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Anti-emetics. Two centres: Emetic centre (EC) and chemoreceptor trigger zone (CTZ) Both near the floor of the fourth ventricle, close to the vital centres EC is within the blood brain barrier (BBB) CTZ outside in the area postrema They are connected together. Anti-emetics: Teleology.

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anti emetics
Anti-emetics
  • Two centres: Emetic centre (EC) and chemoreceptor trigger zone (CTZ)
  • Both near the floor of the fourth ventricle, close to the vital centres
  • EC is within the blood brain barrier (BBB)
  • CTZ outside in the area postrema
  • They are connected together
anti emetics teleology
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’!
slide3

Dopamine

Opioids

Chemotherapy

Anaesthetics

Hormones

Azotaemia

Diabetes

CTZ

BBB

5 HT3

Acetylcholine

Emetic Centre

Vestibular

Sights

Smell

Taste

Histamine

Hypotension

Hypoxaemia

Gut

Vomiting

anti emetic agents
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
anti emetic agents at ctz
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 ?
anti emetic agents at ctz6
Anti-emetic agents at CTZ

Anti- 5 HT3 agents

  • Ondansetron
  • Granisetron

Uses

  • Chemotherapy (cis-platin)
  • Postoperative
  • Expensive !!-
anti emetic agents at ec
Anti-emetic agents at EC

Anticholinergics

  • Atropine and hyoscine
  • Glycopyrrolate ?

Uses

  • Travel sickness
  • Postoperative N and V (combined with opioids)
anti emetic agents at ec8
Anti-emetic agents at EC

Anti-histamines

  • Cyclizine
  • Promethazine (other actions?)

Uses

  • Postoperative N and V
  • Sedation (combined with opioids)
anti emetic agents side effects
Anti-emetic agents: Side effects
  • Extra-pyramidal effects
  • Dry mouth and blurred vision
  • Sedation
  • Tachycardia
  • Hypotension
anti emetic agents choice
Anti-emetic agents: Choice
  • Postoperative
  • Chemotherapy
  • Travel sickness
  • Parkinson’s disease (especially apomorphine)
  • Pregnancy