0:03 our topic today is medications used for
0:08 nausea and vomiting nausea is the
0:10 disagreeable feeling that often comes on
0:14 before vomiting vomiting or emesis may
0:16 be self induced and voluntary as with
0:18 eating disorders like bulimia or
0:22 involuntary as a defense mechanism with
0:27 a wide variety of causes some causes
0:30 include chemotherapy induced
0:32 post-operative due to exposure to
0:35 anesthetics associated with disease
0:39 processes due to organ damage or from
0:41 exposure to a wide variety of harmful
0:46 substances nausea and vomiting are also
0:49 common in pregnancy especially during
0:52 the first trimester recurring emesis
0:54 during pregnancy can lead to a dangerous
0:56 condition known as hyperemesis
1:00 gravidarum where electrolytes and fluids
1:02 get out of whack this affects both the
1:09 mother and the unborn baby as you may
1:11 have experienced nausea and vomiting may
1:15 also be precipitated by motion or sea sickness
1:20 it can also be brought on by memories
1:23 odors tastes and sight for example
1:27 singer smelling a cadaver or getting a
1:33 as mentioned general anesthetics
1:36 especially inhaled volatile liquids such
1:38 as dez fluorine are well known to cause
1:40 nausea and vomiting in the patient after
1:43 they wake up this is known as
1:44 post-operative nausea vomitting
1:48 abbreviated P o NV not only is this
1:50 uncomfortable for the patient with
1:52 vomiting there is increased risk for
1:56 tearing sutures putting excessive
1:59 pressure on organs and increasing
2:06 remember the ongoing emesis will cause
2:09 disturbances in electrolytes fluids and
2:16 acid-base balance pregnant women the
2:18 elderly and the very young are
2:20 especially prone to developing these
2:25 life-threatening imbalances it's useful
2:27 to remember the prolonged emesis is more
2:30 likely to lead to alkalosis this is due
2:32 to the loss of acid from the stomach
2:34 from all the vomiting conversely
2:37 prolonged diarrhea is more likely to
2:40 lead to acidosis due to the excessive
2:44 loss of bicarbonate ions in the feces
2:47 remember that bicarbonate ions are made
2:49 by the pancreas and secreted into the
2:50 lumen of the small intestine to
2:53 neutralize stomach acid these
2:56 bicarbonate ions are lost with lots of
3:02 diarrhea the control centers for nausea
3:04 and vomiting include the chemoreceptor
3:06 trigger zone and the vomiting center
3:14 these two control centers receive a
3:16 ferrant information from the vestibular
3:19 system of the inner ear gastrointestinal
3:26 tract and cerebral cortex when these
3:28 centers become activated they release
3:31 five main neurotransmitters which bring
3:32 about nausea and vomiting these
3:34 neurotransmitters include dopamine
3:38 serotonin histamine acetylcholine and
3:43 substance P when the vomiting Center is
3:45 activated it sends out a furnace signals
3:48 to elicit emesis for example it sends
3:51 efferent signals to the salivary glands
3:53 to increase secretion and to the
3:55 diaphragm to increase intra-abdominal
3:58 pressure and also to the muscles of the
4:01 upper GI tract to reverse peristalsis
4:03 together these actions bring about the
4:11 act of vomiting medications used to
4:14 prevent emesis and nausea are known as
4:17 antiemetics and anti-nausea drugs most
4:19 of the medication classes used to
4:20 prevent and treat nausea and vomiting
4:24 act to block the effects of the elevated
4:27 v neurotransmitters the first is
4:30 anticholinergics which block the effects
4:32 of elevated acetylcholine and include
4:35 scopolamine which may be administered as
4:38 a patch applied behind the ear to
4:42 prevent motion or seasickness try methyl
4:44 benzoate is also in the anticholinergic
4:50 class serotonin receptor antagonists
4:52 more specifically 5-ht three antagonists
4:56 like ondansetron Grenaa citron and palo
4:58 de sautron block the effects of
5:00 serotonin release from antic Rauf and
5:02 like cells in the gastro intestinal
5:04 mucosa as well as in the vomiting
5:06 centered and chemoreceptor trigger zone
5:15 indications for 583 receptor antagonists
5:17 include preventing and treating nausea
5:19 nemesis associated with cancer treatment
5:23 like cisplatin radiation therapy and for
5:25 post-operative nausea and vomiting
5:28 notice the generic names and in citron
5:30 it's a shortened version of the word
5:33 serotonin these medications are even
5:34 more effective when they are
5:37 administered with dexamethasone and a
5:40 prepotency labeled uses for ondansetron
5:44 include bulimia alcoholism and
5:49 hyperemesis gravidarum the next category
5:50 is antihistamines and includes
5:53 medications such as diphenhydramine
5:56 dimenhydrinate and meclizine these are
5:58 especially useful to prevent nausea and
6:00 vomiting related to motion sickness and
6:02 they also have anticholinergic
6:04 properties to additionally block
6:09 acetylcholine there are a lot of nk1
6:11 receptors in both the ctz and vomiting
6:14 center the ligand for this receptor is
6:18 substance P a prep attend is selective
6:20 for the NK one receptor and blocks
6:24 substance P a prep attend is used to
6:26 prevent nausea vomiting associated with
6:33 cancer treatment and P o and V anti
6:36 dopaminergic drugs like prochlorperazine
6:39 promethazine and chlorpromazine are used
6:41 for nausea and vomiting as well as
6:43 psychiatric disorders such as
6:46 schizophrenia and to treat intractable
6:50 hiccups one of the very useful dosage
6:52 forms for these dopamine antagonists is
6:56 suppositories like the antihistamines
6:59 these anti dopaminergic medications also
7:06 metoclopramide has both anti
7:09 dopaminergic and anticholinergic
7:12 properties it is used as an antiemetic
7:16 it is also a prokinetic that promotes
7:22 making it useful in the treatment of
7:26 reflux or regurgitation long-term use of
7:28 metoclopramide may lead to movement
7:34 disorders like tardive dyskinesia during
7:36 a banal may be used when other
7:38 medications don't work well during a
7:41 banal access a cb1 receptor agonist in
7:44 the brainstem and gastrointestinal tract
7:46 and is also used to stimulate appetite
7:52 in cancer and AIDS patients over the
7:55 counter abbreviated OTC medications like
7:57 Emma trawl and nausea relief contains
8:00 sugars like dextrose and fructose with
8:03 phosphoric acid these substances delay
8:06 gastric emptying by reducing smooth
8:09 muscle contraction in the GI tract the
8:12 same concept was used when your mom gave
8:15 you 7 up to settle your stomach it's
8:17 also important to know that the herbal
8:19 remedy ginger is marketed for its
8:24 anti-nausea properties notice the
8:27 various locations or these antiemetics
8:35 to summarize nausea and vomiting can be
8:38 caused by a wide variety of substances
8:39 and conditions
8:42 these include reactions to certain odors
8:46 self-induced overeating emotional
8:50 distress such as fear motion or
8:55 seasickness food poisoning infections
9:00 disease states various injuries organ
9:03 damage various types of pain for example
9:06 from a kidney stone or migraine headache
9:10 chemotherapy and radiation anesthetics
9:15 and many other medications alcohol and
9:19 various harmful substances it is also
9:21 associated with pregnancy especially in
9:24 the first trimester if a persist during
9:26 pregnancy it can develop into a serious
9:28 condition known as hyperemesis
9:35 gravidarum remember the ongoing emesis
9:37 can cause dehydration as well as
9:39 electrolyte and pH abnormalities
9:41 pregnant women the elderly and the very
9:44 young are especially prone to developing
9:48 these life-threatening imbalances the
9:50 two control centers are the ctz and
9:52 vomiting center in the brainstem
9:54 remember that they receive a fern
9:56 information from the inner ear
9:59 gastrointestinal tract and cerebral
10:02 cortex also remember the five
10:04 neurotransmitters that may increase with
10:06 nausea and vomiting including dopamine
10:10 serotonin histamine acetylcholine and
10:16 remember the classes of medication for
10:18 nausea and vomiting including
10:21 anticholinergics 5ht three antagonists
10:24 and histamines and Tide dopaminergic s--
10:28 pro kinetics and k1 receptor antagonists
10:32 cb1 receptor agonists and phosphor ated
10:36 carbohydrate solutions notice that most
10:40 of these are antagonists except for cb1
10:43 receptor agonist and phosphor ated
10:48 carbohydrate solutions now for some
10:50 questions pause the video and determine
10:56 your answers if you answered B you are correct
11:11 if you answer EU are correct if you
11:33 if you answered B you are correct thanks
