YOU GET A ZOFRAN…EVERYBODY GETS A ZOFRAN!!
YOU GET A ZOFRAN….AND YOU GET A ZOFRAN…AND YOU GET A ZOFRAN…EVERYBODY GETS A ZOFRAN!!
WE’VE ALL SAID IT…”JUST GIVE THEM SOME ZOFRAN.” BUT IS THAT REALLY GOING TO HELP EVERYONE?
TURNS OUT, PROBABLY NOT.
To truly understand and appropriately treat a patient’s nausea, you have to understand the pathophysiologic cause specific to that patient.
What’s the easiest way to remember the various causes of nausea, you might ask? Just remember the V.O.M.I.T. acronym. Fitting, huh??
CAUSES & DRUG CLASSES MOST APPLICABLE:
V – Vestibular (vestibular diseases, tumors at the base of the skull, motion sickness)
• Anticholinergics, antihistamines (ex: scopolamine patch, promethazine)
O – Obstruction of bowel (constipation, abdominal carcinomas, ascites)
• Stimulant of the myenteric plexus (ex: Senna products)
M – dysMotility of upper gut (gastric stasis, adhesions, various organ failure, autonomic neuropathy)
• Prokinetic with stimulant of 5HT4 receptors (metoclopramide)
I – Infection/Inflammation (intraabdominal infections)
• Anticholinergic, antihistaminic, 5HT3 antagonists, Neurokinin 1 antagonists (ex: promethazine, prochlorperazine)
T – Toxins (opioids, various medications)
• Antidopaminergic, 5HT3 antagonists (ex: prochlorperazine, haloperidol, ondansetron)
**Some examples of causation are applicable to more than one cause; therefore, more than one medication may be needed. Also, if one medication doesn’t work, you may need to try another associated with a different cause**
Notice that Zofran (ondansetron) is only listed once… Is your mind blown yet??
Moral of the story: We can spend lots of money attempting to treat nausea, and in the process prolong someone’s miserable symptom simply because we are not taking the time to explore the CAUSE and root of the nausea.
Let’s get better at this…and save some money along the way. If the meds you’re using aren’t working, we are basically throwing money down the drain and failing to care for our hospice population.
For more information, refer to the reference below from Palliative Care Fast Facts (great resource)!
- Jaymie Wilson, APRN-CNP, ACHPN