Physiology and pharmacology of nausea and vomiting |
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| Authors: | Barbara J Pleuvry |
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| Institution: | 1. Division of Marine Environment & BioScience, Korea Maritime and Ocean University, Busan 606-791, Republic of Korea;2. Korea Institute of Ocean Science & Technology, Ansan P.O. Box 29, 426-744, Republic of Korea;1. Department of Epidemiology and Health Statistics, School of Public Health, Shandong University, Jinan City, Shandong Province, PR China;;2. Center for Climate Change and Health, School of Public Health, Shandong University, Jinan City, Shandong Province, PR China;;3. School of Public Health, China Studies Centre, The University of Sydney, New South Wales, Australia;1. Programa de Microbiología y Micología, Instituto de Ciencias Biomédicas (ICBM), Facultad de Medicina, Universidad de Chile, Santiago, Chile;2. Secretaría Regional Ministerial de Salud, Santiago, Chile;3. Hospital Dr. Luis Calvo Mackenna, Facultad de Medicina, Universidad de Chile, Chile;4. Washington University School of Medicine, St. Louis, MO, United States |
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| Abstract: | The physiology of nausea and vomiting is poorly understood. The initiation of vomiting varies and may be due to motion, pregnancy, chemotherapy, gastric irritation or post-operative causes. Once initiated, vomiting occurs in two stages, retching and expulsion. The muscles responsible for this sequence of events are controlled by either a vomiting centre or a central pattern generator, probably in the area postrema and the nearby nucleus tractus solitarius. Drugs which induce vomiting include ipecacuanha, a gastric irritant, and apomorphine, a dopamine-receptor agonist. Opioid drugs also induce vomiting, but opioid antagonists are not useful to treat nausea and vomiting. Anti-emetic drugs consist of a variety of neurotransmitter antagonists and may act in the periphery, the CNS or both sites. The most important drugs are antagonists at muscarinic, dopamine D2, 5-HT3, histamine H1 and neurokinin NK1 receptors. These drugs are discussed with particular attention to post-operative nausea and vomiting (PONV). |
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