Names and pronunciation
(a′mi-sul′pride) Barhemsys
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Drug reference
(a′mi-sul′pride) Barhemsys
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Func. class.: Antiemetic
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ACTION: Blocks dopamine receptors (dopamine-2 and dopamine-3). Decrease chemore- ceptor trigger zone (CTZ) responsible for vomiting
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USES: Prevention/treatment of postoperative nausea/vomiting
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CONTRAINDICATIONS: Hypersensitivity Precautions: QT prolongation, preg- nancy, child, renal disease, infertility, pre- existing arrhythmias/cardiac conduction disorders, hypokalemia, hypomagnese- mia, congestive heart failure
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SIDE EFFECTS CNS: Chills, agitation, seizures, confu- sion, insomnia, somnolence, EPS, confu- sion, psychiatric symptoms CV: Postural hypotension bradycardia, torsades de pointes, ventricular tachycar- dia, prolonged QT META: Hypokalemia, hypomagnesemia GI: Abdominal distention, increased LFTs HEMA: Agranulocytosis SYST: Neuroleptic malignant syndrome, angioedema, hypersensitivity
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INTERACTIONS Increase: antagonism—DOPamine ago- nists (levodopa), avoid using together Increase: QT prolongation—drugs that increase QT prolongation (ondanse- tron), monitor ECG NURSING CONSIDERATIONS
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DOSAGE AND ROUTES Prevention of postoperative nausea/ vomiting Adult: IV 5 mg as a single dose given over 1-2 min at the time of induction of anesthesia Treatment of postoperative nausea/ vomiting Adult: IV 10 mg as a single dose given over 1-2 min for nausea/vomiting after surgery Renal dose Adult: IV CCr <30 mL/min: Avoid use
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Available forms: Injection 5 mg/2 mL (2.5 mg/mL), 10 mg/4 mL (2.5 mg/mL) single-dose vial
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Administer: • Visually inspect for particulate matter and discoloration, discard if present • Dilution is not needed • Protect from light, give within 12 hr of removing from carton Solution compatibilities. Water for injection, D5W, 0.9% NaCl
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Assess: • QT prolongation: Monitor ECG if other QT prolongation medications are used or history of QT prolongation • Pregnancy/breastfeeding: Identify if pregnant or breastfeeding
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Evaluate: • Therapeutic response: Absence of nausea/vomiting
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Patient and caregiver information: • QT prolongation: Instruct patients to contact their health care provider imme- diately about change in their heart rate, lightheadedness, syncope • Teach patients to report to their health care provider if they are taking drugs that prolong the QT interval • Pregnancy/breastfeeding: Suggest pumping and discarding breast milk for 48 hr after product use
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PHARMACOKINETICS Onset rapid, peak end of dose, duration unknown, half-life 4-5 hr, protein bind- ing 25%-30%
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