Which drug causes nausea and vomiting?

NORCET 2 - 2021 (shift-1)

Pharmacology

Easy

Appeared in: NORCET 2 - 2021 (shift-1)

Explanation

Methotrexate is a chemotherapy agent and disease-modifying antirheumatic drug (DMARD) whose common and dose-limiting side effect is nausea and vomiting.
It directly stimulates the chemoreceptor trigger zone (CTZ) in the brain, which contains receptors that initiate the vomiting reflex.
The emetogenic (vomiting-inducing) potential is dose-dependent; higher doses used in cancer chemotherapy are more likely to cause severe nausea and vomiting compared to lower doses used for autoimmune conditions.

Option B: While Rifampicin can cause general gastrointestinal upset, its most characteristic and frequently tested side effects are the harmless orange-red discoloration of body fluids (urine, sweat, tears) and the risk of hepatotoxicity (liver damage).
Option C: Diclofenac is a nonsteroidal anti-inflammatory drug (NSAID). Nausea from NSAIDs is typically due to direct irritation of the gastric mucosa (stomach lining), which can lead to dyspepsia and gastritis, rather than a direct effect on the brain's vomiting center.
Option D: Domperidone is an antiemetic and prokinetic agent. Its function is to treat or prevent nausea and vomiting by blocking dopamine (D2) receptors in the CTZ. Therefore, it has the opposite effect of what the question is asking.

Visual 1: Diagram: The mechanism of chemotherapy-induced nausea and vomiting (CINV), showing how drugs like methotrexate stimulate the chemoreceptor trigger zone (CTZ) and the vomiting center in the brainstem.
Visual 2: Chart: Emetogenic potential of various chemotherapy agents, classifying them from low to high risk, with Methotrexate placed in the moderate-to-high category depending on the dose.

Clinical Relevance

Nursing practice connection: Knowing Adverse effects of common medications, specifically emetogenic potential helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
Managing Chemotherapy-Induced Nausea and Vomiting (CINV) is a critical nursing responsibility to ensure patient comfort, maintain nutrition, and promote adherence to life-saving treatment.
A key nursing intervention is to administer prophylactic antiemetics (like ondansetron or palonosetron) 30-60 minutes before methotrexate infusion to prevent the onset of symptoms, as prevention is more effective than treatment.
Patient education is vital. Nurses should advise patients to eat small, frequent, bland meals and maintain adequate hydration to manage symptoms.

How to Approach the Question

First, identify the core of the question: it asks to identify a drug that causes nausea and vomiting as a known side effect.
Next, analyze each option by recalling its drug class and primary mechanism of action or most prominent side effects.
Recognize that Methotrexate is a chemotherapy drug, and this class is famous for causing significant nausea and vomiting.
Evaluate the other options. Rifampicin is an antibiotic with unique side effects (orange fluids, liver toxicity). Diclofenac is an NSAID known for stomach irritation. Domperidone is an antiemetic, meaning it treats nausea.
Eliminate Domperidone immediately as it has the opposite effect.
Compare the remaining options. While Rifampicin and Diclofenac can cause nausea, it is the most prominent and expected side effect for Methotrexate, especially in the context of chemotherapy.

Concept Tested & Keywords

Concept Tested: Adverse effects of common medications, specifically emetogenic potential.
Stem keywords: drug, nausea, vomiting
Lead-in keywords: Which
Negative lead-in flag: false

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