This document discusses emetics and antiemetics. It summarizes that emesis is a protective reflex to rid the body of toxins, and describes the neuronal pathway and receptors involved. Common emetics like apomorphine and ipecacuanha are outlined. The document then provides a detailed overview of various classes of antiemetics including anticholinergics, antihistamines, neuroleptics, prokinetic drugs, 5-HT3 antagonists, NK1 receptor antagonists, and adjuvant antiemetics. Specific drugs within each class are discussed, along with their mechanisms of action, indications, pharmacokinetics, and adverse effects.
Introduction TO VOMITING,Pathophysiology of vomiting,Emetics,Anti emetics,classification,pharmacology,Drug treatment in selected circumstances FOR EMETICS were included.
this will give brief about the peptic ulcer and give information about the drug used for peptic ulcer and classification of drugs including drugs and there use adverse effect.
Introduction TO VOMITING,Pathophysiology of vomiting,Emetics,Anti emetics,classification,pharmacology,Drug treatment in selected circumstances FOR EMETICS were included.
this will give brief about the peptic ulcer and give information about the drug used for peptic ulcer and classification of drugs including drugs and there use adverse effect.
Prokinetics are the type of drugs which enhances gastrointestinal motility/transit by
increasing the frequency or strength of contractions.
They speed up gastric emptying by enhancing coordinated propulsive motility.
Treat Gastrointestinal symptoms : Abdominal discomfort, Bloating, constipation,
Heart burn, nausea and vomiting. And few gastrointestinal disorders : irritable bowel
Syndrome, gastritis, gastroparesis and functional dyspepsia.
Increases gastric emptying
Relief of gastric stasis
Decreases reflux esophagitis/heart burn
Decreases regurgitation of gastric contents& emesis
Presentation on Antacids and antiulcer drugs. Introduction to ulcers, classification of antiulcer drugs, their pharmacological actions, uses and adverse effects.
Prokinetics are the type of drugs which enhances gastrointestinal motility/transit by
increasing the frequency or strength of contractions.
They speed up gastric emptying by enhancing coordinated propulsive motility.
Treat Gastrointestinal symptoms : Abdominal discomfort, Bloating, constipation,
Heart burn, nausea and vomiting. And few gastrointestinal disorders : irritable bowel
Syndrome, gastritis, gastroparesis and functional dyspepsia.
Increases gastric emptying
Relief of gastric stasis
Decreases reflux esophagitis/heart burn
Decreases regurgitation of gastric contents& emesis
Presentation on Antacids and antiulcer drugs. Introduction to ulcers, classification of antiulcer drugs, their pharmacological actions, uses and adverse effects.
Emetics & Anti-emetics presentation for pharmacy studentsLokesh Patil
Emetics and antiemetics are drugs used to induce and prevent vomiting, respectively. Emetics, such as ipecac syrup and apomorphine, stimulate the vomiting center in the brain or irritate the stomach lining to induce vomiting, often used in cases of poisoning. Antiemetics, including drugs like ondansetron, metoclopramide, and promethazine, work by blocking neurotransmitters like serotonin, dopamine, and histamine, which are involved in triggering the vomiting reflex. They are commonly used to treat nausea and vomiting caused by conditions such as motion sickness, chemotherapy, and postoperative recovery. Understanding the mechanisms and applications of these drugs is crucial for effectively managing emesis in various clinical scenarios.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. Emesis:
• A protective reflex that serves to rid the stomach and
intestine of toxic substances and prevent their further
ingestion.
• Vomiting consists of:
Pre-ejection phase: gastric relaxation & retroperistalsis
Retching: rhythmic action of respiratory muscles preceding
vomiting and consisting of contraction of abdominal and
intercostal muscles and diaphragm against a closed glottis
Ejection: intense contraction of the abdominal muscles and
relaxation of the upper esophageal sphincter
3. Neuronal path:
• Centre: lateral reticular formation of Medulla Oblongata
• Relay Centres: chemoreceptor trigger zone (CTZ) and nucleus
tractus solitarius (NTS)
• Afferent impulses: GIT, throat (vagus via NTS), other viscera
(spinal cord), cerebral cortex (anticipatory) & vestibular
apparatus(motion sickness)
4.
5. Receptors:
CTZ:
• serotonin(5-HT3),
• dopamine (D2),
• and opioids(µ)
NTS:
• enkephalin,
• Histamine(H1),
• Ach(M),
• and also contains 5-HT3
Also neurokinin(NK1 activated by substance-p), cannabinoid(CB1)
6. Path:
Exposure to Cytotoxic drugs, radiation and other g.i. irritants
release 5-HT from enterochromaffin cells
Acts on 5-HT3 receptors present on extrinsic primary afferent neurones
(PAN) of the enteric nervous system (ENS)
with vagal and spinal visceral afferents impulses reach NTS and CTZ
Vomiting
5-HT may also spill into circulation and reach CTZ via the vascular
route
7.
8. Emetics:
• Drugs which induce vomiting
• Acts on CTZ: Apomorphine
• Acts reflexly and on CTZ: Ipecacuanha
Apomorphine: Morphine derivative – semisynthetic – Dopaminergic agonist in CTZ
• 6 mg IM/SC – acts within 5 minutes
• Respiratory depression
• Orally – not recommended (large dose – slow inconsistent)
• Parkinsonism
Ipecacuanha: Cephaelais ipecacuanha
• Syrup ipecac – 15 to 30 ml (10 to 15 in child)
• Action takes 15 minutes
• MOA: Irritation of Gastric mucosa and directly on CTZ
Also salt water, mustard seed
11. Anticholinergics:
Hyoscine: Motion Sickness (0.2 to 0.4 mg IM)
• Used IM/SC, but short duration of action
• MOA: Blocking of cholinergic link of vestibular apparatus to
the vomiting centre – does not work in vomiting due to other
aetiology
• ADRs: Sedation, dry mouth and other anticholinergic effects
• Transdermal delivery system (1.5 mg)
Dicyclomine: Prophylaxis of motion sickness and morning
sickness
12. H1 ANTIHISTAMINICS:
• Primarily used in motion sickness, morning sickness and some other
vomiting to lesser extent –
• Also anticholinergic, antihistaminic and antidopaminergic actions
• Promethazine (Phenothiazine), diphenhydramine: 4 – 6 Hours
protection
• Combined with metoclopramide in CINV: additive effect plus counters
extra pyramidal effects
• Promethazine theoclate (Avomine) – motion sickness
• Doxylamine: Sedative H1 antihistaminic – marketed in combination
with Pyridoxine – specifically for morning sickness – duration of
action 10 Hours (at bed time) – drowsiness, dry mouth, vertigo
• Meclizine: Long duration of action – sea sickness
• Cinnarizine: anti vertigo action – inhibits Ca++ influx in endolymph
13. Motion Sickness:
Anticholinergics & H1 Antihistaminics are preferred
antidopaminergics do not work
Morning Sickness:
Preferably drugs should be avoided
Reassurance and dietary modification tried first
Dicyclomine, promethazine or metoclopramide are preferred at low
doses
14. Neuroleptics: (phenothiazines, haloperidol)
Uses:
• Drug induced and postoperative nausea and vomiting (PONV).
• Disease induced vomiting: gastroenteritis, uraemia, liver disease, migraine,
etc.
• Malignancy associated and cancer chemotherapy (mildly emetogenic)
induced vomiting.
• Radiation sickness vomiting (less effective).
• Morning sickness: should not be used except in hyperemesis gravidarum.
ADRs: Sedation, acute muscle dystonia (diagnose the cause first before
administering)
• Prochlorperazine (Stemetil) – D2 blocking agent - labyrinthine suppressant
– antivertigo and antiemetic action. Effective in CINV with vertigo
• EPS and muscle dystonia
15. PROKINETIC DRUGS: Metoclopramide
Actions on GIT: On upper GIT – Increases gastric peristalsis
• Relaxes pylorus and 1st part of duodenum – better gastric emptying
• LES tone increased – also increases Intestinal peristalsis
Actions on CNS: Acts on CNS – can counter Apomorphine induced
vomiting
• Gastrokinetic action contributes
• No antipsychotic property, but has extra pyramidal and prolactin
secreting effects (Promethazine context)
16. MOA:
1. D2 antagonism: Dopamine is inhibitory transmitter via D2
receptor – delays gastric emptying – also relaxation of LES –
nausea and vomiting – Metoclopramide causes opposite
effect
• Also central antidopaminergic action
2. 5-HT4 agonism: enhanced Acetylcholine release in
myenteric plexus – gastric hurrying and increased LES tone
3. 5-HT3 antagonism: at high concentration
• Blocks at inhibitory myenteric interneurons and CTZ/NTS
Pharmacokinetics: Absorbed orally, crosses BBB and
placenta and secreted in milk. Conjugated in liver, t1/2 = 4 –
6 Hrs.
17.
18. Conntd.
ADRs: Sedation, dizziness, loose stool and muscle dystonia
• Long use: Parkinsonism, galactorrhoea, gynaecomastia
• Safe in pregnancy but in lactating mother children may have loose stool,
dystonia etc. DI – abolishes levodopa action
Uses:
• Antiemetic: Postoperative, drug induced, disease associated, radiation
induced etc. but not effective in motion sickness. Still preferred in vomiting
due to anticancer drug – in combination with Promethazine
• Gastrokinetic: To accelerate gastric emptying – Emergency GA,
gastroparesis (post vagotomy), duodenal intubation etc.
• Dyspepsia: stops hiccup
• GERD: Does not aid in healing, PPIs are preferred – used as adjuvant
19. Domperidone:
• Chemically related to haloperidol but action like Metoclopramide
• D2 antagonist – in upper GIT (not attenuated by atropine)
• Rarely EP side effect – does not cross BBB, but hyperprolactinemia occurs
• Acts mainly through CTZ – outside BBB
• Does not abolish action of levodopa
• Kinetics: absorbed orally but 15% bioavailability – high 1st pass
metabolism, completely metabolized and excreted in urine.T1/2 – 7 – 8 Hrs
• ADRs: Less than Metoclopramide – dry mouth, loose stool, headache,
galactorrhoea etc. Arrhythmia on injection
• Uses: Similar as Metoclopramide but milder spectrum of action –not
effective in chemotherapy
20. Cisapride:
• Lacks D2 receptor action(no antiemetic action)
• Fascilitate motility throughout the GI tract(also colon)
• Also 5-HT4 mediated Cl– secretion in the colon- loose stool
• Prolongs QTc- not marketed now
Mosapride:
• Relatively safer
Itopride:
• D2 and Ach receptor blocking action, less 5HT4 affinity.
• Lack QTc prolongation and metabolized by flavin monooxigenases
• safer
21. 5-HT3 ANTAGONISTS: Ondansetron
• Developed for Chemotherapy/radiotherapy induced vomiting – also
effective in others (PONV)
• MOA: Acts peripherally as well as centrally – Blocks depolarizing
action of 5-HT3 receptors in vagus at GIT and CTZ/NTS
• No action on Dopamine receptor – does not block Apomorphine
induced vomiting and mild gastrokinetic effect
• Kinetics: 60 – 70% bioavailability – first pass metabolism.
• Metabolized as glucoronide and sulfate. Eliminated in urine and
faeces. T1/2 life 5-7 Hrs
22. • Dose: 8 mg slow IV for 15 minutes ½ hr before
chemotherapy. Followed by 2 such doses 4 hours apart. Then
8 mg orally twice daily for 1 week. For others 4 – 8 mg IV
followed by every 8 hourly.
• 80% success – better/equal to Metoclopramide – no dystonia
or sedation. Adjuvant improve response.
• ADRs: Headache and dizziness. Mild constipation and
abdominal discomfort. Hypotension, allergic reactions, chest
pain and bradycardia etc.
Granisetron: 10 times more potent, Palonosetron: longest
acting and highest affinity for 5-HT3 receptor(t1/2-40hrs)
23. NK 1 receptor antagonists:
Aprepitant: Newer antiemetic
MOA: Emetogenic chemotherapy releases Substance P – stimulates CTZ
and NTS by acting on NK1 - blocking of NK1 receptors causes emesis
blocking
• Little effect on 5-HT3 or D2 receptor
• GIT motility not affected
Uses: 125 mg + 80 mg + 80 mg for 3 days with IV Ondansetron and
Dexamethasone – for cisplatin induced vomiting – useful in multiple
cycle patients – Orally 40 mg can be used for PONV
• Kinetics: well absorbed orally, metabolized in liver, excreted in faeces
and urine. T1/2 10 – 13 Hrs
• ADRs: Weakness, fatigue, flatulence etc.
24. ADJUVANT ANTIEMETICS:
Corticosteroids: through anti-inflammatory action, also reduce side
effects of other antiemetics
Benzodiazepines: Through sedative action, reduce psychogenic
component and suppress dystonic side effects of others
Cannabinoids: CB1 receptors on CTZ and vomiting center
e.g: dronabinol, nabilone