emetics and antiemetics
TRANSCRIPT
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PREPARED BY SALMAN HABEEB
DRUGS AFFECTING GASTROINTESTINAL
SYSTEM
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COMMONLY DRUGS USED • EMETICS • ANTIEMETICS• PROKINETICS• PURGATIVES• ANTACIDS• ANTIDIARRHOEALS• ANTIULCERS• CARMINATIVES• ANORECTAL PREPARATIONS
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EMETICS • EMESIS =?
DRUGS THAT PRODUCE/ INDUCE VOMITING IS CALLED EMETIS
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MECHANISM OF VOMITING• WHAT IS VOMITING?• It is the forceful expulsion of the contents
of the stomach via the mouth or sometimes through the nose.
• The vomiting reflex is stimulated by two centers in the medulla
1 . vomiting center 2 .chemoreceptor trigger zone(CTZ)
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How this CTZ is stimulated• Tactile stimulation of the back of the
throat, a reflex to get rid of something that is too big or too irritating to be swallowed
• Excessive stomach distention• Increasing intracranial pressure by
direct stimulation• Stimulation of the vestibular
receptors in the inner ear
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• Intense pain fiber stimulation• Direct stimulation by various chemicals,
including fumes, certain drugs, and debris from cellular death
• CTZ is stimulated by several different processes and initiates a complex series of responses that first preparet he system for vomiting and then cause a strong backward peristalsis to rid the stomach of its contents.
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Classification of Emetics 1.Stimulants of CTZ a.Apomorphine b.Morphine2.Irritants of gastric mucosa a.mustard b.sodium chloride3.Both CTZ stimulant and irritant effect a.ipecacuanha b.digitalis
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Apomorphine• It is obtained by treating morphine
with HCL• MECHANISM?• Produce vomiting in 5-10 minutes
after admn• Dose- 2 to 4mg• Route- subcutaneous/IM
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MUSTARD• It is a household remedy to induce
vomiting• Dose- 1teaspoonful with water
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Ipecacuanha• It is obtained from the dried rhizome
and roots of carapicheae ipecacuanha from which it derives its name.
• Commonly available as syrup• Dose- 15 to 20ml• Induce vomiting witin 15 minutes
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Antiemetics • Drugs that prevent vomiting
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CLASSIFICATION1.Prokinetics a.metochlorpramide b.domperidone2.Antimuscarinics a.hyocine b.meclozine3.Antihistamines a.cyclizine b.promethazine(phenergan)4.Neuroleptics a.chlorpromazine b.prochlorpromazine5. 5-HT3 antagonists a.ondancetron b.granicetron
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Prokinetics• These drugs which promote gastrointestinal
motility and quicken gastric emptying• Metoclorpramide(REGLAN) It has both central and peripheral effects Central- blocks the dopeminergic receptors peripheral- increased gastric emptying dose- 5- 10 mg
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Metochlopramide(reglan) • Dose- 5-10 mg• Indications post-operative vomiting, vomiting during induction of anesthesia• Side effects: restlessness, drowsiness, dizziness, and or dystonic reactions.
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Domeperidone • Action- Block the dopaminergic
receptors in the upper GIT• Dose- 10mg,30mg tablets 1mg/ml syrup
Side effects: Headache, dizziness, dry mouth, nervousness, flushing, or irritability
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Antimuscarinics• Action- Competitively inhibits action
of acetylcholine at muscarinic receptors
• Hyoscine –very effective in controlling motion sickness
• Dose -0.4-0.6 mg po 30 min before journey
• It is a labrynthine sedative
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Neuroleptics• Action- they act by suppressing the
CTZ so they antagonize vomiting produced by drugs which stiimulate CTZ
Eg; chlorpromazine • dose; PO: 10-25 mg q4-6hr IV/IM: 25-50 mg q4-6hr
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5-HT3 Antagonists• (5-HT3) receptor antagonists block
the vomiting reflex by inhibiting 5-HT3 receptors in the vomiting center , the chemoreceptor trigger zone and in the small intestine
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Ondansetron(Emeset)• Blocks 5HT3 receptors in git and CTZ • Specially used In chemotherapy,post
op vomiting other drug induced vomiting
• Dose- 4mg in each ampule • 4,8 mg tab
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• Side effects: Headache, constipation, and dizziness are the most commonly reported side effects associated with its use
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Granisetron• It is 10 to 15 times more potent than
ondansetron• More effective in chemotherapy • Dose – IV 1mg
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Antihistamines• They act by sedating the vomiting
centre• They are safer for long term use• Effective in motion sickness and
vomiting due to labrynthine disoders eg. Cyclizine meclozine dose- 50mg/ml inj 50mg tab
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Nursing Considerations for Patients Receiving
an Antiemetic Agent• Assess for possible contraindications
or cautions history of allergy to antiemetic to avoid potential hypersensitivity reactions; impaired renal or hepatic function
• ■ Assess the patient’s neurological status, including level of orientation, affect, and reflexes,
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• ■ Examine the abdomen, including the liver, and auscultate bowel sounds
• ■ Assess complaints of nausea and evaluate emesis; note color, amount, and frequency of vomiting episodes
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• Instruct the client to avoid over-the-counter preparations.
• Instruct the client not to consume alcohol while taking antiemetics.
• Advise pregnant women to avoid antiemetics during the first trimester.