CS 17

EMETICS, ANTIEMETICS
& COUGH REMEDIES
ASHA RUSSEL
INSTRUCTOR H
BSN

Stimulation of vomiting centre

Vomiting centre
brain

in the medulla of the

It is stimulated:
Directly from the labyrinth of the ear
By gastric irritation or distention
By mental activity
Via the Chemoreceptor trigger zone (CTZ)
By stimulation of the 5-HT; serotonin
receptors of the CTZ

Act of vomiting
Before act of vomiting
Stimulation of vomiting centre
Produces a sensation known as nausea
Associated with increased salivary and bronchial
secretions

EMETICS

EMETICS
Drugs that provoke vomiting are called
emetics
Medical use: In case of poisoning
REFLEX

Emetics

CENTRAL

Eg:
ipecacuanha
Eg:
apomorphine

REFLEX EMETICS
This group of drugs produce vomiting by
irritating the stomach
Uses:
Used as a first-aid treatment for over dosage
Can be used up to

1 hour after ingestion of

poison and longer for some substances, when

gastric emptying is delayed
Particularly useful in children

CENTRAL EMETICS
Closely related to morphine, but has none of

its analgesic effects

Used as a powerful emetic and also produces
some cerebral depression
It stimulates dopamine receptors in the CTZ
Formerly used as a emetic, but because of its
depressant action, it should not be used in
treating over dosage
At present, its use is confined to patients with
resistant Parkinsons disease

ANTIEMETICS

ANTIEMETICS
CAUTION:Antiemetics should not be given if the cause of
vomiting is unknown as they may hinder
diagnosis
Substances that trigger vomiting:
It is believed that (1) acetylcholine, (2)
histamine,
(3) dopamine and (4) 5-HT act as intermediate
transmitters in the CTZ and vomiting centre
Treatment to stop vomiting:
By blocking action of the above mentioned
substances on their receptors (prevent or

Classes of antiemetic agents

Acetylcholine (ACh) receptor antagonists
Antihistamines
Dopamine receptor antagonists
5 HT receptor antagonists
Miscellaneous antiemetics

1. ACh Receptor Antagonists

Action:Hyoscine blocks the action of Ach on the vomiting centre
Uses:Useful for short-term control of motion-sickness
Routes: Oral
Transdermal patch (applied behind the ears, 6 hrs before
starting a journey)
Side Effects: Drowsiness
Blurring of vision (due to paralysis of ocular
accommodation)

2. Antihistamines
Antihistamines commonly used as
antiemetics: Cyclizine
Promethazine
Cinnarizine
Action: Blocks the action of histamine on its receptors
Most antihistamines are non-specific and also
block ACh receptors. This makes them effective
antiemetics

2. Antihistamines
Uses: Most useful are cyclicine and promethazine and

also used occassionally in severe vomiting of

pregnancy
Cinnarizine
particular favor among (1)
yatchman and (2) others at risk from sea
sickness. (3) Also used in vomiting associated
with Menieres disease
Side Effect: Main side effect is sedation

3. Dopamine Antagonists
Action: Several phenothiazines (anti psychotics) are

powerful antiemetics
blocking action in
dopamine receptors on the CTZ
They are non-specific in action and therefore have

side effects. Eg: Used as sedatives

Commonly used dopamine

antagonists for antiemetic action
Prochlorperazine
Chlorpromazine
Haloperidol
Levomepromazine
Domperidone
Metoclopramide

A. Prochlorperazine:. Use:
Suppresses opiodinduced vomiting
. Routes: - Oral

- IM
- IV (must be well diluted before
use)
Note : Dont give as SC inj
B. Chlorpromazine:Similar in action to prochlorperazine

C. Haloperidol:-

Similar action, but longer-acting and less

sedating

D. Levomepromazine:. Uses: (1) Used particularly in terminal care, to

control

vomiting
(2) Also reduces agitation

E. Domperidone:. Uses : (1) Suppresses vomiting that

accompanies long-term treatment with the

opiods, levadopa and with the mildly emetic
cytotoxic drugs
(2) Enhances gastric emptying
. Limitation : Only about 15% of the oral dose

reaches the circulation (No parenteral

preparations available)
. Advantages : (1) Less sedating than

chlorpromazine
(2) Less liable to produce

F. Metoclopramide:. Uses :

(1) Increases gastric emptying

(2) Central action on the vomiting
centre
a) Fairly effective antiemetic (given
orally or IM)
b) Used in post-operative & opoid
induced vomiting and in migraine
c) Very large doses block 5-HT
receptors and is used to prevent vomiting due

F. Metoclopramide:. Adverse Effects :

(1) Dystonic reactions even with

normal doses and more common with young
people
(2) Prolonged use can result in
tardive dyskinesia

4. 5-HT ANTAGONISTS

Drugs :
Ondansetron
Granisetron

Action :
Block the 5-HT receptors associated with the
central connections of the vagus nerve in the
brain stem in close proximity to the CTZ
Uses :
Prevent vomiting in patients receiving highly
emetic cytotoxic drugs such as cisplatin, which
release 5-HT

5. MISCELLANEOUS ANTIEMETICS
Cannabinoids
Betahistine
Dexamethazone
Benzodiazapines

A. Cannabinoids
. Derivative of Cannabis sativa (marijuana)
. Cannot be prescribed at present, but

nabilone a derivative is available

. Uses : Used as antiemetic in controlling

vomiting in patients receiving cytotoxic

drugs
. Side Effects : (1) sedation

(2) confusion

B. Betahistine
. Uses : Used as antiemetic and its use is

confined to Menieres disease, in which

vertigo and vomiting are due to a
disturbance in the labyrinth of inner ear
. Action : Believed to lower pressure in the

inner ear and thus relieve symptoms

C. Dexamethazone

Useful antiemetic during cancer

chemotherapy
D. Benzodiazapines

Example :- Diazepam (valium)

. Uses : (1) Used in combination with other

antiemetics
(2) Useful for relieving anxiety (Has
no specific antiemetic effect)

COUGH REMEDIES

COUGH SUPPRESSANTS
(ANTI-TUSSIVE DRUGS)

Anti-tussives are avoided for patients

having cough associated with chronic
bronchitis, bronchiectasis and asthma

Main group of anti-tussives

Demulcents
Opioids
Antihistamines

1. DEMULCENTS

Action:Irritation of mucous membrane of mouth and

throat
Coughs
Soothing action (of syrup)
Forms protective film over inflamed tissues
Example : Simple linctus (flavored syrup)
avoid in diabetic patients as it contains sugar

OPIOIDS
Main opioid groups used as anti-tussives :
Codeine
Dextromethorphan
Pholcodine

A. Codeine
Most popular in this group is linctus codeine

(BPC)
Widely used, but not very effective unless

given in doses above those usually

recommended
leads to constipation

B. DEXTROMETHORPHAN
Structure related to levorphanol, a synthetic

narcotic analgesic
A number of OTC medications for cough, cold

and influenza contain dextromethorphan

Potent as codeine as cough suppressant and

also like codeine cause constipation

depending on the dosage and frequency of
use

C. PHOLCODINE
Closely related to codeine and depress cough

centre
Experiments suggest that they are more active

than codeine and have similar side effects

Action lasts for 4 6 hours
Included in various mixtures, including linctus

pholcodine (BPC)
In terminal care, morphine and diamorphine

(heroin) required to relieve a distressing cough

INHALATIONS AND
MUCOLYTIC AGENTS

 Mucolytic agents
Steam

liquefy mucus

good expectorant
liquefies sputum and enables it to be coughed
up

Others :
Benzoin Tincture
Pulmonary surfactants

(a) Benzoin Tincture

It is one of the balsams (obtained from especially

evergreens) that contain resins and volatile oils

A tincture is a plant extract in alcohol
Benzoin tincture
Added to hot water
Gives off volatile oil
(when inhaled)

Exerts mildly soothing effect on bronchial mucous

membrane
Frequently used in acute bronchitis

 Similar action,

Menthol and Eucalyptus Inhalation

Considerable outpouring from bronchial glands
Transient vasoconstriction of resp. mucous membrane
Clear air passages
Uses : (1) Clearing the chest, esp. in acute bronchitis

(2) Used post-operatively to avoid chest infection

Safety Point : (1) Particular care with young and elderly

patients
(2) Great care while inhaling to avoid
spills of hot water and prevent severe burns

Nursing Point
Avoiding dehydration
Giving hot drinks
Physiotherapy

More effective
than medicines
in clearing the
chest

(b) Pulmonary Surfactants

Natural surfactants
Allow the surfaces of pulmonary alveoli to separate
Allow lungs to expand and function immediately after birth
Premature infants
Lack of natural surfactants
Lungs do not function properly
Respiratory distress syndrome

Treatment of premature infants

(1) Mechanical ventilation
(2) Inhalation via endotracheal tube of

colfosceril palmitate, a synthetic

surfactant