Escolar Documentos
Profissional Documentos
Cultura Documentos
Definition
Pregnancy
Kinetosis
Dispepsia
Liver diseases
Renal failure
Stroke
Surgery (abdominal, ear, eye)
Radiotherapy
Chemotherapy (!!!)
Anatomy of the neuronal pathways controlling emesis
The bulbar center of the Vomiting Reflex
The Brain stem - posterior view , the cerebellum was removed.
Glu, GABAA
H1, M1
5HT3, D2
Drugs used to induce the Vomiting reflex
Ipecacuana syrup
Drugs used to induce the Vomiting reflex
Apomorphine
Drugs used to induce the Vomiting reflex
CuSO4
Overview of the Antiemetic Drugs
Antiserotoninergicondansetron
granisetron
tropisetron
Sites of action of Antiemetic Drugs
Pharmacodynamic profile of the antiemetic drugs
Chemotherapy Induced Nausea and Vomiting
(CINV)
The aetiology and risk factors for CINV and radiotherapy-induced nausea and vomiting
Not all patients receiving chemotherapy or radiotherapy will experience nausea and vomiting but it has been estimated that
(untreated) it occurs in up to 70% of patients receiving cancer chemotherapy[2].
There are three types of nausea and vomiting associated with chemotherapy and radiotherapy, each with different aetiologies:
1-Acute nausea and vomiting. This lasts for 12-24 hours.
2-Delayed nausea and vomiting. This may occur up to 5 days after chemotherapy. It is less apparent in the case of
radiotherapy.
3-Anticipatory nausea and vomiting. This conditioned response results from the patient's expectation (anticipation) of
nausea and vomiting.
Both histamine H1 and muscarinic receptors are present in the vomiting centre and the
vestibular nucleus.
The antihistamine drugs that are used to treat nausea and vomiting also have
antimuscarinic activity, therefore it is unclear which property is more important for their
anti-emetic action.
Cyclizine has been used extensively to treat PONV and most reports demonstrate
efficacy with few side effects such as sedation.
Promethazine is a markedly sedative drug and has been used by anaesthetists to
premedicate children, but whether this is for its sedative effect or anti-emetic effect is
debatable.
Oral dimenhydrinate given at least 1 hour before surgery has also been used to
prevent PONV.
Second-generation antihistamines (e.g. terfenadine, astemizole) are not effective anti-
emetics because they do not cross the bloodbrain barrier.
Antiemetic Drugs Summing Up
Anticholinergic
Kinetosis (scopolamine transdermic)
Diziness, sedation, cycloplegia, dry mouth
Rapid effects
Antihistaminic
Kinetosis, Meniere Syndrome, vertigo
sedation
Antidopaminergic
Vertigo, chemotherapy, dispepsia
Prolonged effect
Extrapiramidal symptoms, hyperprolattinemia
Antiserotonergic
Chemotherapy
Headache stipsis
Corticosteroids
Chemotherapy
Vit B6
Pregnancy
Cannabinoids
Chemotherapy
Sedation, dysphoria, vertigo,
Benzodiazepin
Anticipation Emesis