/Antiemetics

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Groups of Centrally Acting Antiemetics

Phenothiazines

Nonphenothiazines

Anticholinergics/antihistamines

Serotonin (5-HT3) receptor blockers

Substance P/neurokinin 1 receptor antagonists

Miscellaneous group

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 Phenothiazines

Actions

Depresses various areas of CNS

Indications

Treatment of nausea and vomiting

Adverse effects

Drowsiness

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 Nonphenothiazines
Actions
Act to reduce the responsiveness of the nerve cells in
the CTZ to circulating chemicals that induce vomiting
Indications
Prevention of nausea and vomiting
Adverse effects
Drowsiness
Fatigue
Restlessness
Extrapyramidal symptoms

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 Anticholinergics/Antihistamines
Action
Anticholinergics act as antihistamines to block the
transmission of impulses to the CTZ
Indication
Prevention and treatment of nausea and vomiting
Adverse effects
Drowsiness
Confusion
Dry mouth
Anorexia
Urinary frequency
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 Serotonin (5-HT3) Receptor Blockers

Actions
Block those receptors associated with nausea
and vomiting in the CTZ and locally
Indications
Control of nausea and vomiting
Pharmacokinetics
Rapidly absorbed, metabolized in the liver,
and excreted in the urine and feces
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Serotonin (5-HT3) Receptor Blockers
(cont.)

Caution

Pregnancy and lactation

Adverse effects

Headache, drowsiness, myalgia, urinary

retention, constipation, and pain at the
injection site

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 Substance P/Neurokinin 1
Receptor Antagonists
Actions

Act directly in the CNS to block receptors

associated with nausea and vomiting

Indications

Used in combination with other agents to

prevent nausea and vomiting

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 Substance P/Neurokinin 1
Receptor Antagonists (cont.)
Pharmacokinetics

Given orally, metabolized in the liver, and

excreted in the urine and feces

Adverse effects

Anorexia, fatigue, constipation, diarrhea, liver

enzyme elevation, and dehydration

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 Miscellaneous Agents

Actions

Vary with agent

Indication

Treatment and prevention of nausea and

vomiting

Pharmacokinetics

Vary according to agent

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Miscellaneous Agents (cont.)
Contraindications
Coma
Severe CNS depression
Brain damage or injury
Hypotension and hypertension
Severe liver dysfunction
Cautions
Renal dysfunction
Active peptic ulcer disease
Pregnancy
Lactation
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 Miscellaneous Agents (cont.)
Adverse effects
Linked to interference with normal CNS stimulation
or response
Drowsiness
Dizziness
Weakness
Photosensitivity
Hypotension, hypertension, and cardiac arrhythmias
Drug-to-drug interaction
Alcohol
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Use of Antiemetic Agents
Across the Lifespan

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Prototype Phenothiazines

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Prototype Nonphenothiazines

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Prototype Anticholinergics/
Antihistamines

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Prototype Serotonin (5-HT3)
Receptor Blockers

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Prototype Substance P/Neurokinin 1
Receptor Antagonists

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Nursing Considerations for Antiemetics

Assessment (history and physical exam)

Nursing diagnosis

Implementation

Evaluation

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