Rational reflex prevention of ingestion of noxious substances (sight, smell, taste, texture) local gut reflexes stimulate vomiting e.g. toxins backup blood monitoring system, should former two protective reflexes be breached Irrational reflexes labyrinth pregnancy ‘visual nasties’!

1. ANTI EMETICS
RAVI RANJAN
AssISSTANT Professor
Dept. of Pharmacy Practice
ISF COLLEGE OF PHARMACY
Website: - www.isfcp.org
Email:
ISF College of Pharmacy, Moga
Ghal Kalan,nGT Road, Moga- 142001, Punjab, INDIA
Internal Quality Assurance Cell - (IQAC)

2. Anti-emetics: Teleology
• Rational reflex
– prevention of ingestion of noxious substances
(sight, smell, taste, texture)
– local gut reflexes stimulate vomiting e.g. toxins
– backup blood monitoring system, should
former two protective reflexes be breached
• Irrational reflexes
– labyrinth
– pregnancy
– ‘visual nasties’!

3. Emetic Centre
CTZ
Hormones
Azotaemia
Diabetes
Vestibular
Sights
Smell
Taste
Vomiting Gut
Opioids
Chemotherapy
Anaesthetics
BBB
Hypotension
Hypoxaemia

4. Anti-emetic agents
Chemoreceptor trigger zone
• Anti-dopaminergic agents
– phenothiazines e.g. chlorpromazine
– butyrophenones e.g. droperidol
– procainamide derivs. e.g. metoclopramide
– benzimidazole derivs. e.g. domperidone

5. Anti-emetic agents at CTZ
Anti-dopaminergic agents … uses
• Chemotherapy
• Drug induced N and V e.g. opioids and
chemotherapy
• Parkinson’s disease (domperidone)
• Postoperative N and V
• Motion sickness ?

6. Anti-emetic agents at CTZ
Anti- 5 HT3 agents
• Ondansetron
• Granisetron
Uses
• Chemotherapy (cis-platin)
• Postoperative
• Expensive !!-

7. Anti-emetic agents at EC
Anticholinergics
• Atropine and hyoscine
• Glycopyrrolate ?
Uses
• Travel sickness
• Postoperative N and V (combined with opioids)

8. Anti-emetic agents at EC
Anti-histamines
• Cyclizine
• Promethazine (other actions?)
Uses
• Postoperative N and V
• Sedation (combined with opioids)

9. Anti-emetic agents: Side effects
• Extra-pyramidal effects
• Dry mouth and blurred vision
• Sedation
• Tachycardia
• Hypotension

10. Anti-emetic agents: Choice
• Postoperative
• Chemotherapy
• Travel sickness
• Parkinson’s disease (especially
apomorphine)
• Pregnancy