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Causes of Vomiting
Nausea and vomiting may be manifestations
of many conditions and may occur due to
stimulation of vomiting center that respond to
inputs from:
Pathophysiology of Emesis
chemotherapy
Opioids
Anesthetics
Chemoreceptor
Trigger Zone
(CTZ)
(Outside BBB)
5 HT3
Dopamine D2
Opioid receptors
Substance p
Cerebral cortex
Smell
Sight
Thought
Anticipatory emesis
Vomiting Centre
(medulla)
Muscarinic, 5 HT3 &
Histaminic H1
Motion
sickness
Vestibular
nuclei
Muscarinic
Histaminic H1
5-HT3 antagonists
D2 receptor antagonists
NK1 antagonists
H1-receptor antagonists
Muscarinic receptor antagonists
Cannabinoids
Glucocorticoids
5-HT3 antagonists
Side effects
o Well tolerated
o mild headache, dizziness and constipation
o minor ECG abnormalities (QT prolongation)
D2 receptor antagonists
Neuroleptics (antipsychotics)
D2 receptor antagonists
1) Prokinetics drugs
D2 receptor antagonists
Neuroleptics (Antipsychotics)
H1-receptor antagonists
Hyoscine (scopolamine)
Orally, injection, patches
Used as transdermal patches in motion
sickness (applied behind the external ear).
Not in chemotherapy-induced vomiting
Side effects: tachycardia, blurred vision,
dry mouth, constipation, urinary retention
(atropine-like actions).
Cannabinoids
Nabilone, dronabinol
mechanism of action not understood.
act at central cannabinoid receptors.
Used in vomiting due to cytotoxic
anticancer drugs (adjuvant therapy).
Not commonly used.
Side effects: euphoria, dysphoria, sedation,
hallucination.
Glucocorticoids
Dexamethasone - methylprednisolone
Used in chemotherapy-induced vomiting
combined with 5-HT3 antagonists or NK1
receptor antagonists.
Glucocorticoids
Side effects:
Hyperglycemia
Hypertension
Cataract
Osteoporosis
Increased intraocular pressure
Increased susceptibility to infection
Increased appetite & obesity
Summary
The choice of antiemetic depends on the etiology
Motion sickness
Muscarinic antagonists
Antihistaminics
Vomiting with pregnancy (morning sickness)
avoid all drugs in the first trimester
Pyridoxine (B6)
.Promethazine ( late pregnancy)
Thank you
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