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    Nonsedating anxiolytic

    Immediate availability of resuscitative drugs and age- and size-appropriate equipment for bag/valve/mask ventilation and intubation, and personnel trained in their use and skilled in airway management should be assured (see WARNINGS).

    For deeply sedated pediatric patients, a dedicated individual, other than the practitioner performing the procedure, should monitor the patient throughout the procedure.

    Long term anticholinergic use is associated with an increased risk for cognitive decline and dementia among older people.

    Topical diphenhydramine is sometimes used especially on patients in hospice.

    Several levels of evidence strongly indicate diphenhydramine (similar to chlorpheniramine ) can block the delayed rectifier potassium channel and, as a consequence, prolong the QT interval, leading to cardiac arrhythmias such as torsades de pointes.

    As diphenhydramine is extensively metabolized by the liver, caution should be exercised when giving the drug to individuals with hepatic impairment.

    D., Fort Collins Family Medicine Residency Program, Fort Collins, Colorado ROBERT D. D., University of Wyoming School of Pharmacy, Laramie, Wyoming AUSTIN G. D., Fort Collins Family Medicine Residency Program, Fort Collins, Colorado Am Fam Physician. An understanding of the pathophysiology of nausea and the mechanisms of antiemetics can help family physicians improve the cost-effectiveness and efficacy of therapy.

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    Treatment of nausea and vomiting ideally involves correcting the underlying cause.A Cochrane review of second-generation antipsychotic drugs found that quetiapine and risperidone were effective when combined with antidepressants; however, adverse side effects were also reported.The SSRIs include paroxetine (Paxil), escitalopram (Lexapro), sertraline (Zoloft), fluoxetine (Prozac), fluvoxamine (Luvox), and citalopram (Celexa).Both drug classes limit stimulation of the vomiting center from the vestibular system (which is rich in histamine and acetylcholine) but have minimal effect on afferent visceral stimulation.5Antihistamines such as meclizine (Antivert) are associated with minor side effects involving the central nervous system, such as confusion, sedation, dizziness, tinnitus, insomnia, incoordination, fatigue, and tremors.56 Scopolamine (Transderm Scop) is a primary antimuscarinic agent with prominent central nervous system activity.WARNING Adult and Pediatrics Intravenous midazolam has been associated with respiratory depression and respiratory arrest, especially when used for sedation in noncritical care settings.

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