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CHAPTER 18 Gastrointestinal System

Seretonin Antagonist
Use

Prevention, treatment of
nausea and vomiting due
to cancer chemotherapy,
including high-dose
cisplatin. Prevention of
postop nausea, vomiting.
Prevention of radiationinduced nausea, vomiting.

Example

Ondanestron
(Zofran)

How it works

Half-life:
4h

Route:
PO/IM/IV

Onset:
30 min

Pregnancy
category: B

Peaks:
12 h

Duration:
1224 h

Pharmacokinetic:
Readily absorbed from
GI tract; PB: 7076%;
metabolized in liver;
excreted in urine.
Unknown if removed
by hemodialysis.

Action may be central (CTZ) or peripheral (vagus nerve

terminal), preventing nausea/vomiting associated with
cancer chemotherapy.

Adult dose

Note: All oral doses given 30 minutes before chemotherapy

and repeated at 8 h intervals.

Nausea, vomiting: chemotherapy.

PO: 24 mg once a day or 8 mg 3 times/day; IV: 3 doses
0.15 mg/kg. First dose given 30 min before chemotherapy;
then 4 h and 8 h after first dose of ondanestron.

Nausea, vomiting: postop.

IM/IV: 4 mg undiluted over 25 min.

Nausea, vomiting: radiation.

PO: 8 mg 3 times/day.
Before administration

Assess for dehydration if excessive vomiting occurs.

Provide emotional support.
Assess medical and drug history (reduced dose for hepatic
impairment).

Assess bowel and nutritional status.

Assess electrolytes.
Assess baseline vital signs.

Pharmacology Demystified

Seretonin Antagonist (continued)

Administration

PO: Give without regard to food.

IM: Inject into large muscle mass.
IV: Give IV push over 25 min; infusion over 15 min.

After administration

Monitor patient in environment for safety.

Assess bowel sounds for peristalsis.
Assess mental status.
Monitor daily bowel activity and stool consistency and record
time of evacuation.

Monitor for dehydration.

Monitor patient comfort.
Contraindications

None significant.

Side effects/
adverse reaction

Frequent: Anxiety, dizziness, drowsiness, headache, fatigue,

constipation, diarrhea, hypoxia, urinary retention.

Occasional: Abdominal pain, xerostomia (diminished saliva

secretion), fever, feeling of cold, redness/pain at injection site,
paresthesia, weakness.

Rare: Hypersensitivity reaction (rash, itching), blurred vision.

Adverse/toxic:

Overdose may produce combination of CNS stimulation and

depressant effects.
Patient education

Relief from nausea/vomiting generally occurs shortly after

drug administration.

Avoid alcohol, barbiturates.

Report persistent vomiting.