A 64-year-old woman with stage IV ovarian cancer and peritoneal carcinomatosis is admitted to the palliative care unit with 3 days of vomiting 4 to 5 times daily, abdominal distension, and mild intermittent abdominal cramping. She is still passing small amounts of stool and flatus. Her abdominal pain is controlled with hydromorphone PO, but she can no longer keep oral medications down. Abdominal examination shows a distended, mildly tender abdomen with high-pitched bowel sounds. CT shows multiple dilated loops of small bowel with contrast reaching the colon, and the gynecologic oncology team has determined that she is not a candidate for surgery. Sodium is 133 mmol/L (135-145), potassium 3.4 mmol/L (3.5-5.0), and creatinine 112 µmol/L (45-90). She has no known drug allergies.
| Heart rate | 104/min |
| Respiratory rate | 18/min |
| Temperature | 36.9 °C |
| O2 saturation | 96%, room air |
| Blood pressure | 102/64 mm Hg |
Question 1 of 29
Which one of the following is the most appropriate initial antiemetic for this patient?
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