This document discusses drugs used to induce vomiting (emetics) and prevent vomiting (antiemetics). It lists common emetics like apomorphine, mustard, and ipecacuanha, and their mechanisms and uses. Common antiemetics classes include prokinetics like metochlorpramide, antimuscarinics like hyoscine, antihistamines like cyclizine, neuroleptics like chlorpromazine, and 5-HT3 antagonists like ondansetron. Nursing considerations for antiemetic administration include assessing for contraindications, monitoring for side effects, and instructing patients on proper use.

1. PREPARED BY
SALMAN HABEEB

2. COMMONLY DRUGS USED
• EMETICS
• ANTIEMETICS
• PROKINETICS
• PURGATIVES
• ANTACIDS
• ANTIDIARRHOEALS
• ANTIULCERS
• CARMINATIVES
• ANORECTAL PREPARATIONS

3. EMETICS
• EMESIS =?
DRUGS THAT PRODUCE/ INDUCE
VOMITING IS CALLED EMETIS

4. MECHANISM OF VOMITING
• WHAT IS VOMITING?
• It is the forceful expulsion of the contents of the
stomach via the mouth or sometimes through
the nose.
• The vomiting reflex is stimulated by two centers
in the medulla
1 . vomiting center
2 .chemoreceptor trigger zone(CTZ)

5. How this CTZ is stimulated
• Tactile stimulation of the back of the throat,
a reflex to get rid of something that is too
big or too irritating to be swallowed
• Excessive stomach distention
• Increasing intracranial pressure by direct
stimulation
• Stimulation of the vestibular receptors in
the inner ear

6. • Intense pain fiber stimulation
• Direct stimulation by various chemicals,
including fumes, certain drugs, and debris
from cellular death
• CTZ is stimulated by several different
processes and initiates a complex series of
responses that first preparet he system for
vomiting and then cause a strong backward
peristalsis to rid the stomach of its contents.

7. Classification of Emetics
1.Stimulants of CTZ
a.Apomorphine
b.Morphine
2.Irritants of gastric mucosa
a.mustard
b.sodium chloride
3.Both CTZ stimulant and irritant effect
a.ipecacuanha
b.digitalis

8. Apomorphine
• It is obtained by treating morphine with
HCL
• MECHANISM?
• Produce vomiting in 5-10 minutes after
admn
• Dose- 2 to 4mg
• Route- subcutaneous/IM

9. MUSTARD
• It is a household remedy to induce
vomiting
• Dose- 1teaspoonful with water

10. Ipecacuanha
• It is obtained from the dried rhizome
and roots of carapicheae ipecacuanha
from which it derives its name.
• Commonly available as syrup
• Dose- 15 to 20ml
• Induce vomiting witin
15 minutes

11. Antiemetics
• Drugs that prevent vomiting

12. CLASSIFICATION
1.Prokinetics
a.metochlorpramide
b.domperidone
2.Antimuscarinics
a.hyocine
b.meclozine
3.Antihistamines
a.cyclizine
b.promethazine(phenergan)
4.Neuroleptics
a.chlorpromazine
b.prochlorpromazine
5. 5-HT3 antagonists
a.ondancetron
b.granicetron

13. Prokinetics
• These drugs which promote gastrointestinal
motility and quicken gastric emptying
• Metoclorpramide(REGLAN)
It has both central and peripheral
effects
Central- blocks the dopeminergic
receptors
peripheral- increased gastric emptying
dose- 5- 10 mg

14. Metochlopramide(reglan)
• Dose- 5-10 mg
• Indications
post-operative vomiting, vomiting during
induction of anesthesia
• Side effects: restlessness,
drowsiness, dizziness,
and or dystonic reactions.

15. Domeperidone
• Action- Block the dopaminergic receptors
in the upper GIT
• Dose- 10mg,30mg tablets
1mg/ml syrup
Side effects: Headache, dizziness, dry
mouth, nervousness, flushing, or irritability

16. Antimuscarinics
• Action- Competitively inhibits action of
acetylcholine at muscarinic receptors
• Hyoscine –very effective in controlling
motion sickness
• Dose -0.4-0.6 mg po 30 min before
journey
• It is a labrynthine sedative

17. Neuroleptics
• Action- they act by suppressing the CTZ
so they antagonize vomiting produced by
drugs which stiimulate CTZ
Eg; chlorpromazine
• dose; PO: 10-25 mg q4-6hr
IV/IM: 25-50 mg q4-6hr

18. 5-HT3 Antagonists
• (5-HT3) receptor antagonists block the
vomiting reflex by inhibiting 5-HT3
receptors in the vomiting center , the
chemoreceptor trigger zone and in the
small intestine

19. Ondansetron(Emeset)
• Blocks 5HT3 receptors in git and CTZ
• Specially used In chemotherapy,post op
vomiting other drug induced vomiting
• Dose- 4mg in each ampule
• 4,8 mg tab

20. • Side effects:
Headache, constipation, and dizziness are
the most commonly reported side effects
associated with its use

21. Granisetron
• It is 10 to 15 times more potent than
ondansetron
• More effective in chemotherapy
• Dose – IV 1mg

22. Antihistamines
• They act by sedating the vomiting centre
• They are safer for long term use
• Effective in motion sickness and vomiting
due to labrynthine disoders
eg. Cyclizine
meclozine
dose- 50mg/ml inj
50mg tab

23. Nursing Considerations for Patients
Receiving
an Antiemetic Agent
• Assess for possible contraindications or
cautions history of allergy to antiemetic to
avoid potential hypersensitivity reactions;
impaired renal or hepatic function
• ■ Assess the patient’s neurological status,
including level of orientation, affect, and
reflexes,

24. • ■ Examine the abdomen, including the
liver, and auscultate bowel sounds
• ■ Assess complaints of nausea and
evaluate emesis; note color, amount, and
frequency of vomiting episodes

25. • Instruct the client to avoid over-the-counter
preparations.
• Instruct the client not to consume alcohol
while taking antiemetics.
• Advise pregnant women to avoid
antiemetics during the first trimester.