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You are here: Home / 09. Medical/Surgical / Nausea and Vomiting

Nausea and Vomiting

July 14, 2011 by CrashMaster

Propofol

really works the best for emesis, but it is an anesthetic med and one must never underestimate the apnea power of propofol  

Haldol

Haloperidol is as effective as ondansetron for preventing postoperative nausea and vomiting (Canadian Journal of Anesthesia 54:349-354 (2007))

 

5HT3 Receptor Antagonists

Zofran

4 mg, excellent but very expensive given IV can be used in pregnancy

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Benzamides

Metoclopramide (Reglan)

D2 receptors at low doses, 5HT3 receptors at higher doses. prokinetic agent especially suited for opoid induced delayed gastric emptying At higher

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doses, EPS side effects in up to 1/5 of patients. Trimethobenzaminde (Tigan) unknown mechanism, ? indirect D2 blockade

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Butyrophenones

stronger D2 receptor affinity with no anticholinergic or antihistamine effects Droperidol 0.625 mg good to excellent Given IV In one study, it was better than reglan or compazine. They used 1.25 dose (AJEM 2006;24:177) Haldol may be as effective as droperidol

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Phenothiazines

avoid in pregnancy, glaucoma and gastric outlet obstruction

Chlorpromazine (Thorazine)

probably as effective as compazine

Perphenazine (Trilafon)

May be more potent

Prochlorpermazine (Compazine)

10 mg good to excellent, given iv

Promethazine (Phenergan)

suppositories, IV or IM, however in my experience, it causes some pain given IV I do not like to use it that way unless put into an IV bag. Probably better IM than IV. Has strong antihistamine effects as well

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Anticholinergics

particularly useful in N/V of vestibular origin

Scopolamine

can be given transdermally

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Antihistamines

have anticholinergic effects as well as H1 blockade

Hydroxyzine (Atarax/Vistaril)

25-50 mg IM or PO, use just like phenergan Dimenhydrinate (Dramamine) for motion sickness Diphenhydramine (Benadryl) for motion sickness Meclizine (Antivert) for motion sickness and possibly vestibular disease   | | |

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Filed Under: 09. Medical/Surgical

Section Index

  • 5HT3 Receptor Antagonists
  • Benzamides
  • Butyrophenones
  • Phenothiazines
  • Anticholinergics
  • Antihistamines

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