This document provides information on various drugs used to induce vomiting (emetics) or prevent vomiting (anti-emetics). It discusses the uses of ipecac syrup and other emetics to induce vomiting in poisonings when indicated. It also covers different classes of anti-emetic drugs like antihistamines, anticholinergics, dopamine antagonists, benzodiazepines, serotonin antagonists and their mechanisms of action and side effects. Common anti-emetic drugs discussed include promethazine, scopolamine, droperidol, lorazepam, ondansetron and metoclopramide. The document also summarizes purgatives and laxatives used to

1. PRESENTED BY:
ROSHANI NAIK
DATE : 16-2-2015

2. GSTRO
INTESTINAL
SYSTEM

4. THE CHEMORECEPTOR
TRIGEER ZONE AND
VOMITING CENTER….

5. EMETICS DRUG

6. EMETICS
O Emetics are drug used to induce vomiting.
O When an individual has consumed certain toxic
substances, induced vomiting may be indicated to
expel the substance before absorption occurs.
O There are many ways to induce vomiting without
using drugs, such as putting the finger in the back
part of the throat.

7. .
O Vomiting should not be induced if caustic substances, such as
ammonia, chlorine bleach, lye toilet cleaners, or battery acid, have
been ingested.
O Regurgitation these substances, can cause additional injury to the
esophagus.
O Activated charcoal is given when emesis is contraindicated.

8. IPECAC
O Administration of ipecac has diminished greatly but
it is still used when indicated.
O DOSES: PO: 15-30 ml
O USES: induce vomiting after poisoning,
O CONSIDERATIONS: should be given within 60
min of poisoning.

9.  Ipecac may be appropriate for the client who is alert and if
administered within 60 minutes of poisoning.
 When the client purchases ipecac, instruct the client to get
ipecac syrup and not ipecac fluid extract, which is more potent
and may cause fatalities.
 When ipecac is kept in the household, it should be kept out of
the reach of children.
 Ipecac syrup induces vomiting by stimulating the CTZ in the
medulla and acting directly on the gastric mucosa.

10.  Ipecac should be taken with a glass of water .
 The onset of emesis production following administration of
ipecac syrup is usually 15 to 30 minutes.
 When vomiting is not induced, clients should be treated with an
adsorbent, such as activated charcoal, or gastric lavage.
 Individuals with bulimia and anorexia nervosa often abuse
ipecac, which may lead to cardiomyopathy, ventricular
fibrillation ,and death.

11. ANTI EMETIC
DRUGS

12. INTRODUCTION
O Anti emetic drugs are
used to prevent or
suppress vomiting occurs
due to the stimulation of
the emetic center situated
in the medulla oblongata.
O Vomiting may occur by a
number of reasons.

13. DEFINITION
O Anti emetics are drugs used to prevent vomiting.

14. CLASSIFICATION
O Anti emetics are classified into following:
• Antihistamines
• Anticholinergic
• Dopamine antagonist
• Benzodiazepines

15. • Serotonin antagonists
• Glucocorticoids
• Cannabinoids
• Miscellaneous

16. ANTIHISTAMINES
O Antihistamines compete with histamines for H1
receptor sites.
O They antagonize in varying degrees most of the
pharmacologic effects of histamines..
O It act primarily on the vomiting center and they also
act by decreasing stimulation of the CTZ and
vestibular pathways.

17. O USES:
O To control symptoms of allergies, rhinitis, & pruritis.
O CONTRAINDICATION:
O Acute lower respiratory tract disease
O Closed angle glaucoma
O Bladder neck obstruction
O peptic ulcer
O Systemic prostatic hypertrophy
O New born
O Breast feeding

18. ANTICHOLINERGICS
O Anticholinergic inhibit the muscarinic actions of
acetylcholine at receptor sites in the autonomic
nervous system.
O Anticholinergic are also known as antimuscarinic
product.

19. O USES:
O Decrease involuntary movement in parkinsonism
O Brady dysrhythmias
O Nausea and vomiting
O CONTRAINDICATION:
O Closed angle glaucoma
O Myasthenia gravis
O GI obstruction

20. DOPAMINE ANTAGONISTS
O The dopamine antagonists is a drug which blocks
dopamine receptors by receptor antagonism.
O These agents suppress emesis by blocking dopamine2
receptors in the CTZ.
O Side effects:
O Extrapyramidal symptoms , which are caused by
blocking dopamine receptors and hypotension.

21. BENZODIAZEPINES
O Benzodiazepine are a class of psychoactive drugs
whose core chemical structure is the fusion of a
benzene ring and a diazepam ring.
O Selected benzodiazepines indirectly control nausea
and vomiting that may occur with cancer
chemotherapy.
O Lorazepam is the drug of choice.

22. O Uses:
O Emesis control
O Sedation
O Anxiety reduction
O amnesia

23. SEROTONIN ANTAGONISTS
O A serotonin antagonists is a drug used to inhibit the
action at serotonin receptors.
O Serotonin antagonists suppress nausea and vomiting
by blocking the serotonin receptors in the CTZ and
afferent vagal nerve terminals in the upper GI tract.

24. O USES:
O Preoperatively and postoperatively to prevent nausea
and vomitting
O Side effects:
O Headache
O Diarrhea
O Dizziness
O fatigue

25. GLUCOCORTICOIDS
O Glucocorticoids are class of steroid hormones that bind to the
glucocorticoid receptor which is present in almost every
vertebrate animal cell.
O Side effect:
O Increased blood sugar
O Abnormal fat deposit
O Muscle wasting
O Edema
O Hypertension
O Peptic ulcer
O Growth retardation

26. CANNABINOIDS
O Cannabinoids are naturally occurring compounds
found in the cannabis sativa plant.
O Uses:
O appetite stimulant
O Nausea and vomiting

27. O Side effects:
O Drowsiness,
O Headache
O Depersonalization
O Nightmares
O Confusion
O Incoordination
O Memory lapse
O dry mouth

28. MISCELLANEOUS
O Diphenidol and trimethobenzamide are in the class
of miscellaneous antiemetic, because they do not act
strictly as antihistamines, anticholinergic or
phenothiazine.
O These drugs suppress impulses to the CTZ.
O Diphenidol also prevent vertigo by inhibiting
impulses to vestibular area.

29. O Side effect:
O Drowsiness
O Dry mouth
O Increased heart rate
O Urine retention
O Constipation
O Blurred vision
O Hypotension
O Diarrhea
O Postural disturbances

30. PHARMACOLOGICAL ACTION
O The anti emetics are divided into the 5-HT3 receptor
antagonists, the phenothiazine and the miscellaneous
products.
O The 5-HT3 receptor antagonist work by blocking
serotonin peripherally, centrally, and in small
intestine.

31. O The phenothiazine act by blocking the chemoreceptor
trigger zone in the brain.
O The miscellaneous products work by either decreasing
motion sickness or delaying gastric emptying

32. USES
O Anti emetics are used to prevent nausea and vomiting
due to cancer chemotherapy, radiotherapy, and
surgery.
O Some of the miscellaneous products work by
decreasing motion sickness.
O Most other products are used for many types of
nausea and vomiting.

33. PHARMACOKINETICS
O Onset, peak, and duration vary widely among
products.
O Most products are metabolized by the liver and
excreted by the kidney.

34. SIDE EFFECT
O The most common side effects are …
 Headache
 dizziness
 fatigue
 Diarrhea

35. PROMETHAZINE
O DRUG CLASS:- antihistamine
-h1 receptor antagonist
-antiemetic
Chemical class: - phenothiazine derivative
Dose: adult:- PO/IM/IV 12.5 – 25 mg
child >2 year: PO/IM/IV 0.25 – 0.5 mg/ kg

36. O USES:
O Motion sickness
O Sedation
O Nausea
O Pre operative and post
operative sedation

37. O Contraindication:
O Hypersensitivity
O Breastfeeding
O Agranulocytosis
O Bone marrow suppression
O Comma,
O Jaundice

38. O Precaution: pregnancy
OCardiac/ renal/ hepatic disease
OProstatic hypertrophy
OAsthma
OBladder obstruction
OGlaucoma
OCOPD
OSleep apnea

39. SCOPOLAMINE
O DRUG CLASS:-
cholinergic blocker
Chemical class: - belladonna
alkaloid
Dose: adult:- subcutaneous
0.6 – 1 mg
child : subcutaneous
0.006 mg/ kg

40. O USES:
O Pre operatively to produce amnesia
O Sedation
O Motion sickness
O Parkinsonian symptoms

41. O Contraindication:
O Hypersensitivity
O Closed angle glaucoma
O Myasthenia gravis
O GI obstruction
O barbiturates

42. DROPERIDOL
Function class: sedative/ hypotonic
Chemical class: butyrophenone
ing
Dose: adult : - IV/ IM 1.25- 2.5 mg
child 2- 12 year: - IV 0.05- 0.1 mg/kg
Uses: premedication for surgery
maintains in general anesthesia
post operatively for nausea vomit

43. O Contraindication:
O Breast feeding
O hypersensitivity

44. LORAZEPAM
O Function class:
O sedative,
O Hypnotic
O Antianxiety
O Chemical class:
O Benzodiazepine,
O Short acting

45. O Dose: adult: PO 2-3 mg/day
Geriatrics: PO 1-2 mg/day
O Uses: anxiety,
O Preoperatively organic disorder
O Insomnia
O Endoscopic procedure

46. O Contraindication:
O Pregnancy
O Breastfeeding
O Hypersensitivity
O Closed angle glaucoma

47. ONDANSETRON
O Function class:
antiemetic
O Chemical class: 5 HT3
antagonist
O dose: adult: PO 8mg BD
IV 10 mg /
kg

48. O Uses: prevention of
nausea,
vomiting associated
with cancer chemotherapy
O Contraindication:
O Hypersensitivity
O phenylketonuric

49. METOCLOPRAMIDE
O FUNCTION CLASS: cholinergic, antiemetic
O Chemical class: central dopamine receptor antagonist
O Dose: adult:- IV 1-2 mg/kg
child: IV 1-2 mg/kg

50. O Uses: prevention of
nausea, vomiting induced
chemotherapy, gastro
esophageal reflux
O Contraindication:
hypersensitivity, breast
cancer, GI obstruction

51. PURGATIVES

52. INTRODUCTION
O Purgatives are strong medicines usually administered
orally to promote evacuation of bowel or several
bowels.
O These drugs are used in the treatment of constipation
which acts on GI Tract by softening of feaces by
lubricating intestinal wall or increase fluidity of
intestinal contents.
O It is also called cathartic or caprogogue.

53. LAXATIVE
O Laxative are the drugs which cause evacuation of
bowel by a mild action by increasing bulk of faeces,
softening the stool or by lubricating intestinal walls.

54. CONSTIPATION
O Constipation is a state of difficulty in passing stools
or incomplete passage of hard stool. The cause of
constipation may be organic or / and functional
cause are intestinal obstruction, tumours.

55. O Many drugs in low doses act as laxative and in
higher does act as purgatives.
O Based on the intensity of action purgatives can be
classified as under:-
i) Laxatives when the action is mild.
ii) Purgatives when the action is severe.

56. CLASSIFICATION
O Stool softner or Lubricant purgatives :
i) Liquid paraffin
ii) Dicotyl sodium sulfosuccinate.
O Bulk Forming purgatives:
i)Methyl cellulose
ii)Ispaghula
iii) Bran

57. O Irritant oils:
i) Castor Oil
ii) Croton Oil
O Stimulant Purgatives:
i) Bisacodyl
ii) Phenolphthalein
iii) Sodium picosulfate.

58. O Osmotic purgatives:
i) Magnesium sulphate,
ii) Magnesium citrate
iii) Milk of magnesia
iv) lactulose
v) Sodium potassium tartrate
O Anthra Quinones:
i) Senna
ii)Aloe
iii) Cascara Sagrada.

59. ISPAGHULA (PSYLLIUM):
O These are dried ripe seeds of
plantago ovata, plantago
indica, plantgo psyllium.
The husk contains natural
colloidal mucilage which
forms a gelatinous material
by absorbing water. It
should not be taken,
swallowed, dry by mouth.

60. ISAPGHULA SEEDS
O Dosage: Adult: 5 to 15 gm orally mixed with water
or milk at bed time.
O Children : Half of the adult dose.
it is not absorbed in the inteenstinaes, so it does not
produce any systemic toxicity. The purgative effact
occurs in 12 to 18 hours.

61. • Indications: Demulcent, used in the treatment of
constipation.
• Contraindications: Intestinal obstruction, gut
ulceration, Pregnancy, abdominal pain.
• Availability:
It consists of dried ripe seeds of herbal plant plantago
ovata. The seed is pinkish brown in colour having
glossy brown oval spot in the centre. Its taste is
nulcilaginous. It is available in market as Isapgol
husk, isapgol powder.

62. O Side effects: Safe in use, have no side effects. Vomiting may occur in the
exceptional case.
O Pharmacokinetics: Excreted through stools, not absorbed in intestines.
NURSING RESPONSIBILITY
 To advise pateient to take orally isapgol (isabgol) in the morning or
evening oral dose.
 Not to take dry powder. It should be mixed with sufficient water or with
milk immediately before use followed by a full glass of water or fruit
juice.

63. NURSING RESPONSIBILITY
 To assess cause of
constipation,
consumption of fluid
diet, excess of physical
exercise, decrease intake
of diet.
 In case of cramps,
vomiting, rectal bleeding,
vomiting, use of isapgol
should be discontinued.

64.  It should be administered alone for better absorption.
 To analyse therapeutic response, decrease in
constipation or decrease in diarrhoea in collitis.

65. CASTOR OIL
• It is obtained from the seeds of Ricinus communis. It
contains ricinoleic acid. The oil is faintly yellow or
colourless, viscous oil of high density. It also contains
small amount of other glycerides, fatty acids. Castor
oil stimulates small and large intestines and action is
exerted after 4 to 6 hours.
• It should be mixed in fruit juice and or milk before
ingestion. Now a days, castor oil has been replaced by
pleasant and less drastic purgatives.
• Dose : 5 to 20 ml.

66. O Indications : Used as
Purgatives, emollient.
O Contraindications :
Pregnancy, menstruation,
lactation.
O The castor oil is uncompatible
which causes frequent cramps.
It has violent action amd may
cause dehydration after
relieving of constipation. It
should not be used regularly.
It is now rarely used these
days.

67. PHENOLPHTHALEIN
O It is a Diphenyl methane
irritant purgative.
O It acts on the smooth
muscles of intestine and
increases motor activity.
O It is avalilable at 60 mg, 90
mg, 125 mg tablets.
O It is also available as
mixure of Paraffin liquid
and phenolphthalein.

68. O Preparation of phenolphthalein with magnesium
sulphate is also used. Molecular formula is C20H14O4.
O it is white crystalline, odourless, tasteless powder,
slightly solube in water.

69. • Indications: In the treatment of constipation, in bed
ridden pateients, digestive disorders.
• Dosage : Adults: 50 mg to 300 mg usually to be
administered at bed time (night) to act in the
mornging.
• Contraindications: Hypesenstivity, rectal fissure,
pain abdomen, vomiting, hemorrhoids, pregenancy,
lactation.
• Side effects :Rash, urticaria, vomiting, abdominal
pain, electrolyte fluid imbalance.
• Pharmaco kinetics: On set action 6 to 8 hours,
excreted in faeces.

70. NURSING RESPONSIBILITY
 Administer drug alone for complete absorption.
 Cause of constipation to be assessed.
 In case of pain abdomen, rectal bleeding, vomiting,
drug should be discontinued.
 To be administered orally in the morning or evening.
 To advise patient to keep drup out of reach of
children.
 Laxatives should not be used for long time. Not to
crush chew or break tablet.

71. Magnessium Sulphate
• : It is also known as Epsom salt.
• Molecular formula is MgSO4:7H2O.
• It is white crystalline powder with bitter taste.
• It is sobuble in water.
• Magnessium Suplhate is a saline purgative.
• It is not readily absorbed from the intestines.

72. O When Magnessium Sulphate is taken by mouth in
solution it decreases the absorption of water from
intestines thus forms the bowel bulky.
O The active refex peristalsis is exicted leads to
evacution of intestinal contants within one to two
hours.
O Magnessium Sulphate wet dressings of a 25%
solution of MgSO4 are some times used in the
treatment of boils and carbuncles.

73. • Dose: Adult dose: 5 to 15 gms, orally.
• Children dose: 1 to 4 gms, orally.
• Indications : Purgative, Hypomagnesemic seizures,
Seizures in actue nephritis.
• Contraindications : Hypersenstivity, Pregnancy.
• Side Effects: Hypothermia, sedation, weakness,
sweating, Hypotension, decreased cardiac function.
• Pharmacokinetics: On set action 1 hour, duration 3
to 4 hours excreted by kidneys.

74. • Drug interactions: Increased CNS depression
withbarbiturates, antipsychotics drugs.
 To assess cardiac functions, monitoring, magnesium level.
 Assess mental status, mood, memory of patient.
 Assess respiratory depression, respiratory dysfunction. If
respiration ratio observed below 16 per minute discontinue
use of drug.
 Treatment overdose: discontinue drug, administer calcium
gluconate.

75. MILK OF MAGNESIA
O Magnesium hydroxide (Mg
(OH)2) is an amorphous
powder.
O Magnesium hydroxide is an
antacid.
O It forms Magnesium chloride
in stomach.
O It acts as a mild saline
laxative and it does not
produce alkalosis.
O It is known as philip’s milk of
magnesia / milk of of
magnesia.

76. O Dose: Adult Dose: antacid 500 to 700 mg orally.
O Laxative dose is 2 to 4 gms daily orally.
O Milk of magnesia liquid 30 to 60 ml at bed time
orally.
O Children dose: 5 to 15 ml at bed time orally.
O Indications: constipation, saline antacid.

77. O Contraindications: Hypersenstivity, abdomen pain,
vomiting, Pregnancy, renal disease.
O Side effects: Flushing, sweating, flacidity, sedation,
flaccidity, vomiting, hypotension, circulatory
collapse.
O Pharmacokinetics: Peak plasma concentration 1 to 2
hours excreted in feces.

78. NURSING RESPONSIBILITY
 To assess cause of constipation, lack of fluids, lack of
proper diet, lack of exercise.
 Cramping, vomiting, nausea, vomiting if assessed drug
should be discontinued.
 Intake and out put ratio be assessed.
 Evaluate therapeutic response decrease of constipation.
 Advise patient to take orange, mausami (citric fruit) to
counteract unpleasant taste. Not to use laxative for long
term therapy.

79. ALOE
• Aloe is a purgative,
leaves of aloes are cut
and liquid drains from
leave is collect and
concetrated by
evaporating.
• On cooling it silidifies in
crystalline form.

80. • The solid crystalline residue is obtained by
cutting leaves of Aloe barbadensis, Aloe
capensis.
• Aloes have characteristic odour and bitter
taste.
• It is administered orally.
• It colours urine red.

81. O Dose: 100 mg to 200
milligrams.
O Occasionally 30 mg dose are
some times administered,
Antispasmodic drug may be
administered with aloes to
prevent griping.
O Indication: Purgative, it is
an ingrediant of compound
Benzoin tincture.

82. O Contraindications: Pregnancy, Lactation, abdominal
pain.
O Side effect: Pelvic congestion syndrome, intestinal
irritation. Aloe has been replaced by safer purgatives
and are rarely used now a days.

83. PARAFFIN LIQUID
• It is transparent
colourless oily odourless
liquid.
• It is obtained from
petroleum.
• It is also called as
mineral oil.
• It is a mixture of liquid
hydrocarbons.

84. • Liquid paraffin is administered orally, it keeps the stools
soft and there is easy evacuation of bowel.
• It is useful in the treatment of chronic constipation and is
also helpful in painful conditions of rectum and anus,
• Sterile Liquid paraffin is used in surgical dressings.

85. • It is also used as a lubricant for surgical instruments.
• It is administered with various chemical compounds. (i)
Liquid paraffin with magnesium hydroxide mixture (ii)
Liquid paraffin with phenolphthalein mixture etc.
• Pharmacologically Liquid paraffin is inert.
• Dose: 10 to 30 millilitres daily preferably between meals.
• Uses: Laxative. (should be administered for two to three
days).

86. SIDE EFFECTS AND
DISADVANTAGES
(i) It is very unpleasant to swallow because of its oily
consistancy.
(ii) When passes into intestinal mucosa it may produce
granuloma in the intestinal submucosa, liver and spleen by
absorption / deposition is tissue.
(iii) It may trickle into lungs while swallowing and may cause
lipid pneumonia.
(iv) It may interfere with anorectal region wound healing.
(v) Excessive doses may result in seepage and anal irritation.
(vi) It carries fat soluble vitamins with it to stools. Thus vitamin
deficiency may occur.

87. NURSING RESPONSIBILITY
 To assess cause of constipation.
 To advise patient to take Liquid paraffin emulsion
between foods.
 To assess anal irritation and seepage if any
complained by patient drug should be discontinued.
 To evaluate therapeutic response, relieve of
constipation.