N

Nabilone

INTRODUCTION

Indications

Treatment of nausea and vomiting due to chemotherapy that has not responded to other conventional antiemetics.

Action

Antiemetic action may be due to interaction with cannabinoid receptor system in the brain. Therapeutic Effects: Decreased nausea and vomiting due to emetogenic chemotherapy.

Adverse Reactions/Side Effects

CNS: concentration difficulty, drowsiness, euphoria, sleep disturbance, vertigo, altered mental state, anxiety, depression, detachment, disorientation, headache, panic, paranoia, psychotomimetic reactions. CV: hypotension, tachycardia. GI: dry mouth, increased appetite, nausea. Neuro: ataxia, physical dependence, psychologic dependence.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor improvements in GI symptoms (decreased nausea and vomiting, increased appetite) to help document whether drug therapy is successful.

• Assess vertigo or ataxia that might affect gait, balance, and other functional activities. Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor changes in mood and behavior such as anxiety, euphoria, depression, disorientation, paranoia, memory lapses, impaired concentration, paranoia, panic, psychosis-like reactions, or other changes in mental state. Notify physician if these changes become problematic.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report fast heart rate (tachycardia) and symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth) caused by vertigo or ataxia; implement fall-prevention strategies (See Appendix E).

• Because of the risk of arrhythmias and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

Patient/Client-Related Instruction

• Advise patient about the risk of daytime drowsiness and decreased attention and mental focus. Avoid driving, and use caution in other activities that require strong concentration.

• Educate patient about the risk of physical and psychologic dependence during excessive or prolonged use; encourage patient to adhere to proper dosing schedule.

• Instruct patient to report bothersome side effects such as severe or prolonged headache, nausea, increased appetite, or dry mouth.

Pharmacokinetics

Absorption: Completely absorbed following oral administration.

Distribution: Unknown.

Protein Binding: Highly protein bound.

Metabolism and Excretion: Highly metabolized with extensive first pass hepatic metabolism; metabolites excreted ...