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Emetics and antiemetics
Emetics and antiemetics
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Emetics and antiemetics

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Emetics and antiemetics

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Emetics and antiemetics

  1. 1. PREPARED BY SALMAN HABEEB
  2. 2. COMMONLY DRUGS USED • EMETICS • ANTIEMETICS • PROKINETICS • PURGATIVES • ANTACIDS • ANTIDIARRHOEALS • ANTIULCERS • CARMINATIVES • ANORECTAL PREPARATIONS
  3. 3. EMETICS • EMESIS =? DRUGS THAT PRODUCE/ INDUCE VOMITING IS CALLED EMETIS
  4. 4. 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)
  5. 5. 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
  6. 6. • 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.
  7. 7. Classification of Emetics 1.Stimulants of CTZ a.Apomorphine b.Morphine 2.Irritants of gastric mucosa a.mustard b.sodium chloride 3.Both CTZ stimulant and irritant effect a.ipecacuanha b.digitalis
  8. 8. 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
  9. 9. MUSTARD • It is a household remedy to induce vomiting • Dose- 1teaspoonful with water
  10. 10. 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
  11. 11. Antiemetics • Drugs that prevent vomiting
  12. 12. CLASSIFICATION 1.Prokinetics a.metochlorpramide b.domperidone 2.Antimuscarinics a.hyocine b.meclozine 3.Antihistamines a.cyclizine b.promethazine(phenergan) 4.Neuroleptics a.chlorpromazine b.prochlorpromazine 5. 5-HT3 antagonists a.ondancetron b.granicetron
  13. 13. 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
  14. 14. Metochlopramide(reglan) • Dose- 5-10 mg • Indications post-operative vomiting, vomiting during induction of anesthesia • Side effects: restlessness, drowsiness, dizziness, and or dystonic reactions.
  15. 15. 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
  16. 16. 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
  17. 17. 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
  18. 18. 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
  19. 19. 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
  20. 20. • Side effects: Headache, constipation, and dizziness are the most commonly reported side effects associated with its use
  21. 21. Granisetron • It is 10 to 15 times more potent than ondansetron • More effective in chemotherapy • Dose – IV 1mg
  22. 22. 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
  23. 23. 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,
  24. 24. • ■ 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
  25. 25. • 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.

Editor's Notes

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