SESSION 10
COMMON EMETICS AND ANTI-EMETICS
Learning Tasks
At the end of this session a learner is expected
to be able to:
• Define emetics, anti-emetics
• Identify common emetics and anti-emetics
• Explain mechanism of action and side effects
emetics and anti-emetics
• Explain management of side effects of
emetics and anti-emetics
Definitions
Emetic,
any agent that produces nausea and vomiting.
The use of emetics is limited to the treatment
of poisoning with certain toxins that have
been swallowed. Although its use is now
discouraged.
Anti-emetics:
are drugs prescribed to help with nausea and
vomiting that are side effects of other drugs
This may include drugs for anaesthesia used
during surgeries or chemotherapy for cancer.
Antiemetic drugs are also used for nausea
and vomiting caused by
▪ motion sickness
▪ morning sickness during pregnancy
▪ severe cases of the stomach flu (gastroenteritis)
▪ other infections
Common Emetics and Anti-Emetics
Common Emetics
There are two general classes of emetics,
one acting on the chemoreceptor trigger
zone (CTZ) of the medulla
The second acting on the stomach itself.
The prototypical central emetic is
apomorphine, and the prototypical gastric
emetic is ipecac.
Common Anti-Emetics
Some antiemetic drugs are taken orally;
others are available as an injection or as a
patch placed on body.
The type of antiemetic drugs depends on
what is causing the symptoms:
Antiemetics for motion sickness they prevent
nausea and vomiting e.g dimenhydrinate
(Dramamine, Gravol) and meclizine
(Dramamine Less Drowsy
Antiemetics for chemotherapy e.g
▪ serotonin 5-HT3 receptor antagonists: dolasetro,
ondansetron
▪ dopamine antagonists:
prochlorperazine ,domperidone and olanzapine
Hyperemesis gravidarum
▪ antihistamines, such as dimenhydrinate
▪ vitamin B-6 (pyridoxine)
▪ dopamine antagonists, such as prochlorperazine,
promethazine (Pentazine, Phenergan)
▪ metoclopramide if other treatments don’t work
Mechanism of Action and Side Effects of Common
emetics and anti-emetics
EMETICS DRUGS
The prototypical central emetic is apomorphine, and the
prototypical gastric emetic is ipecac.
Mechanism of action of Emetics
The precise mechanism of action of apomorphine as a
treatment for Parkinson's disease is unknown, although it
is believed to be due to stimulation of post-synaptic
dopamine D2-type receptors within the brain.
Apomorphine causes vomiting by acting on dopamine
receptors in the chemoreceptor trigger zone of the medulla;
this activates the nearby vomiting center
Pharmacokinetics of apomorphine it lower
bioavailability when taken orally, due to not
being absorbed well in the GI tract and
undergoing heavy first-pass metabolism.
It has a bioavailability of 100% when given
subcutaneously. It reaches peak plasma
concentration in10–60 minutes.
Side Effects of Emetics
Emetics are contraindicated in patients that
are hypoxic, dyspneic, unable to swallow,
hypovolemic or comatose.
ANTI-EMETICS
Mechanism of action of Anti-emetics
(Domperidone, ondansetron, metochlopramide)
Antiemetics including: 5-HT3 receptor antagonists
block serotonin receptors in the central nervous
system and gastrointestinal tract.
Dopamine antagonists act in the brain and are used
to treat nausea and vomiting associated with
neoplastic disease, radiation sickness, opioids,
cytotoxic drugs and general anaesthetics.
Ondansetron; block the serotonin receptors in the
chemoreceptor trigger zone (CTZ) within the
medulla oblongata. The CTZ communicates with
the vomiting center to initiate vomiting.
By blocking the serotonin receptors, there's less
serotonin that enters the CTZ, which decreases
communication with the vomiting center.
Ultimately, the patient experiences reduced
nausea and vomiting
Side effects of Anti-Emetics
The side effects depend on the type of antiemetic drug
taken:
antihistamines: drowsiness, dry mouth
dopamine antagonists: dry mouth, fatigue, constipation,
tinnitus, muscle spasms, restlessness
serotonin 5-HT3 receptor antagonists: constipation, dry
mouth, fatigue
corticosteroids: indigestion, acne, increased appetite and thirst
cannabinoids: changes in perception, dizziness
If you experience any of the following, consult your doctor:
worsening of nausea or vomiting
severe constipation
muscle weakness
convulsions
loss of hearing
rapid heartbeat
severe drowsiness
slurred speech
psychological symptoms, like hallucinations or confusion
Management of Side Effects of Common Emetics and Anti-
Emetics
Coping with emetics and Anti-emetics Side Effects
In taking medication to control nausea may experience
symptoms some of which may be side effects from the
medication.
Many medication-related side effects diminish with time.
but if they persist or are troublesome,
a prescriber may be able to minimize them by lowering the dosage,
switching to another drug,
Prescribing medication to counteract the side effects.
Alternatively, some side effects—particularly the less severe
ones—can be managed with lifestyle or self-care measures.
Key Points
Anti-emetics:are drugs prescribed to help with nausea and
vomiting.
Dopamine antagonists act in the brain and are used to treat nausea
and vomiting associated with neoplastic disease, radiation
sickness, opioids, cytotoxic drugs and general anaesthetics.
Ondansetron; block the serotonin receptors in the chemoreceptor
trigger zone (CTZ) within the medulla oblongata drugs.
The side effects of antiemetic drug depend on the type of drug
taken: examples antihistamines causing drowsiness and dry
mouth,dopamine antagonists causing dry mouth, fatigue,
constipation, tinnitus, muscle spasms, restlessness and serotonin 5-
HT3 receptor antagonists causing constipation, dry mouth, fatigue
Evaluation
• What are emetics?
• What are common anti-emetics drugs?
• What are side effects of anti-emetics?
