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Symptom Control in Hospice-State of the Art
Published in Inge B. Corless, Zelda Foster, The Hospice Heritage: Celebrating Our Future, 2020
J. Cameron Muir, Lisa M. Krammer, Jacqueline R. Cameron, Charles F. von Gunten
Emesis due to cortical stimulation may be ameliorated by using corticosteroids (e.g., dexamethasone), anxiolytics (lorazepam) and cannabinoids (tetrahydrocannibinol). Vomiting induced by stimulation of the chemoreceptor trigger zone can be treated with dopamine antagonists (haloperidol, prochlorperazine) antihistamines, anticholergics, and selective serotonin antagonists (ondansetron, granisetron). Nausea and vomiting associated with stimulation of the vestibular apparatus is best treated with such agents as antihistamines and anticholinergics (scopolamine). Emesis associated with vagally mediated peripheral afferents, may be alleviated when using dopamine antagonists, serotonin antagonists, and prokinetic agents (metoclopramide, cisapride).48,50
General Anesthetics
Published in Sahab Uddin, Rashid Mamunur, Advances in Neuropharmacology, 2020
Aman Upaganlawar, Abdulla Sherikar, Chandrashekhar Upasani
The different chemical mediators such as serotonin, histamine, dopamine, and acetylcholine the activity of chemoreceptor trigger zone of vomiting. The postoperative use 5 HT-3 receptor antagonist such as ondansetron, droperidol, metoclopramide, and dexamethasone causes the inhibition of nausea and vomiting due to stimulation of chemoreceptor trigger zone and brainstem by general anesthetics (Brunton et al., 2011; Tripathi, 2013; Sharma, 2017).
Migraine
Published in M.D. Francesco Amenta, Peripheral Dopamine Pathophysiology, 2019
Marcello Fanciullacci, Massimo Alessandri, Bruno M. Fusco
The frequent presence in the headache phase of nausea and sometimes emesis accounts for a possible involvement of chemoreceptor trigger zone (CTZ). In migraineurs tested during the headache-free phase, these receptors appear to be hyperresponsive to pharmacological stimulation.
PEGylated Tween 80-functionalized chitosan-lipidic nano-vesicular hybrids for heightening nose-to-brain delivery and bioavailability of metoclopramide
Published in Drug Delivery, 2023
Saeed A. S. Al-Zuhairy, Mahmoud H. Teaima, Nabil A. Shoman, Mohamed Elasaly, Mohamed A. El-Nabarawi, Hossam S. El-Sawy
MTC has been classified as Biopharmaceutics Classification System (BCS) Class III; a high water-soluble drug with poor permeability, which explains the wide variability and poor bioavailability of orally administered MTC (Stosik et al., 2008). MTC also suffers from extensive hepatic metabolism, which significantly limits its efficiency (Lee & Kuo, 2010; Shakhatreh et al., 2019). However, MTC is one of the most renowned medications that widely prescribed for the treatment of nausea and vomiting. Regarding MTC site of action, the chemoreceptor trigger zone (CTZ) in the postrema region of the brain is where MTC mainly inhibits the dopamine D2 and serotonin 5-HT3 receptors, which are responsible for the antiemetic actions (Lee & Kuo, 2010). MTC is the sole FDA-approved antiemetic drug for the management of diabetic gastroparesis (Pasricha et al., 2006). The FDA clearly states that MTC is recommended for relieving symptoms in adults with acute and recurring diabetic gastroparesis and treating adults with gastroesophageal reflux symptoms (Shakhatreh et al., 2019). MTC also helps chemotherapy patients who are experiencing nausea and vomiting (Herrstedt et al., 2022).
A pharmacological overview of aprepitant for the prevention of postoperative nausea and vomiting
Published in Expert Review of Clinical Pharmacology, 2023
Andrew Padilla, Ashraf S Habib
The pathogenesis of PONV is complex, involving both central and peripheral pathways. The central pathway involves the area postrema in the fourth ventricle that is sensitive to neurotransmitters, toxins, and drugs in the blood and cerebrospinal fluid due to the lack of a blood-brain-barrier [9]. Stimulation of the chemoreceptor trigger zone (CTZ) in the area postrema projects to the nucleus tractus solitarius (NTS), an important coordinator of the vomiting response. Peripherally, enterochromaffin cells in the stomach and intestine release serotonin which then binds to 5-HT3 receptors in the gastrointestinal tract and sends afferent impulses that converge at the area postrema. Additionally, inputs from enterochromaffin cells, the vagal nerve via the pharynx, as well as from the vestibular and limbic system stimulate the NTS. The neurons that mediate these signals frequently include serotonin, dopamine, NK-1, histamine H1 and cholinergic receptors. Stimulation of the NTS via the area postrema and peripheral afferent signals then projects to a central pattern generator (CPG) which coordinates efferent pathways to abdominal muscles, salivatory center and cranial nerves, causing vomiting [10,11].
Impact of timing of midazolam administration on incidence of postoperative nausea and vomiting in patients undergoing laparoscopic gynecological surgery: A randomized, double-blinded, controlled study
Published in Egyptian Journal of Anaesthesia, 2022
Samar Rafik Amin, Taghreed Elshahat Sakr, Shaimaa Ezzat Amin
Midazolam is a short-acting sedative which attaches to benzodiazepine receptors placed on gamma-aminobutyric acid (GABA) type-A receptors within the central nervous system. Releasing GABA neurotransmitters restrains the central dopaminergic pathway, leading to sedation and anxiolysis. However, it is not entirely clear how midazolam acts as an antiemetic. Some hypothesized mechanisms involve reduced dopaminergic stimulation in the chemoreceptor trigger zone, along with reduced 5-hydroxytryptamine outflux by attaching to GABA-benzodiazepine complex [6]. Also, it is unclear whether midazolam antiemetic properties are correlated with its anxiolytic action. Previous research has revealed that preoperative anxiety increases stomach acidity and decreases gastric motility, which could raise the risk of PONV [7].