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Lecture

Antiemetics and other GI medications.docx

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Department
Nursing
Course
NURS 2050
Professor
Cynthia Barkhouse Mckeen
Semester
Fall

Description
Antiemetics and other GI medications Antimetics: drugs that are effective against Nausea and Vomiting Medulla Oblongata: Vomiting centre  Direct stimuli = signals from cerebral cortex (fear), sensory organs, vestibular apparatus in the inner ear  Indirect stimuli = activate the chemoreceptor trigger zone (CTZ) -- in turn activates vomiting centre • Signals from the stomach – vagal afferents • Direct actions of drugs and chemicals Chemotherapy Induced Nausea & Vomiting 1. Anticipatory – triggers memory or past experiences 2. Acute – few minutes after chemo begins 3. Delayed – a day or 2 later PREVENTION vs stopping existing episode Knowledge of highly emetogenic regimens are available and antiemetics are chosen based on this. Receptors Important for Nausea & Vomiting 1. Serotonin  Receptors located in the upper GI and Chemo Receptor Trigger Zone (5HT3)  Ondansetron (Zofran) and others – 5HT3 receptor antagonist – Useful for N/V from chemotherapy Side Effects:  Diarrhea  Headache  Dizziness 2. Dopamine  Receptors located in the upper GI and CTZ  Dopamine antagonists – Phenothiazines, metoclopramide (Maxeran) • Block D2 receptors in the CTZ • Metoclopramide (high dose) = 5HT3 receptor blocker – Useful for N/V from chemotherapy Side Effects:  EPS  Sedation  hypotension 3. Acetylcholine • Muscarinic antagonists (Scopolamine) • Used for motion sickness • Suppress neuronal traffic from vestibular apparatus to vomiting centre Side Effects: 4. Histamine • Used for motion sickness • Antihistamines (e.g. dimenhydrinate) – Block receptors for histamine – Are also able to block acetylcholine (muscarinic) receptors • Block these receptors in the neuronal pathway that leads from
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