1. EMETICS AND ANTIEMETICS

3. EMETICS Apomorphine- dopaminergic agonist on CTZ Ipecacuanha- emetine syrup ipecac 15-20ml- adults 10-15ml- children 5ml- infants

4. Vomiting Centre CTZ Hormones Diabetes Dopamine Acetylcholine Histamine Vestibular Sights Smell Taste Vomiting Gut Opioids Chemotherapy Anaesthetics BBB Hypotension Hypoxaemia

5. Anticholinergics MOA - block conduction of nerve impulses Drugs - Hyoscine (0.2-0.5mg oral,i.m) Dicyclomine (10-20mg oral) Uses Motion sickness Short brisk journies Transdermal patch- 1.5mg,delivered over 3 days .(Hyoscine)

6. Anti-histamines-H 1 antagonist Drugs Promethazine Diphenhydramine Cyclizine Meclozine Cinnarizine Uses Motion sickness Postoperative Vomiting Side effects- sedation & dry mouth

7. Neuroleptics MOA - block D2 receptors in CTZ Drugs Chlorpromazine Prochlorperazine Haloperidol Uses Drug induced and postanaesthetic nausea & vomiting Disease induced vomiting Cancer chemotherapy induced vomiting Side effects- sedation & muscle dystonia

8. Prokinetics Drugs Metoclopramide- D2 antagonist,5-HT 4 agonist & 5HT 3 antagonist Domperidone- D2 antagonist Cisapride- 5-HT 4 agonist, 5-HT 3 antagonist Mosapride Uses Drug, disease & postoperative induced vomiting Dyspepsia GERD Side effects- sedation, dry mouth, headache, loose stools etc.

9. 5-HT 3 Antagonists Drugs Ondensetron- mild 5-HT 4 blocker Granisetron- 10-15 times potent Uses Cancer chemotherapy/radiotherapy induced vomiting Side effects- headache, mild constipation or diarrhoea .

10. Adjuvant antiemetics Dexamethasone Benzodiazepines Cannabinoids