antiemetik gastritis (b.happy) (1)

7/24/2019 Antiemetik Gastritis (b.happy) (1)

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Welcome to

my class!


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Manajemen Mual dan MuntahManajemen Mual dan MuntahAntiemetic

Mengurangi dan mencegah mual -muntah

Berefek sentral atau berefek lokal

Bervariasi tingkat efektivitasnya


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Letak aksi kerja dariLetak aksi kerja dari

Emetics/AntiemeticsEmetics/Antiemetics


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Vomiting Centre

(medulla)

Stomach

Small intestine

Higher cortical

centres

Chemoreceptor

Trigger Zone

(area prostrema,

4th ventricle)

Memory, fear, anticiation!ensory inut "ain, smell, sight#

!urgery

!urgery

Labrinths

Anaesthetics

Vomiting !e"le#

$euronal ath%ays

&actors %hich can

cause nausea ' vomiting

(hemotheray

(hemotheray

)adiotheray

*ioids

Sites of action of drugs

5HT3antagonists

Sphincter modulators

Histamine antagonistsMuscarinic antagonists

Gastroprokinetic

agents

BenzodiazepinesHistamine antagonists

Muscarinic antagonists

Dopamine antagonists

Cannabinoids

Vomiting :The act of vomiting and the sensation ofnausea that accompanies it are protective reexes thatserve to rid the stomach and intestine of toxic substances

and prevent their further ingestion

Antiemetics


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Area Tpe o" receptors Stimulus

(hemorecetor trigger +one"(#

a# .oamine .b# 012c# *ioid

3# (ancer chemotheray

# *ioids

4estibular nuclei a# Mscarinicb# 1istamine 13 3# Motion sickness

5haryn6 and 78 a# 012 3# (ancer chemotheray

# )adio theray

2# 7astroenteritis

(erebral corte6 3# !mell

# !ight

2# hought9# Anticiatory emesis

Serotonin $HT% receptor antagonists $HT% receptor

5henothia+ines .oamine .recetorsAntihistaminicAnticholinergic

!ubstituted ben+amides .oamine .recetors

Anticholinergic drugs Muscarinic recetors

Antihistaminic drugs 1istamine 13recetors


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8ndications of antiemetics8ndications of antiemetics

3- (hemotheray-induced vomiting

- 5ost irradiation vomiting

2- 5ostoerative vomiting

9- 4omiting of regnancy0- Motion sickness

Serotonin 5 HT3Antagonists:Dopamine D2Antagonist:

Antichoinergics:

7rou of drugs used as antiemetics


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:elomok antiemetik:elomok antiemetik

5henothia+ines "rochlorera+ine#

$onhenothia+ines " Metocloramide,

steroids e6; .e6amethasone#

!erotonin "0-12# recetor blockers

"ondasetron#

!ubstance 5/neurokinin 3 recetor

antagonists

Anticholinergics "scoolamine#


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Serotonin 5 HT3Antagonist

&otent antiemetics'echanism o" action

3- 5eriheral 0-12 recetor blockade on intestinal vagalafferents;

- (entral 0-12 recetor blockade in the vomiting center and

chemorecetor trigger +one

Antiemetic action is mainl against

Emesis mediated by vagal stimulation "e;g; ostoerative and

chemotheray#

High "irst pass metabolism

#creted b liver * +idne

$o dose reduction in renal insufficiency but needed in heatic

insufficiency


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Drugs Available

!" #ndansetron

2" $ranisetron

3" Doasetron

%" &aonosteron

Indications

!' (hemotherap) induced nausea andvomiting

2' postradiation nausea * vomiting

3' Vomiting of pregnanc)

%' &ostoperative vomiting

The most commonadverse e+ects are:

!, Headache and

di--iness2, (onstipation or

diarrhoea

Adverse Efects


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(orticosteroids(orticosteroids

(orticosteroids have antiemetic roerties

Mechanism of action< ossibly by

suressing eritumoral inflammationand rostaglandin roduction;

=se< to enhance efficacy of 012recetor

antagonists in the treatment ofchemotheray-induced vomiting;


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5henothia+ines5henothia+ines

5henothia+ines as rometha+ine are antisychoticagents

=se< (hemotheray-induced vomiting )adiotheray-induced vomiting ostoerative nausea and vomiting

Mechanism of the antiemetic action< inhibition ofcentral doamine, muscarinic and 13 histaminerecetors recetors


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ButyrohenonesButyrohenones

Butyrohenones as droeridole are antisychotic agents Mechanism of the antiemetic action< inhibition of central

doamine recetors

=se< (hemotheray-induced vomiting )adiotheray-induced vomiting ostoerative nausea and vomiting Adverse effects< droeridol may rolong the > inter,

therefore, it should not be used in atients %ith >rolongation "should only be used in atients %ho havenot resonded ade?uately to alternative agents#;


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!ubstituted Ben+amides!ubstituted Ben+amides

3- Metocloramide- rimethoben+amide

Mechanism of antiemetic action< (entraldoamine-recetor blockade

!ide effects< "mainly e6trayramidal#uick E+e

.osage< 4aries to individual; &asting effects lasts @-

9@ mins; 3 hour after meal effects u to 2 hours;Li?uid and o%der from more effective


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=lcer healing drugs=lcer healing drugsAcid secretion reducers

1istamine 1 recetor antagonists

(imetidine and ranitidine block the action of

histamine on the arietal cells and reduce acid

secretion)elieve ain and usually heal ulcers in 9- %eeks;

(ommon adverse reactions include diarrhoea,

constiation, headache, di++iness, rash and

confusion;


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!ucralfate!ucralfate

(omosed of sulhated sucrose andaluminium hydro6ide;

8n resence of acid undergoes chemical

reaction that results in sticky yello% %hite gelthat forms a rotective acid resistant shield

his barrier hastens healing of etic ulcers

by rotecting the mucosa for u to si6 hours

!hort term use u to C %eeks


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MisorostilMisorostil8ndicated for treatment of etic ulcers and

revention of gastric ulcers assoc %ith the useof $!A8.!;

Misorostil suresses gastric acid secretion

and thus hels to heal gastric ulcers

(an cause hyotension in atients %ith

cerebrovascular and coronary artery disease

Misorostil can induce remature labour and

may be teratogenic in large doses


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modifikasi gaya hidu ' menghindari obatenyebab ulcer "asirin ' $!A8.s lain,bishoshonat oral, :(l, engobatanimunosuresan#

Menghindari stress

!to merokok ' alkohol

!to kafein "stimulan asam lambung#

Menghindari makanan dan minuman soda

Menghindari makan malam

Terapi non farmakologi


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!AD=)A$ ME$A1 "LALA5A$#


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ME)8(A

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33 !*L=!8 (E7A1 7A$77=A$33 !*L=!8 (E7A1 7A$77=A$

5E$(E)$AA$5E$(E)$AA$Biasakan makan dengan teratur

:unyah makanan dengan baik suaya

en+im tialin dalam kelenjar ludah daatmelakukan fungsinya dengan semurna

angan makan terlalu banyak

angan berbaring setelah makan


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LanjutanFLanjutanF1indari %aktu makan yang terlalu ber-

dekatan suaya roses mencerna tidak

terganggu "interval -2 jam#

angan makan sambil minum "setia cairanyang dikonsumsi dengan makanan adat

akan mengurangi aktivitas cairan

encernaan yang terlibat dalam rosesencernaan#

antiemetik gastritis (b.happy) (1)

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