Match each clinical presentation of nausea and vomiting in the palliative care setting with the most appropriate targeted initial pharmacologic intervention based on its underlying pathophysiologic mechanism.
- A patient with advanced malignancy presenting with nausea, early satiety, and upper abdominal bloating, without evidence of mechanical bowel obstruction.Metoclopramide
- A patient with widely metastatic lung cancer who develops early morning projectile vomiting and a progressive global headache.Dexamethasone
- A patient receiving palliative chemotherapy who experiences acute, severe emesis beginning 6 hours after an infusion of highly emetogenic agents.Ondansetron
- A patient with terminal illness whose nausea and emesis are strictly exacerbated by head turning and transitioning from a supine to a seated position.Scopolamine
Answer
The correct mapping aligns each presentation of nausea with its pathophysiologic mechanism: gastroparesis requires metoclopramide, increased intracranial pressure requires dexamethasone, acute chemotherapy-induced nausea requires ondansetron, and vestibular nausea requires scopolamine.
Each match represents the standard of care for targeted antiemetic therapy in palliative medicine. Early satiety and bloating suggest gastroparesis, best treated with the prokinetic metoclopramide. Morning vomiting with headache suggests increased intracranial pressure, treated with dexamethasone to reduce edema. Acute nausea after chemotherapy is mediated by serotonin, treated with ondansetron. Movement-triggered nausea is vestibular, treated with scopolamine.
Step-by-Step Solution
Key Concept
In palliative care, the treatment of nausea and vomiting must be mechanism-based, utilizing targeted pharmacologic agents that antagonize the specific pathways (e.g., dopamine, serotonin, histamine, acetylcholine) mediating the patient's symptoms.