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