Antiemetic Agents
Terms
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- Four ways to stimulate nausea and vomitting
-
stretch afferents in stomach
stimulus of the Area Postrema
Vestibular afferents
Higher cortical centers - Exception to the rule that drugs for motion sickness don't work for drug induced nausea
- promethazine
- Promethazine is unique because
- it is effective against motion sicknes and drug-induced nausea
- Drugs that work for motion sickness also work for...?
- nausea induced by vertigo
- Drugs for motion sickness
-
muscarinic antagonists of histamine anatgonists
scopolamine
dimenhydrinate
hydroxyzine
Must use 1 hours before (4 hours if transdermal) - Motion sickness drugs side effects
- sedation and antimuscarinic effects
- Ondansetron
-
5HT-3 antagonist
1st line anti N/V from operation, opiates or chemo - 1st line antiemtic that can be used alone or combined for different uses
- Ondansetron
- Its prokinetic effects is atropine sensitive
- Metoclopromide
- Metoclopromide
-
Dopamine antag, prokinetic
May produce akathisia, dystonic reactions
Sensitive to atropine - Safe alternative to metoclopromide
- Domperidone
- Domperidone
- Alternative to metoclopromide because it doesn' cross the BBB
- Third line rescue therapy for chemp N/V
-
phenothiazines
Chlorpromazine
Prochlorperazine
Have high incidence of extrapyramidal side effects -
Chlorpromazine
Procholorperazine - Third line anti cancers due to extra pyramidal side effects
- Greatly enance effectiveness of other antiemetics
-
Dexamethasone
Used with Ondansetron for actue emesis from drugs - Dexamthasone
- Enhances effectiveness of other cancer drugs
- Lorazepam
- Pretreatment to reduce stress and anticipatory emesis