Nausea anticipatory

Motion sickness is caused by stimulation of the vestibular system. This area contains many histaminic (Hj) and muscarinic cholinergic receptors. The higher brain (i.e., cerebral cortex) is affected by sensory input such as sights, smells, or emotions that can lead to vomiting. This area is involved in anticipatory nausea and vomiting associated with chemotherapy. 

Anticipatory nausea Lorazepam 0.04-0.08 mg/kg Lack of active metabolites Galloway and Yaster, 2000... 

Patients may complain of headaches, muscle aches, and nausea associated with an individual treatment. Many also report anticipatory anxiety or fearfulness before receiving a treatment. This may require management with anxiolytics, but type and dose must be chosen carefully to avoid increasing the seizure threshold, thus undermining the adequacy of therapy. 

Nausea and vomiting are common adverse effects of cytostatic drugs (48). They can be acute (occurring within 24 hours of therapy), delayed (persisting for 6-7 days after therapy), or anticipatory (occurring before chemotherapy) (49). Their treatment has been reviewed (50,51). 

HT3 antagonists are effective for acute nausea, but are not effective for anticipatory nausea, and efficacy is low for delayed nausea. Lorazepam is very effective for anticipatory nausea. Other agents used in chemotherapy-induced emesis are dopamine antagonists, scopolamine, and dronabinol. Antihistamines are generally less effective for chemotherapy-induced nausea and vomiting. 

E Lorazepam is most effective for anticipatory nausea and vomiting, or emesis that oaurs prior to chemotherapy administration. The antiemetic effects may be related to the sedative and anxiolytic properties of lorazepam. 5-HT3 antagonists and dopamine antagonists are poor choices because efficacy has not been shown in anticipatory nausea and vomiting. 

Optimal control of acute nausea and vomiting positively impacts the incidence and control of delayed and anticipatory nausea and vomiting. 

Nausea and vomiting that occurs within 24 hours of chemotherapy administration is defined as acute, whereas when it starts more than 24 hours after chemotherapy administration, it is defined as delayed. The primary goal with CINV is to prevent nausea and/or vomiting optimal control of acute nausea and vomiting positively impacts the incidence and control of delayed and anticipatory nausea and vomiting. Clinical practice guidelines for the use of antiemetics in CINV have been published. Despite the availability of nationally recommended guidelines, individual practice varies from one institution to the next. Product availability and recommended doses are institution-specific and may vary considerably from the doses listed in Table 35-5. 

Montgomery GH, Bovbjerg DH. The development of anticipatory nausea in patients receiving adjuvant chemotherapy for breast cancer. Physiol Behav 1997 61 737-741. 

Morrow GR, Morrell C. Behavioral treatment for the anticipatory nausea and vomiting induced by cancer chemotherapy. N Engl J Med 1982 307 1476-1480. 

Parker, L.A. and Kemp, S.W. (2001) Tetrahydrocaimabinol (THC) interferes with conditioned retching in Suncus murinus an animal model of anticipatory nausea and vomiting (ANV), Neuroreport 12 749-751. 

Anticipatory nausea and vomiting are very difficult to control. It is important for the nurse to medicate the cKent to prevent the nausea from occurring. This client should be medicated first. 

Limebeer CL, Krohn IP, Cross-Mellor S, Litt DE, Ossenkopp K, Parker LA (2008) Exposure to a context previously associated with nausea elicits conditioned gaping in rats a model of anticipatory nausea. Behav Brain Res 187 33-40 Luk GD, Bay less TM, Baylin SB (1980) Diamine oxidase (Histaminase). A circulating marker for rat intestinal mucosal maturation and integrity. J Clin Invest 66(l) 66-70 Luk GD, Vaughan WP, Burke PJ, Baylin SB (1981) Diamine oxidase as a plasma marker of rat intestinal mucosal injury and regeneration after administration of 1-b-D-arabinofuranosyl-cytosine. Cancer Res 41 2334—2337... 

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