E
Nausea Not for children !
↳
lose gastric tone (reflux from intestines) (exception6mos= 12yrs ER acute
:
gastroenteritis
1 dose PO ondansetron)
Corticosteroids
=
Vestibular system
- H1 rec ·
alone/combined use Retching ↓
histamines-
.
↳
M1 rec .
·
methylprednisolone/dexamethasone spasmodic resp movement against closed glottis
.
yrsv caution but
(generates pressure for vomiting)
Benzodiazepines Emetic Response
·
SHORT-term ; combination therapy ↳
center in medulla
·
control extrapyramidals of D2 anta
activate
vomitting oblongata
directions ↳
.
D2
Lorazepam
Indirect
rec .
chemoreceptor
trigger zone 3 NK1
5Hirec
rec .
Cannabinoids
·
fear (cerebral cortex) ·
activate chemoreceptor zone
.
vomiting center (which activates
vomiting center)
a7
R ·_ medulla sensory organs
·
-
·
opsychiatric disorders
Oblongata vestibular apparatus stomach + s intestine vagal afferent nerve fibers
Tachycardia
· ·
hypotension
=
· + .
H1 rec .
↳ CAUTION patients
·
anticancer drugs-opioids
M1 rec
: CVD
3
.
(to chemoreceptor zone)
NK1 rec ·
2nd line for CINV
+
.
5HT3 rec Gitract heart
.
Nabilone
- 5H3 rec .
>
-
*
Diarrhea
&
Pregnancy N+ V
I
·
Treat dehydration electrolytes
Pyridoxine-VitBo analog No antidiarrheals for
gastro-enteritis !
·
Serotonin Rec Antagonists .
↓
-
↓ -Non-specific
prolong QT interval
·
can combine in ginger
↳
specific
!
heart disease/electrolyte imb
S
↑
-
-
-
.
Ondansetron
Opioids
*
Laxatives
I
Irritable Bowel Syndrome (IBS) ·
GI motility 14 water absorption
Sub . /Neurokinin Antagonists Alosetron /Lotronex) *
Check fluid/electrolyte before initiating therapy ↓ rectal spasm ↓ pain
·
- =
·
Block NK1 rec for Sub P SH antagonist
NV abdominal pain
Lopramide (Imodium)
·
.
. ·
or ·
For CINV combine w corticosteroid/SHTs anta
only for WOMEN !
·
=
↳ no
euphoric effect
·
Bulk-forming Metamucila
.
·
↑ liver enzymes + ↓ effect of warfarin + OCs ·
Gl toxicity risk
!
Take fluid ! n
Bismuth Salicylates (Pepto-Bismoll
·
V
*
aprepitants
② Emollien+ Laxatives (ubricants) Inflammatory Bowel Disease (IBD) ·
Coat GI tract
Vitamin absorption (fat-soluble) Sulfasalazine (5-Aminosalicylates) Bind-eliminate causative toxin
·
·
·
DopamineAntagonistsa
Budesonide (Glucocorticoids)
Tinnitus ,
·
electrolyte imbalance bleeding time dark stools
·
·
·
Azathioprine (Immunosuppressants) ,
· Ducosate Salts (Colace) ·
Infliximab (immunomodulators)
·
anticholinergic ,
sedation hypotension .
Stimulant
③ Laxatives
↳
pancreatitis/neutropenia Anticholinergies
atropine
,
Metronidazole (Antibiotics)
extrapyrimidal
~
rxns /tremors restlessness etc. )
·
·
surgical prep .; give in 20
·
,
peripheral neuropathy
, ↳
Metaclopramide ·
Castor oil, Senna (Senokot)
20-60
Antihistamine-Like
Osmotic Laxatives my Fiber/day
Drugs surgical prep
·
·
Block H1, 1 rec ( vestibular stim )
electrolyte imb -dysrhythmias
. . ·
CNS depressant anticholinergic,
.
polyethylene glycol (PEG)
·
, *
antihistaminic, antiemetic
Saline Laxatives
*
Dimenhydrinate (Gravol) ·
MG toxicity Sk
magnesium hydroxide
·
(milk of
magnesia)
Nausea Not for children !
↳
lose gastric tone (reflux from intestines) (exception6mos= 12yrs ER acute
:
gastroenteritis
1 dose PO ondansetron)
Corticosteroids
=
Vestibular system
- H1 rec ·
alone/combined use Retching ↓
histamines-
.
↳
M1 rec .
·
methylprednisolone/dexamethasone spasmodic resp movement against closed glottis
.
yrsv caution but
(generates pressure for vomiting)
Benzodiazepines Emetic Response
·
SHORT-term ; combination therapy ↳
center in medulla
·
control extrapyramidals of D2 anta
activate
vomitting oblongata
directions ↳
.
D2
Lorazepam
Indirect
rec .
chemoreceptor
trigger zone 3 NK1
5Hirec
rec .
Cannabinoids
·
fear (cerebral cortex) ·
activate chemoreceptor zone
.
vomiting center (which activates
vomiting center)
a7
R ·_ medulla sensory organs
·
-
·
opsychiatric disorders
Oblongata vestibular apparatus stomach + s intestine vagal afferent nerve fibers
Tachycardia
· ·
hypotension
=
· + .
H1 rec .
↳ CAUTION patients
·
anticancer drugs-opioids
M1 rec
: CVD
3
.
(to chemoreceptor zone)
NK1 rec ·
2nd line for CINV
+
.
5HT3 rec Gitract heart
.
Nabilone
- 5H3 rec .
>
-
*
Diarrhea
&
Pregnancy N+ V
I
·
Treat dehydration electrolytes
Pyridoxine-VitBo analog No antidiarrheals for
gastro-enteritis !
·
Serotonin Rec Antagonists .
↓
-
↓ -Non-specific
prolong QT interval
·
can combine in ginger
↳
specific
!
heart disease/electrolyte imb
S
↑
-
-
-
.
Ondansetron
Opioids
*
Laxatives
I
Irritable Bowel Syndrome (IBS) ·
GI motility 14 water absorption
Sub . /Neurokinin Antagonists Alosetron /Lotronex) *
Check fluid/electrolyte before initiating therapy ↓ rectal spasm ↓ pain
·
- =
·
Block NK1 rec for Sub P SH antagonist
NV abdominal pain
Lopramide (Imodium)
·
.
. ·
or ·
For CINV combine w corticosteroid/SHTs anta
only for WOMEN !
·
=
↳ no
euphoric effect
·
Bulk-forming Metamucila
.
·
↑ liver enzymes + ↓ effect of warfarin + OCs ·
Gl toxicity risk
!
Take fluid ! n
Bismuth Salicylates (Pepto-Bismoll
·
V
*
aprepitants
② Emollien+ Laxatives (ubricants) Inflammatory Bowel Disease (IBD) ·
Coat GI tract
Vitamin absorption (fat-soluble) Sulfasalazine (5-Aminosalicylates) Bind-eliminate causative toxin
·
·
·
DopamineAntagonistsa
Budesonide (Glucocorticoids)
Tinnitus ,
·
electrolyte imbalance bleeding time dark stools
·
·
·
Azathioprine (Immunosuppressants) ,
· Ducosate Salts (Colace) ·
Infliximab (immunomodulators)
·
anticholinergic ,
sedation hypotension .
Stimulant
③ Laxatives
↳
pancreatitis/neutropenia Anticholinergies
atropine
,
Metronidazole (Antibiotics)
extrapyrimidal
~
rxns /tremors restlessness etc. )
·
·
surgical prep .; give in 20
·
,
peripheral neuropathy
, ↳
Metaclopramide ·
Castor oil, Senna (Senokot)
20-60
Antihistamine-Like
Osmotic Laxatives my Fiber/day
Drugs surgical prep
·
·
Block H1, 1 rec ( vestibular stim )
electrolyte imb -dysrhythmias
. . ·
CNS depressant anticholinergic,
.
polyethylene glycol (PEG)
·
, *
antihistaminic, antiemetic
Saline Laxatives
*
Dimenhydrinate (Gravol) ·
MG toxicity Sk
magnesium hydroxide
·
(milk of
magnesia)
