This document discusses four classes of anti-emetic and anti-vertigo agents: 1) antidopaminergics such as phenothiazines, 2) antihistamines and anticholinergics, 3) serotonin 5-HT3 receptor antagonists, and 4) miscellaneous agents. It describes the mechanisms of nausea, vomiting, and vertigo, including the roles of the chemoreceptor trigger zone and vomiting center. Specific agents are discussed within each class, along with their indications, mechanisms of action, formulations, and other important information.
Introduction TO VOMITING,Pathophysiology of vomiting,Emetics,Anti emetics,classification,pharmacology,Drug treatment in selected circumstances FOR EMETICS were included.
This file is published by Kartik Tiwari......you can follow YouTube account for latest video. The link for YouTube channel (PW knowledge) is https://youtube.com/channel/UC0xONj-RH6AiGB6s-dSoKQA
Thankyou for visiting
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Introduction TO VOMITING,Pathophysiology of vomiting,Emetics,Anti emetics,classification,pharmacology,Drug treatment in selected circumstances FOR EMETICS were included.
This file is published by Kartik Tiwari......you can follow YouTube account for latest video. The link for YouTube channel (PW knowledge) is https://youtube.com/channel/UC0xONj-RH6AiGB6s-dSoKQA
Thankyou for visiting
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Antiemetics.ppt
1. Four classes of agents:
1. Antidopaminergics – Phenothiazines and Metoclopramide
2. Antihistamines (HT1 antagonists) and Anticholinergics (M)
3. Serotonin 5-HT3 receptor antagonists
4. Misc. agents
Mechanisms of N/V and vertigo:
• Vomiting from drugs, radiation and metabolic disorders are
generally stimulated through the CNS chemotrigger zone (CTZ-
dopamine mediated) which further triggers the vomiting center
(VC-acetylcholine mediated) in the brain.
• Nausea of motion sickness is initiated by stimulation of the
labyrinthine mechanism of the ear which sends a signal to the
CTZ
• The VC may also be stimulated by GI irritation, motion sickness,
vestibular neuritis and others
Anti-emetic & Anti-vertigo Agents
3. Prophylactic use in patients undergoing cancer chemotherapy is very
important so that they continue the regimen to the end. All
chemotherapy drugs vary in their emetic potential - some are
extremely severe.
Vertigo is a sensation of whirling or rotation accompanied by involuntary
swaying, weakness and lightheadedness.
Motion sickness is a functional disorder caused by repetitive angular,
linear or vertical motion - both are characterized by pallor, sweating,
hyperventilation and N/V.
Antidopaminergic agents are GENERAL PURPOSE anti-emetics
Antihistamines and Anticholinergics think motion sickness
Patient information:
• All of these agents cause drowsiness.
• Avoid alcohol and other CNS depressants due to an additive effect.
Anti-emetic & Anti-vertigo Agents
4. Antidopaminergic agents: Phenothiazines (also used as antipsychotic agents)
MOA: D2 – receptor antagonists at the CTZ (Chemotrigger Zone)
N
S
N
CH3
C
H3
Cl
Chlorpromazine HCl - Thorazine®
N
S
N
CH3
C
H3
CF3
Triflupromazine HCl - Vesprin®
Indications: control of N/V, relief of
intractable hiccups
Tablets 10-200 mg, SR capsules, syrup,
concentrate, suppositories, injection
Side effect: Thorazine shuffle
Do NOT use in children <6 months unless to
save a life
Indications: control of N/V
Injection 10 or 20 mg/mL
Do NOT use in children <2.5 years old, do
NOT use IV in children
Anti-emetic & Anti-vertigo Agents
5. Prochlorperazine maleate
- Compazine®
N
N
N
S
Cl
C
H3
Perphenazine - Trilafon®
N
N
N
S
Cl
O
H
Indications: Control of severe N/V including
during surgery
Tablets 5-25 mg, SR capsules, suppositories,
syrup, injection
Dosage must be individualized, can be
administered oral, IV, IM or SC
Use only in children >2 years of age
Indications: control of severe N/V, relief of
intractable hiccup
Tablets, concentrate, injection
Use only in children >12 years of age and use
IV only when needed to control violent
vomiting
Anti-emetic & Anti-vertigo Agents
Antidopaminergic agents: Phenothiazines
MOA: D2 – receptor antagonists at the CTZ (Chemotrigger Zone)
6. N
N
N
S
S
C
H3
CH3
Thiethylperazine maleate - Torecan®
N
S
CH3
(CH3)2N
Promethazine HCl - Phenergan®
Indications: Relief of N/V
Tablets and injection
Do NOT use this drug IV since it will
cause severe hypotension, IM preferred
route
Do NOT use in children <12 years old
Indications: prevention of N/V but
primary use is an an antihistamine
for type I hypersensitivity, sedation,
adjunct analgesia, motion sickness
Anti-emetic & Anti-vertigo Agents
Antidopaminergic agents: Phenothiazines
MOA: D2 – receptor antagonists at the CTZ (Chemotrigger Zone)
7. N
H
N CH3
O
CH3
OMe
Cl
NH2
Metoclopramide - Reglan®, Maxolan®
Indications: Prevention of N/V associated with emetogenic cancer
chemotherapy, possibly useful in N/V associated with pregnancy and labor
Available as a syrup, 5 and 10 mg tablets, and injection forms
If extrapyramidal symptoms occur administer 50 mg diphenhydramine IM.
For extremely emetogenic drugs such as cisplatin or dacarbazine use an IV
dose of 2 mg/kg
Anti-emetic & Anti-vertigo Agents
Antidopaminergic agents: Non-Phenothiazines
MOA:
1. D2 – receptor antagonists at the CTZ (Chemotrigger Zone)
2. Some HT3 Antagonist activity
9. Antihistamines (H1 antagonists) - Piperazines
Meclizine HCl - Antivert®, Bonine®, Vergon®
N
N
Cl
CH3
Buclizine HCl - Bucladin-S®
N
N
CH3
C
H3
CH3
Cl
Indications: Prevention of N/V, and dizziness
of motion sickness, may be effective in
management of vertigo
12.5-50 mg tablets and capsules
Do NOT use morphine or other respiratory
depressants concurrently
Indications: Control of N/V and dizziness of
motion sickness
50 mg tablet that can be taken without water
by chewing, dissolving or swallowing whole
Dosage up to 150 mg/day
Not indicated for children
Anti-emetic & Anti-vertigo Agents
10. Cyclizine HCl - Marezine®
N
N
CH3
Indications: Control of N/V and dizziness of motion sickness
50 mg tablet that can be taken without water by chewing, dissolving or swallowing
whole
Dosage up to 200 mg/day, NOT recommended for children <12 years old
Anti-emetic & Anti-vertigo Agents
Antihistamines (H1 antagonists) - Piperazines
11. Diphenhydramine HCl - Benadryl®
O
N
CH3
CH3
Structural similarity?
Antihistamines (H1 antagonists)
N
S
CH3
(CH3)2N
Promethazine HCl - Phenergan®
12. Diphenhydramine theoclate or Dimenhydrinate - Dramamine®
O
N
CH3
CH3 N
N
N
N
H
Cl
CH3
O
O
CH3
Diphenhydramine HCl - Benadryl®
O
N
CH3
CH3
Indications: prevention and treatment of N/V, dizziness and vertigo of motion sickness
(Benadryl oral use only agent)
Available as tablets, injection and liquid
MOA: a depressant action on the hyperstimulated labyrinthine function of the middle ear
Anti-emetic & Anti-vertigo Agents
Antihistamines (H1 antagonists)
13. Others
N
H
OMe
OMe
OMe
O
O
N
C
H3
CH3
Trimethobenzamide HCl - Tigan®, Ticon®, Tebamide®
C
H3
N
O
H
O
OH
O
Scopolamine - Scopace®, Transderm-Scop®
Indications: Control of N/V
100 and 250 mg capsules, 100
(pediatric) and 200 (adult) mg
suppositories, injection
MOA: May inhibit CTZ but direct signals
to the VC NOT inhibited. Ex:.morphine
emesis relieved but not CuSO4
Indications: Motion sickness
prevention, some post-op utility
0.4 mg tablets, transdermal system
Do NOT use in children
Will cause a dry mouth, use caution in
spastic and Parkinsons patients
MOA: Anti-muscarinic
Anti-emetic & Anti-vertigo Agents
16. Serotonin 5-HT3 receptor antagonists – improved treatment of severe N/V
Indications: Prevention of N/V under the following situations:
1. Initial and repeat course of chemotherapy especially high dose cisplatin
2. Postoperative N/V (ondansetron and dolasetron)
3. Radiotherapy in patients receiving total body irradiation, single high dose
fraction or daily fraction to the abdomen (ondansetron and granisetron)
4. Irritable bowel syndrome (IBS) in women (alosetron only)
MOA: Selective inhibition of 5-HT3 receptors that are located peripherally on
vagal nerve terminals, enteric neurons in the GI tract and centrally in the CTZ:
Mucosal enterochromaffin cells in the small intestine when subjected to chemo-
or radiotherapy release serotonin evoking a vagal discharge and vomiting. In
IBS it is believed that the pain, distension and exaggerated motor response are
caused by serotonin.
Metabolism: CYP 450 enzymes
Anti-emetic & Anti-vertigo Agents
17. Serotonin 5-HT3 receptor antagonists
N
N
N
O
CH3
C
H3
Ondansetron HCl - Zofran®
Dolasetron mesylate - Anzemet®
N
N
N
CH3
O
O
H
Indications: N/V; Unlabeled uses: N/V due to APAP poisoning,
treatment of acute levodopa-induced visual hallucinations,
prostacyclin induced N/V, reduction in bulimic episodes in
bulimia nervosa patients, social anxiety disorders, spinal or
epidural morphine-induced pruritus
4,8,24 mg tablets, 4 and 8 mg oral disintegrating tablets,
injection
Indications: N/V
50 and 100 mg tablets, injection
Use with caution in patients with QT abnormalities, taking
diuretics
Do NOT mix injection with other drugs - be sure to flush the IV
line before injecting
Can be mixed with apple or apple-grape juice for children
Anti-emetic & Anti-vertigo Agents
18. Serotonin 5-HT3 receptor antagonists
Granisetron HCl - Kytril®
N CH3
N
N
CH3
O
Alosetron HCl - Lotronex®
N
NH
N
N
CH3
O
C
H3
Indications: N/V
1 mg tablets and injection
Metabolism hepatic via N-demethylation, aromatic
ring hydroxylation and conjugation---metabolites
appear to be active - Liver cancer patients should
be watched carefully
Recommended for re-released May 2002 by the
FDA following withdrawl from the market
Indications: Irritable bowel syndrome (IBS) in
women only (safety in males has not been
demonstrated), carcinoid diarrhea
1 mg tablets, side-effect is severe constipation
that can lead to perforated colon
Anti-emetic & Anti-vertigo Agents
19. A NEW class of drug: Serotonin 5-HT4 receptor partial agonist
• this stimulates the peristaltic reflex, increases intestinal secretions and inhibits
visceral sensitivity
Indications: Short-term treatment of irritable
bowel syndrome in women only (safety in males
has not been demonstrated) - specifically where
the primary symptom is constipation
Not indicated for diarrhea-prominenet IBS
Side-effects are headaches and usually of
diarrhea is possible
No affinity for 5-HT3 or dopamine receptors
Elimination: 66% excreted unchanged in the urine
and the balance oxidized hepatically followed by
glucuronidation
Contraindicated in patients with severe renal
impairment and moderate/severe hepatic failure
Take before meals
N
H
O
CH3
N N
H
N
H
N
H
CH3
Tegaserod maleate - ZelnormTM
Anti-emetic & Anti-vertigo Agents
20. Misc. Agents
O CH3
C
H3
C
H3
CH3
OH
Dronabinol or THC - Marinol®
Phosphorylated Carbohydrate solution - Emetrol®
Indications: Antiemetic in cancer chemotherapy
Unlabeled uses: appetite stimulation in treating
anorexia associated with weight loss in AIDS
patients
2.5, 5 and 10 mg gelatin capsules containing
sesame oil
MOA: Complex CNS effects including central
sympathomimetic activity that appear to be
mediated by CNS cannabinoid receptors in
neural tissues
Avoid alcohol and barbiturates, patients should
remain under the supervision of a responsible
adult
Indications: relief of N/V caused by upset stomach from intestinal flu, stomach flu
and food and drink indiscretions
Contains dextrose, fructose and phosphoric acid
Anti-emetic & Anti-vertigo Agents