Antiemetics on the NCLEX
Ondansetron, promethazine, metoclopramide: indications, QT prolongation, EPS.
Different antiemetic classes for different causes. NCLEX tests ondansetron QT, promethazine extravasation, and metoclopramide EPS.
5-HT3 antagonists (-setron)
Ondansetron (Zofran), granisetron. First-line for chemo and post-op N/V. QT prolongation, caution with other QT drugs.
Antihistamines
Promethazine, dimenhydrinate, meclizine. Motion sickness, vertigo. Sedating. Promethazine, extravasation causes severe tissue damage. Give deep IM or central line.
Prokinetics
Metoclopramide (Reglan). Gastroparesis, GERD. Extrapyramidal symptoms (EPS), tardive dyskinesia, limit duration.
Neurokinin-1 antagonists
Aprepitant. Chemo-induced N/V, especially delayed.
Cannabinoids
Dronabinol. Refractory chemo N/V.
Frequently asked
Post-op nausea, first choice?
Ondansetron. Reliable, well-tolerated.
Pregnancy N/V?
Vitamin B6 + doxylamine (Diclegis) first-line. Ondansetron used though some controversy.
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