[NP-Clinical] Phenergan, Compazine & Zofran

[Conrad Rios]

I do pretty much the same as Diane. However I also use  Zofran(class B) for
my pregnant women with hyperemesis. Have not seen dystonia with Zofran.
Also document that they were able to tolerate fluids, so hold on to them
until they do.


Conrad J. Rios, NP, PA, MSN
Faculty
UC Davis, FNP/PA Program
Ph: (559) 241-7529

Email: conrad.rios at ucdmc.ucdavis.edu
Web: http://fnppa.ucdavis.edu


                                                                           
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             Dito"                                                         
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                                       RE: [NP-Clinical] Phenergan,        
             12/24/2004 11:25          Compazine & Zofran                  
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I usually stick with Compazine or Phenergan, unless the patient is allergic
or has had a prior dystonic or akasthetic response in the past. If the
patient has low body weight, I’ll usually start with a half dose IV (5 mg
and 12.5 mg, respectively). However, if the patient is already sedated, or
I’m worried about sedation for any reason, or has had an adverse reaction
to Compazine or Phenergan in the past, I will order Zofran as it seems to
be much less sedating and has a different mechanism of action. I also order
Zofran if the patient’s N/V is refractory to Compazine or Phenergan after
repeat dosing. I don’t order droperidol much, because of its black box
warning. I’ve used Reglan before, but don’t find it to be any more
effective in simple AGE than the above, plus have seen dystonia/akasthesia
to the same degree and frequency as with Compazine and Phenergan. I have
never seen dystonia or akasthesia with Zofran, probably due to its
differing mechanism of action. If anyone out there has seen it with Zofran,
please let me know.

I do have them do a PO clears challenge before d/c so that I can document
that they can tolerate fluids. It only has to be a few sips of water. I
usually discourage clear juice if they’ve got diarrhea, too, because of the
sugar content.

We’re seeing a lot of GI stuff here, too. We haven’t seen much influenza as
yet, though.

Merry Christmas!

Diane Dito


From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Christine Smith
Sent: Friday, December 24, 2004 11:09 AM
To: np-clinical at nurse.net
Subject: [NP-Clinical] Phenergan, Compazine & Zofran

What makes you choose what anti-emetic? Particularly when you are ordering
it IV? What do you see as the real advantages with Zofran, particularly
since it is costly?

Do you  insist that Gastroenteritis type of patients tolerate PO fluids
before you discharge them?

There is some major GI bug floating around in my area.


Christine Smith, NP
Antioch, CA


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