CASE STUDY Chapter 59 (ANTIEMETIC AGENTS)

Kate Angelique G. Rodriguez Nov.
10, 2020
BSN – 2D
Case Study, Chapter 59, Antiemetic Agents
A nursing student is preparing for an exam on antiemetic agents. The nursing

student knows that one of the most common and most uncomfortable complaints
encountered in clinical practice is that of nausea and vomiting. The student
knows that antiemetic drugs are used to decrease or prevent nausea and
vomiting. The nursing student is preparing a concept map on antiemetic agents
that includes answers to these key questions. (Learning Objectives 2, 4 and 5)
a. What are the indications, therapeutic actions, and most common

adverse effects of phenothiazines, nonphenothiazines, and
anticholinergics/antihistamines?
Phenothiazines
Indications: Phenothiazines are used to treat serious mental and
emotional disorders, including schizophrenia and other psychotic
disorders. Some are used also to control agitation in certain patients,
severe nausea and vomiting, severe hiccups, and moderate to severe
pain in some hospitalized patients.
Therapeutic Actions: One of a group of tranquilizing drugs with
antipsychotic actions thought to act by blocking dopaminergic
transmission (messages sent using the substance dopamine) within the
brain.
Common Adverse Effects: Constipation, trouble urinating, dryness of
mouth, confusion, problems with memory, dizziness or fainting,
drowsiness, trembling of the hands and fingers, and problems with
muscle movement, such as decreased or unusual movements, are
especially likely to occur in elderly patients
Source/s: Definition of Phenothiazine. (2018, December 11). RxList.
https://www.rxlist.com/script/main/art.asp?articlekey=11999
Phenothiazine (Oral Route, Parenteral Route, Rectal Route). (2020, November 2). Â.
https://www.mayoclinic.org/drugs-supplements/phenothiazine-oral-route-parenteral-route-rectal-
Kate Angelique G. Rodriguez Nov. 10, 2020
BSN – 2D
route/description/drg-20070394#:%7E:text=Phenothiazines%20are%20used%20to%20treat,pain%20in%20some
%20hospitalized%20patients.
Phenothiazine (Oral Route, Parenteral Route, Rectal Route) Side Effects - Mayo Clinic. (n.d.). Mayo Clinic. Retrieved
November 10, 2020, from https://www.mayoclinic.org/drugs-supplements/phenothiazine-oral-route-parenteral-route-
rectal-route/side-effects/drg-20070394?p=1#:%7E:text=Constipation%2C%20trouble%20urinating%2C%20dryness
%20of,are%20usually%20more%20sensitive%20than
Nonphenothiazines
Indications: To control psychotic behavior; Less sedative than
phenothizines
Therapeutic Actions: Primarily blocks dopamine receptors; Considered
as effective as phenothiazines
Common Adverse Effects: Sedation, Seizures, QT prolongation, EPS
Source/s: Chapter 27 Flashcards | Chegg.com. (n.d.). Chegg.Com. Retrieved November 10, 2020, from
https://www.chegg.com/flashcards/chapter-27-c5e6e285-24b6-42e5-80d7-9a997aaec9f1/deck
Anticholinergics/antihistamines
Indications:
Anticholinergics are indicated for the following medical conditions:
 Prevention of nausea, vomiting, and dizziness associated with
motion sickness.
 Adjunctive therapy for treatment of GI ulcers
 Decrease secretions before anesthesia or intubation
 Maintenance treatment of bronchospasm associated with COPD.
 Treatment of irritable or hyperactive bowel in adults.
Therapeutic Actions:
The desired and beneficial actions of anticholinergics are as follows:
 Competitively blocking the ACh receptors at muscarinic cholinergic
receptor sites that are responsible for mediating the effects of the
parasympathetic postganglionic impulses.
BSN – 2D
 Atropine, the prototype drug, is derived from the plant
belladonna. It is used to depress salivation and bronchial
secretions and to dilate the bronchi, but it can thicken respiratory
secretions (causing obstruction of airways).
 Atropine and scopolamine work by blocking only the muscarinic
effectors in the parasympathetic nervous system and the few
cholinergic receptors in the SNS.
Common Adverse Effects:
Use of anticholinergic agents may result to these adverse effects:
 CNS: blurred vision, pupil dilation, photophobia, cycloplegia,
increased intraocular pressure, weakness, dizziness, insomnia
 CV: tachycardia, palpitation
 GI: dry mouth, altered taste perception, nausea, heartburn,
constipation
 GU: urinary hesitancy and retention, heat prostration
Source/s: Tabangcora, D. R. I. N. (2019, June 6). Anticholinergics (Parasympatholytics). Nurseslabs.
https://nurseslabs.com/anticholinergics-parasympatholytics/#indications
b. What are the indications for 5-HT3 receptor blockers?

 Chemotherapy associated Nausea
 Radiation Therapy associated Nausea
 Vomiting refractory to first-line Antiemetics
 Theophylline Overdose
 Used instead of phenothiazines due to Seizure risk
Source/s: Moses, S. (2014, January 18). 5-HT3 Receptor Antagonist. FPnotebook.Com.
https://fpnotebook.com/gi/pharm/5Ht3RcptrAntgnst.htm
c. What are the most important teaching points to include for a

patient receiving prochlorperazine?
BSN – 2D
 Take drug only as prescribed and do not alter dose or schedule.
Consult physician before stopping the medication.
 Avoid hazardous activities such as driving a car until response to drug
is known because drug may impair mental and physical abilities,
especially during first few days of therapy.
 Be aware that drug may color urine reddish brown. It also may cause
the sun-exposed skin to turn gray-blue.
 Protect skin from direct sun's rays and use a sunscreen lotion (SPF
>12) to prevent photosensitivity reaction.
 Withhold dose and report to the physician if the following symptoms
persist more than a few hours: Tremor, involuntary twitching,
exaggerated restlessness. Other reportable symptoms include light-
colored stools, changes in vision, sore throat, fever, rash.
 Do not breast feed while taking this drug.
Source/s: PROCHLORPERAZINE. (n.d.). Robholland.Com. Retrieved November 10, 2020, from
http://robholland.com/Nursing/Drug_Guide/data/monographframes/P081.html

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Kate Angelique G. Rodriguez Nov.

Case Study, Chapter 59, Antiemetic Agents

A nursing student is preparing for an exam on antiemetic agents. The nursing

a. What are the indications, therapeutic actions, and most common

November 10, 2020, from https://www.mayoclinic.org/drugs-supplements/phenothiazine-oral-route-parenteral-route-

Source/s: Tabangcora, D. R. I. N. (2019, June 6). Anticholinergics (Parasympatholytics). Nurseslabs.

b. What are the indications for 5-HT3 receptor blockers?

Source/s: Moses, S. (2014, January 18). 5-HT3 Receptor Antagonist. FPnotebook.Com.

c. What are the most important teaching points to include for a

Source/s: PROCHLORPERAZINE. (n.d.). Robholland.Com. Retrieved November 10, 2020, from

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