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regimens Although serotonin antagonists are effective for the prevention of postoperative nausea and vomiting, less expensive alternatives (eg, dexamethasone or droperidol) are equally effective 2 Corticosteroids Corticosteroids (eg, dexamethasone) have antiemetic properties, but the basis for these effects is unknown These agents enhance the efficacy of serotonin receptor antagonists for preventing acute and delayed nausea and vomiting in patients receiving moderately to highly emetogenic chemotherapy regimens For the prevention of postoperative nausea and vomiting, corticosteroids, serotonin antagonists, and droperidol have efficacy; however, combinations of these agents have additive benefit 3 Neurokinin receptor antagonists Aprepitant is a highly selective antagonist for NK1-receptors in the area postrema It is used in combination with corticosteroids and serotonin antagonists for the prevention of acute and delayed nausea and vomiting with highly emetogenic chemotherapy regimens Combined therapy with aprepitant prevents acute emesis in 80 90% and delayed emesis in > 70% of patients treated with highly emetogenic regimens 4 Dopamine antagonists The phenothiazines, butyrophenones, and substituted benzamides have antiemetic properties that are due to dopaminergic blockade as well as to their sedative effects High doses of these agents are associated with antidopaminergic side effects, including extrapyramidal reactions and depression These agents are used in a variety of situations Cases of QT prolongation leading to ventricular tachycardia (torsades de pointes) have been reported in several patients receiving droperidol, hence electrocardiographic monitoring is recommended before and after administration 5 Antihistamines and anticholinergics These drugs (eg, meclizine, dimenhydrinate, transdermal scopolamine) may be valuable in the prevention of vomiting arising from stimulation of the labyrinth, ie, motion sickness, vertigo, and migraines They may induce drowsiness 6 Sedatives Benzodiazepines are used in psychogenic and anticipatory vomiting 7 Cannabinoids Marijuana has been used widely as an appetite stimulant and antiemetic Pure 9-tetrahydrocannabinol (THC) is the major active ingredient in marijuana and is available by prescription as dronabinol In doses of 5 15 mg/m2, oral dronabinol is effective in treating nausea associated with chemotherapy, but it is associated with central nervous system side effects in most patients.

Carlisle JB et al Drugs for preventing postoperative nausea and vomiting Cochrane Database Syst Rev 2006 Jul 19;3: CD004125 [PMID: 16856030] Kris MG et al American Society of Clinical Oncology guideline for chemotherapy-induced nausea or vomiting J Clin Oncol 2006 Jun 20;24(18):2932 47 [PMID: 16717289] Sharma R et al Management of chemotherapy-induced nausea, vomiting, oral mucositis, and diarrhea Lancet Oncol 2005 Feb;6(2):93 102 [PMID: 15683818]

Medications may be given either to prevent or to control vomiting (see above) Combinations of drugs from different classes may provide better control of symptoms with less toxicity in some patients All of these medications should be avoided in pregnancy (For dosages, see Table 14 2) 1 Serotonin 5-HT3-receptor antagonists Ondansetron, granisetron, dolasetron, and palonosetron are effective in preventing chemotherapy- and radiation-induced emesis when initiated prior to treatment Single-dose administration schedules are as effective as multiple-dose

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Dosage Serotonin 5-HT3 antagonists Ondansetron 8 32 mg or 015 mg/kg once daily 8 mg twice daily 1 mg or 001 mg/kg once daily 2 mg once daily 100 mg or 18 mg/kg once daily 100 mg once daily 025 mg once as a single dose 30 min before start of chemotherapy 8 20 mg once daily 4 20 mg once or twice daily 40 100 mg once daily IV PO IV PO IV PO IV Route

Lists are used throughout the system to generate an overview of documents displayed in a certain style and totaled by a certain parameter You will use lists in all document processes, from inquiries to invoices As the procedure is standard throughout, I will concentrate on the configuration of one example sales order lists There are many sales document lists that are used, the most common in Sales and Distribution being the sales document list [VA05] If you proceed to the bottom of the screen and select the small matchcode shown in Figure 4-28, you will see the program being used for sales document list in [VA05] is SAPMV75A

Corticosteroids Dexamethasone Methylpredni solone Metoclopramide Prochlorperazine Promethazine Trimethobenzamide Sedatives Diazepam Lorazepam 2 5 mg every 4 6 hours 1 2 mg every 4 6 hours PO, IV PO, IV IV PO IV

Dopamine receptor antagonists 10 20 mg or 05 mg/kg every 6 8 hours 10 20 mg every 6 8 hours 5 10 mg every 4 6 hours 25 mg suppository every 6 hours 25 mg every 4 6 hours 250 mg every 6 8 hours 200 mg every 6 8 hours IV PO PO, IM, IV PR PO, PR, IM, IV PO IM, PR

Moretti R et al Gabapentin as a drug therapy of intractable hiccup because of vascular lesion: a three-year follow up Neurologist 2004 Mar;10(2):102 6 [PMID: 14998440]

HICCUPS (SINGULTUS)

Though usually a benign and self-limited annoyance, hiccups may be persistent and a sign of serious underlying illness In patients on mechanical ventilation, hiccups can trigger a full respiratory cycle and result in respiratory alkalosis Causes of benign, self-limited hiccups include gastric distention (carbonated beverages, air swallowing, overeating), sudden temperature changes (hot then cold liquids, hot then cold shower), alcohol ingestion, and states of heightened emotion (excitement, stress, laughing) There are over 100 causes of recurrent or persistent hiccups, grouped into the following categories: Central nervous system: Neoplasms, infections, cerebrovascular accident, trauma Metabolic: Uremia, hypocapnia (hyperventilation) Irritation of the vagus or phrenic nerve: (1) Head, neck: Foreign body in ear, goiter, neoplasms (2) Thorax: Pneumonia, empyema, neoplasms, myocardial infarction, pericarditis, aneurysm, esophageal obstruction, reflux esophagitis (3) Abdomen: Subphrenic abscess, hepatomegaly, hepatitis, cholecystitis, gastric distention, gastric neoplasm, pancreatitis, or pancreatic malignancy Surgical: General anesthesia, postoperative Psychogenic and idiopathic

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