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First-generation antihistamines with antiemetic properties through histamine H1-receptor blockade have several indications. With primary indications that include motion sickness and vertigo-induced nausea and vomiting, these agents also exhibit secondary efficacy in addressing allergic rhinitis, insomnia, allergic reactions, and parkinsonism and as antitussive measures. The program outlines the essential aspects of antiemetic H1 receptor blocker use, including indications, contraindications, pharmacological activity, and potential adverse events. Healthcare professionals participating in this initiative gain a comprehensive understanding of the pharmacological intricacies associated with these agents, empowering them to tailor treatment plans, optimize dosage regimens, and mitigate adverse reactions. This heightened knowledge facilitates informed decision-making in prescribing antiemetic histamine H1 receptor blockers, enabling healthcare professionals to deliver precise, safe, and individualized care, thereby improving patient outcomes in conditions necessitating antiemetic interventions involving H1 receptor blockers. Objectives: Evaluate the mechanism of action of H1 receptor blockers. Identify the approved indications for H1 receptor blockers. Assess the potential adverse events related to H1 receptor antagonists. Implement interprofessional team strategies for improving care coordination and communication to advance appropriate clinical outcomes with H1 receptor antagonist therapy to treat nausea and vomiting and drive optimal results. Access free multiple choice questions on this topic.

Initial treatment should be stabilizing the airway and monitoring breathing and circulation. The patient should receive supplemental oxygen, continuous pulse oximetry, intravenous access, and an ECG. In patients with prolonged QRS intervals or arrhythmias, sodium bicarbonate is an option.[25] Benzodiazepines can be helpful to address agitation and seizures. Hypothermia treatment includes evaporative cooling. If no altered mental status is present and ingestion of anticholinergic agents is likely, activated charcoal is an option.[26] If the airway access is threatened, consider intubation instead. Supportive care is usually adequate; however, administration of the anticholinesterase inhibitor, physostigmine, may be warranted in patients with peripheral and central anticholinergic toxicity. Consultation with a regional poison center or medical toxicologist is recommended before administration. Caution is necessary for patients with cardiac abnormalities, reactive airway disease, or gastrointestinal obstruction. Atropine should be available at the bedside in case of an overdose of physostigmine. If there is any question about the etiology of the poisoning, please call the United States Poison Control network at 1-800-222-1222.

Antihistamine toxicity usually manifests itself as anticholinergic poisoning and requires an interprofessional team of nurses, physicians, laboratory technologists, and pharmacists to narrow down the differential diagnosis. Without proper management, a patient can receive incorrect treatment and could cause cardiac arrest. A patient with delirium, seizures, or tachycardia has a wide range of diagnoses when initially admitted. When a diagnosis of anticholinergic toxicity is suspected, a healthcare provider should perform a screening test. Finger-stick glucose, acetaminophen concentrations, salicylate concentrations, EKG, and a pregnancy test for women of childbearing age are necessary. Monitoring the patient for any cardiac arrhythmias or altered mental status will further dictate treatment. Clinicians should use benzodiazepines for agitation, but physostigmine may be more effective.[27][28] A toxicologist consult is required to determine if physostigmine is needed. The patient should be placed on a cardiac monitor and have resuscitation equipment and atropine available at the bedside when administering physostigmine. Pharmacists should review the patient's medication record before and after the toxicity and consult with the clinicians regarding a plan to move forward. Nurses will monitor treatment and report any concerns to the treating clinicians. After patient stabilization, the patient will need a thorough history to assess for underlying psychiatric problems, medication nonadherence, exposure, or medical issues causing an increased concentration of the offending medication. An interprofessional team approach and open communication among clinicians can result in safer use of antihistamines and minimize the risk of toxicity.