Patient admitted in the ward had 3 episodes of vomiting. Which of the following drug should not be given?

AIIMS Delhi NO- 2019

Pharmacology

Hard

Appeared in: AIIMS Delhi NO- 2019

Explanation

Tramadol is a centrally-acting analgesic with a well-documented high incidence of nausea and vomiting as a common side effect.
Administering a drug known to frequently cause vomiting to a patient already experiencing multiple episodes of emesis is clinically inappropriate.
Giving Tramadol would likely exacerbate the patient's condition, increasing the risk of complications like dehydration and electrolyte imbalance.

Option A: Fentanyl is an opioid analgesic that can also cause nausea and vomiting. However, Tramadol is generally associated with a higher incidence and severity of this adverse effect, making it the more critical drug to avoid in a patient who is actively vomiting.
Option B: Promethazine is an antiemetic drug. Its purpose is to treat and prevent nausea and vomiting. Therefore, it would be an appropriate medication to administer to this patient.
Option D: Ondansetron is a potent, first-line antiemetic drug. It is a serotonin 5-HT3 receptor antagonist specifically designed to prevent and treat nausea and vomiting. It is a highly appropriate medication for this patient.

Clinical Relevance

Nursing practice connection: Use the key finding related to Pharmacology: Adverse Drug Reactions and Contraindications to guide bedside assessment, documentation, and the next nursing action.
A fundamental nursing responsibility is to assess a patient's current symptoms before administering medications to prevent causing harm or exacerbating their condition.
Nurses must act as patient advocates by questioning and clarifying medication orders that may be inappropriate or contraindicated based on the patient's clinical presentation.
What if the patient's vomiting was accompanied by severe pain needing an opioid? The nurse should immediately inform the prescriber about the vomiting and request an alternative analgesic with a lower emetic risk, or an order for a prophylactic antiemetic to be given with the opioid.

How to Approach the Question

First, identify the patient's primary clinical problem from the stem, which is active vomiting (3 episodes).
Next, analyze the question's core task, which uses the negative keyword 'not'. You are looking for the contraindicated drug.
Categorize each medication option: determine if its primary purpose is to cause pain relief (analgesic) or to stop vomiting (antiemetic).
Based on the categories, eliminate the antiemetics (Promethazine, Ondansetron), as they are treatments for the patient's symptom.
Evaluate the remaining analgesics (Fentanyl, Tramadol). Both can cause vomiting, a known side effect of opioids.
Recall or deduce which of the two has a higher incidence or is more strongly associated with causing nausea and vomiting. Tramadol is well-known for this, making it the most inappropriate choice.

Concept Tested & Keywords

Concept Tested: Pharmacology: Adverse Drug Reactions and Contraindications
Stem keywords: vomiting, drug should not be given
Lead-in keywords: not
Clinical cues: 3 episodes of vomiting indicates an active and significant symptom.
Negative lead-in flag: The question asks to identify the drug that is contraindicated, which requires knowing the adverse effects of each medication.

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E6 Pharmacology Nursing Lilley 11e Part 3 pp. 187-189, 189-191