M11

• ANTICHOLINERGICS

  Nursing Implication/s:

  ➢ Hx of allergy, glaucoma, obstruction to establish

  ➢ Assess for skin color, lesions, bilateral grip strength, urine output

  ➢ Avoid alcohol

  ➢ Skin rash and other side eǣects to report

  ➢ 30 mins. before meals intake
• ANTIEMETICS

  Nursing Implication/s: ➢ Give drug deep IM

  ➢ Underlying cause of vomiting to

  identify

  ➢ Monitor for the adverse reaction such

  as: dizziness, sedation, drowsiness ➢ History of allergy to the drug to monitor ➢ Assess for skin color, lesions, texture ➢ Alcohol to avoid which can increase

  drug eǣect

  ➢ Report diǤculty of breathing, tremors
• ANTIEMETICS

  MECHANISM OF ACTION

  ➢ Suppression of subcortical areas of

  the CNS ○ antihistaminic, ○ analgesic, ○ antispasmodic, ○ antiemetic, ○ mild anti secretory
• ANTICHOLINERGICS

  CONTRAINDICATIONS

  ➢ Myocardial ischemia ➢ Allergy to drug ➢ Glaucoma

  ➢ Ileus, intestinal atony ➢ COPD

  ➢ Caution use in Down’s Syndrome
• PHENOTHIAZINES

  MECHANISM OF ACTION

  ➢ Depress parts of the brain involving

  wakefulness and emesis
• PHENOTHIAZINES

  THERAPEUTIC USES

  ➢ Control nausea and vomiting ➢ Anti psychotic

  ➢ Relief of pre-op restlessness and apprehension
• Gastrointestinal (GI) system


  Comprises the alimentary canal and the digestive tract, begins at the oral cavity and ends at the anus
• Major structures of the GI system

  • Oral cavity (mouth, tongue, and pharynx)
  • Esophagus
  • Stomach
  • Small intestine (duodenum, jejunum, and ileum)
  • Large intestine (cecum, colon, and rectum)
  • Anus
• Accessory organs and glands that contribute to the digestive process

  • Salivary glands
  • Pancreas
  • Gallbladder
  • Liver
• Main functions of the GI system


  Digestion of food particles and absorption of the digestive contents—nutrients, electrolytes, minerals, and fluids—into the circulatory system for cellular use
• Vomiting


  A reflex composed of the coordinated series of motor and autonomic responses that results in the forceful expulsion of gastric contents through the mouth activated by humoral or neuronal stimuli
• Vomiting continues to be a major problem throughout the world
• Diarrhea


  Classically thought of as a physical sign of a disease rather than a disease in itself
• The World Health Organization (WHO) estimates approximately 4 billion cases of diarrhea worldwide per year, with such episodes responsible for a staggering 2.2 million deaths annually
• Constipation


  The most common digestive complaint in the United States, affecting up to 27% of the North American population
• In 1.6% of cases of constipation in children younger than 2 years, underlying disease was responsible
• Antiemetics, Antidiarrheals, & Laxatives

  • Antiemetics
  • Antidiarrheals
  • Laxatives
• Chemoreceptor trigger zone (CTZ)


  Lies near the medulla and receives most of the impulses from drugs, toxins, and the vestibular center in the ear and transmits them to the vomiting center
• Vomiting center


  In the medulla, causes vomiting when stimulated
• The neurotransmitter dopamine stimulates the CTZ, which in turn stimulates the vomiting center
• Vomiting


  1. Contraction of the diaphragm, the anterior abdominal muscles, and the stomach

  2. Glottis closes

  3. Abdominal wall moves upward
• Major groups of antiemetics

  • Nonprescription (antihistamines, bismuth subsalicylate, and phosphorated carbohydrate solution)
  • Prescription (antihistamines, dopamine antagonists, benzodiazepines, serotonin antagonists, glucocorticoids, cannabinoids, and miscellaneous antiemetics)
• Classification of antidiarrheals


  • Opiates and opiate-related agents
  • Somatostatin analogues
  • Adsorbents
  • Miscellaneous antidiarrheals
• Laxatives


  Promote a soft stool
• Cathartics


  Result in a soft to watery stool with some cramping
• Frequently dosage determines whether a drug acts as a laxative or cathartic
• Over-the-counter antiemetics


  • dimenhydrinate (Dramamine)
  • cyclizine hydrocholoride (Marezine)
  • meclizine hydrochloride (Benadryl)
• Prescription antiemetics


  • antihistamine
  • anticholenergics
  • benzodiazepines
  • cannabinnoids
  • dopamine antagonist
  • miscellaneous
  • serotonin antagonist
  • glucocorticoids
• Antiemetic mechanism of action

  Suppression of subcortical areas of the CNS
• Antiemetic mechanism of action

  • antihistaminic
  • analgesic
  • antispasmodic
  • antiemetic
  • mild anti secretory
• Antiemetic contraindications


  • Allergy to the drug
  • Uncomplicated vomiting can contribute to Reye's syndrome
• Antiemetic side effects (3D's)

  • CNS: drowsiness
  • GI: dry mouth
  • Hypersensitivity: dyspnea
• Nursing implications for antiemetics

  • Give drug deep IM
  • Underlying cause of vomiting to identify
  • Monitor for the adverse reaction such as: dizziness, sedation, drowsiness
  • History of allergy to the drug to monitor
  • Assess for skin color, lesions, texture
  • Alcohol to avoid which can increase drug effect
  • Report difficulty of breathing, tremors
• Anticholinergic drug classes


  • Anticholinergic
  • Antimuscarinic
  • Anti motion sickness
• Anticholinergic mechanism of action

  • Mediates the interference with cholinergic impulses to the vomiting center
  • Unclear action to motion sickness
  • Has sedative effect
  • Blocks acethylcholine at muscarinic cholinergic receptors which depress salivary secretions and bronchial secretions
• Anticholinergic therapeutic uses


  • Prevention and control of nausea and vomiting
  • Adjunct therapy with antacids & H2 antihistamines in peptic ulcer
• Anticholinergic contraindications


  • Myocardial ischemia
  • Allergy to drug
  • Glaucoma
  • Ileus, intestinal atony
  • COPD
  • Caution use in Down's Syndrome
• Anticholinergic side effects


  • CNS: pupil dilation, photophobia, headache, drowsiness, blurred vision
  • GI: dry mouth, urinary hesitancy, constipation
  • CV: palpitations, tachycardia
• Nursing implications for anticholinergics

  • Hx of allergy, glaucoma, obstruction to establish
  • Assess for skin color, lesions, bilateral grip strength, urine output
  • Avoid alcohol
  • Skin rash and other side effects to report
  • 30 mins. before meals intake
• Phenothiazine drug classes


  • Phenothiazine
  • Dopaminergic blocker
  • Antiemetic
  • Anti anxiety