published_or_final_version / Nursing Studies / Master / Master of Nursing

Class of 2013 Abstract / Specific Aims: To describe the outcomes of olanzapine in the treatment of refractory chemotherapy-induced nausea and vomiting (CINV). Methods: Data were collected regarding demographic information, chemotherapy regimen, CINV prophylaxis, rescue antiemetics, and olanzapine usage for subjects, age 18-79, who were admitted to the University of Arizona Medical Center for chemotherapy and received at least one dose of olanzapine for CINV between January 2008 and January 2012. The primary outcome measure was the number of rescue antiemetics required following the first dose of olanzapine (greater than 10 doses was considered treatment failure). Comparisons using chi square to determine if differences existed with respect to the level of chemotherapy emetogenicity and demographic information were conducted. Main Results: No statistical difference between chemotherapy regimens of high versus low-to-moderate emetogenicity was seen (P=0.79). However, 7 of 10 (70%) subjects receiving highly emetogenic chemotherapy achieved success and 15 of 23 (65%) subjects receiving low-to-moderately emetogenic chemotherapy achieved success. No statistical differences appeared when evaluating usage of 1 versus 2 or more prophylactic antiemetics (P=0.77), men versus women (P=0.08), and age over 50 versus 50 years or younger (P<0.99). Conclusion: This study demonstrated a trend towards greater emetic control with the addition of olanzapine in patients failing first-line antiemetic pharmacotherapy. Additionally, a trend towards greater emetic control was seen in women. The rates of success among all groups may suggest benefit to adding olanzapine to subjects experiencing refractory CINV. Due to the limited sample size and retrospective methodology of the study, the use of olanzapine in refractory CINV merits further research with large, prospective studies directly comparing addition of olanzapine to other appropriate antiemetics.

Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 4 uppsatser.

Kan Ka-wing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (p. [161]-[184]). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

<p>Illamående och kräkning är förekommande biverkningar hos patienter med cancer som behandlas med cytostatika och är därmed tillstånd som sjuksköterskan kommer i kontakt med. Om patientens illamående och kräkning inte förebyggs kan det leda till konsekvenser som att patienten blir dehydrerad, tappar aptiten, blir undernärd och försvårar skadad vävnad att återhämta sig från cytostatikabehandling. Trots att de flesta patienter får antiemetika lyckas inte deras illamående och kräkning förebyggas. Syftet var att belysa komplementära behandlingsmetoder vid cytostatikarelaterat illamående och kräkning. Studien är utförd som en litteraturstudie och baserad på 14 vetenskapliga studier. Resultatet visar att komplementära behandlingsmetoder har ett visst vetenskapligt stöd och är ett bra komplement till antiemetika. Akupressur är den behandlingsmetod som är effektivast för att förebygga cytostatikarelaterat illamående och kräkning. Även akustimulation, elektroakupunktur och avslappning minskar patienternas illamående och kräkning. Mer forskning behövs för att ge mer styrka åt de olika komplementära behandlingsmetoder, eftersom sjuksköterskans arbete måste utföras utifrån vetenskap och beprövad erfarenhet. Genom att sjuksköterskan får ökad kunskap om hur cytostatikarelaterat illamående och kräkning förebyggs kan patientens lidande minska.</p>

ABSTRACT Purpose: Dexamethasone provides potent analgesic and antiemetic effects. Sevoflurane are associated with an increased incidence of postoperative nausea and vomiting (PONV) and delayed patient discharge compared to propofol. This study was designed to evaluate whether the prophylatic use of dexamethasone with sevoflurane could minimize the incidence of PONV and facilitate early recovery after outpatient anorectal surgery. Methods: Forty outpatients undergoing anorectal surgery were randomly assigned to receive either dexamethasone (5 mg IV; n=20) or an equal volume of saline (n=20) before the induction of anesthesia. Anesthesia was induced with sevoflurane 8% and N2O 67% in oxygen (at 6 L/min) followed by placement of laryngeal mask. Anesthesia was maintained with sevoflurane 2-4% end-tidal in combination with N2O 50% in oxygen 3 L/min. All patients were allowed to breathe spontaneously during the operation. The postoperative nausea and vomiting (PONV), VAS pain score and patient satisfaction were recorded. Results: The incidence of PONV and VAS pain score were significant lower in dexamethasone-treated patients compared with saline-treated ones. The time required for discharge was significantly shorter in dexamethasone-treated patients. Above all, the dexamethasone-treated patients expressed higher satisfaction index. There was no significant difference in recovery time for eye opening, response to commands, orientation, and ambulatory. Conclusions: The prophylactic administration of dexamethasone reduces the incidence of PONV andVAS pain score, promotes recovery to home readiness, and improves the satisfaction after the anesthesia with spontaneously breathing of sevoflurane through laryngeal mask in outpatients undergoing anorectal surgery.

Illamående och kräkning är förekommande biverkningar hos patienter med cancer som behandlas med cytostatika och är därmed tillstånd som sjuksköterskan kommer i kontakt med. Om patientens illamående och kräkning inte förebyggs kan det leda till konsekvenser som att patienten blir dehydrerad, tappar aptiten, blir undernärd och försvårar skadad vävnad att återhämta sig från cytostatikabehandling. Trots att de flesta patienter får antiemetika lyckas inte deras illamående och kräkning förebyggas. Syftet var att belysa komplementära behandlingsmetoder vid cytostatikarelaterat illamående och kräkning. Studien är utförd som en litteraturstudie och baserad på 14 vetenskapliga studier. Resultatet visar att komplementära behandlingsmetoder har ett visst vetenskapligt stöd och är ett bra komplement till antiemetika. Akupressur är den behandlingsmetod som är effektivast för att förebygga cytostatikarelaterat illamående och kräkning. Även akustimulation, elektroakupunktur och avslappning minskar patienternas illamående och kräkning. Mer forskning behövs för att ge mer styrka åt de olika komplementära behandlingsmetoder, eftersom sjuksköterskans arbete måste utföras utifrån vetenskap och beprövad erfarenhet. Genom att sjuksköterskan får ökad kunskap om hur cytostatikarelaterat illamående och kräkning förebyggs kan patientens lidande minska.

Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, and, unfortunately, variability exists among pregnant women in the therapeutic effect of anti-emetics as well as in factors that can exacerbate NVP. Identifying and managing these sources of variability will result in significant improvements in the quality of life of pregnant woman. This dissertation addressed clinical pharmacology strategies in managing NVP by focusing on three predominant areas of variability. The first challenge addressed in this dissertation was women with pre-existing gastrointestinal (GI) conditions and adherence and tolerability to prenatal multivitamin supplementation. To identify the role of iron in reducing adherence and increasing NVP and GI symptoms, two separate studies were conducted. In the first study, women randomized to a prenatal multivitamin supplementation with higher iron content experienced more adverse GI effects and increased severity of NVP symptoms. In the second study, after discontinuing iron-containing prenatal multivitamins, two-thirds of women in a prospective cohort reported improvement in their NVP symptoms which was corroborated with validated scales to quantify NVP severity. The second challenge addressed in this dissertation was the effect of heartburn and acid reflux on the severity of NVP. In a controlled, prospective study, women experiencing heartburn and acid reflux experienced greater severity of NVP compared to women with no GI symptoms. Furthermore, treatment of heartburn and acid reflux with acid-reducing pharmacotherapy with associated with a reduction in GI symptoms and NVP severity. Therefore, histamine 2 blockers or proton pump inhibitors, which do not appear to be associated with increased fetal risks, should be administered when required. The third clinical pharmacology challenge addressed in this dissertation was to determine the pharmacokinetic variability of the active ingredients of Diclectin®, first-line pharmacotherapy for the treatment of NVP. Large variability was observed in the area under the curve for both active metabolites: a 6.5-fold difference for pyridoxal-5’-phosphate and a 2.1-fold difference for doxylamine. Whether these pharmacokinetic differences contribute to suboptimal efficacy remains to be determined. In conclusion, based on the results presented in this dissertation, several improvements in clinical pharmacology strategies can be made to enhance management of NVP.

Nausea and vomiting of pregnancy (NVP) is the most common medical condition in pregnancy, and, unfortunately, variability exists among pregnant women in the therapeutic effect of anti-emetics as well as in factors that can exacerbate NVP. Identifying and managing these sources of variability will result in significant improvements in the quality of life of pregnant woman. This dissertation addressed clinical pharmacology strategies in managing NVP by focusing on three predominant areas of variability. The first challenge addressed in this dissertation was women with pre-existing gastrointestinal (GI) conditions and adherence and tolerability to prenatal multivitamin supplementation. To identify the role of iron in reducing adherence and increasing NVP and GI symptoms, two separate studies were conducted. In the first study, women randomized to a prenatal multivitamin supplementation with higher iron content experienced more adverse GI effects and increased severity of NVP symptoms. In the second study, after discontinuing iron-containing prenatal multivitamins, two-thirds of women in a prospective cohort reported improvement in their NVP symptoms which was corroborated with validated scales to quantify NVP severity. The second challenge addressed in this dissertation was the effect of heartburn and acid reflux on the severity of NVP. In a controlled, prospective study, women experiencing heartburn and acid reflux experienced greater severity of NVP compared to women with no GI symptoms. Furthermore, treatment of heartburn and acid reflux with acid-reducing pharmacotherapy with associated with a reduction in GI symptoms and NVP severity. Therefore, histamine 2 blockers or proton pump inhibitors, which do not appear to be associated with increased fetal risks, should be administered when required. The third clinical pharmacology challenge addressed in this dissertation was to determine the pharmacokinetic variability of the active ingredients of Diclectin®, first-line pharmacotherapy for the treatment of NVP. Large variability was observed in the area under the curve for both active metabolites: a 6.5-fold difference for pyridoxal-5’-phosphate and a 2.1-fold difference for doxylamine. Whether these pharmacokinetic differences contribute to suboptimal efficacy remains to be determined. In conclusion, based on the results presented in this dissertation, several improvements in clinical pharmacology strategies can be made to enhance management of NVP.

Cannabidiol (CBD), a non-psychoactive cannabinoid found in cannabis suppresses vomiting in shrews (Suncus murinus, Parker et al., 2004), and conditioned gaping in rats (a selective measure of nausea-like behaviour, Parker et al., 2002). CBD‘s anti-emetic/anti-nausea mechanism of action is unknown. However, evidence suggests that CBD may act as a somatodendritic 5-hydroxytryptamine 1A (5-HT1A) autoreceptor agonist in the dorsal raphe nucleus (DRN), because the anxiolytic (Campos and Guimaraes, 2008a) and neuroprotectant (Mishima et al., 2005) properties of CBD are 5-HT1A-mediated. Therefore, here we investigated if administration of 5-HT1A receptor antagonists, (WAY100135 or WAY100635) would block CBD‘s anti-emetic/anti-nausea-like effects. Systemic administration of WAY100135 prevented the anti-emetic effect of CBD in shrews, and WAY100135 and WAY100635 attenuated the anti-nausea-like effect of CBD in rats. The effect of CBD on conditioned gaping reactions was most likely the result of its action on somatodendritic 5-HT1A receptors in the DRN, because the anti-nausea-like action of systemic CBD was reversed by intra-DRN administration of WAY100635. As well, when administered into the DRN, CBD suppressed conditioned gaping, an effect that was blocked by systemic WAY100635. In vitro studies revealed that CBD enhanced the ability of 8-OH-DPAT to stimulate [35S]GTPS binding and in vivo studies revealed that systemic subthreshold doses of combined CBD and 8-OH-DPAT synergistically suppressed conditioned gaping. These results suggest that CBD produces its anti-emetic/anti-nausea-like effects by indirect receptor agonism of DRN somatodendritic 5-HT1A autoreceptors. CBD‘s mechanism of action was explored further, by examining its interaction with cannabigerol (CBG), another cannabinoid, which acts in vitro as a 5-HT1A receptor antagonist (Cascio et al., 2010). CBG blocked the systemic CBD-, and 8-OH-DPAT-induced suppression of gaping in rats, as well as the systemic CBD-induced suppression of vomiting in shrews. Therefore, CBG and CBD may be in opposition at the 5-HT1A receptor. These findings shed light on the mechanism of action of non-psychoactive cannabinoids in the cannabis plant, and their effect on nausea and vomiting. These results suggest CBD alone may be an effective treatment in reducing nausea and vomiting. / This research was supported by research grants from the Natural Sciences and Engineering Research Council (NSERC) of Canada to Dr. Parker, a scholarship from NSERC to Erin Rock, and a grant from NIDA to Dr. Mechoulam and Dr. Pertwee.