多巴胺拮抗剂治疗姑息治疗患者恶心呕吐的研究进展。

IF 0.9 Q3 ANESTHESIOLOGY Journal of Pain & Palliative Care Pharmacotherapy Pub Date : 2024-03-01 Epub Date: 2023-10-16 DOI:10.1080/15360288.2023.2268065
Grace Jenkins
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引用次数: 0

摘要

恶心和呕吐的症状在姑息治疗和临终关怀患者中很常见。用于治疗恶心和呕吐的多种药物之一是多巴胺受体拮抗剂,其特别有助于治疗由化学受体触发区(CTZ)介导的恶心和胃肠功能受损。虽然多巴胺拮抗剂可以非常有效地治疗恶心,但应谨慎使用,因为它们具有QTc延长的风险,对迟发性运动障碍(TD)有美国食品药品监督管理局的黑匣子警告,并增加痴呆患者引发精神病和死亡的风险。这篇综述将涵盖氟哌啶醇、奥氮平、普氯哌嗪和甲氧氯普胺治疗恶心和呕吐,包括疗效、药代动力学和药效学证据,以提高在临床实践中的安全有效利用率。这包括组胺受体、毒蕈碱受体、5-羟色胺能受体和α-肾上腺素能受体的药物受体位点亲和力,这可以帮助提供者预测潜在的不良反应和锥体外系症状(EPS)、TD和QTc延长的风险。这篇综述还包括根据肾功能、肝功能和年龄调整剂量的考虑因素。了解多巴胺拮抗剂的药理学可以帮助提供者选择控制恶心和呕吐的最佳治疗方法,从而提高患者的生活质量。
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Review of Dopamine Antagonists for Nausea and Vomiting in Palliative Care Patients.

Symptoms of nausea and vomiting are common in palliative care and hospice patients. One of the many classes of medications used for the treatment of nausea and vomiting is dopamine receptor antagonists which are particularly helpful for treating nausea mediated by the chemoreceptor trigger zone (CTZ) and impaired gastrointestinal function. While dopamine antagonists can be very effective treatments for nausea they should be used with caution as they carry the risk of QTc prolongation, have a FDA black box warning for tardive dyskinesia (TD), and increased risk of precipitating psychosis and death in patients with dementia. This review will cover haloperidol, olanzapine, prochlorperazine, and metoclopramide for treatment of nausea and vomiting including evidence of efficacy, pharmacokinetics, and pharmacodynamics to improve safe and effective utilization in clinical practice. This includes medication receptor site affinities at histaminic, muscarinic, serotonergic, and alpha-adrenergic receptors which can help providers anticipate potential adverse effects and risk of extrapyramidal symptoms (EPS), TD, and QTc prolongation. This review also includes considerations for dose adjustments based on renal function, hepatic function, and age. Understanding the pharmacology of dopamine antagonists can help providers choose the best treatment for control of nausea and vomiting and subsequently improve patients' quality of life.

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CiteScore
1.60
自引率
9.10%
发文量
40
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