of treatment, but normalizes in the majority of individuals. Headaches may be another side effect. There are no known drug interactions. Vomiting and nausea are symptoms of a wide range of conditions including medicinal side effects, systemic infections or disorders, pregnancy, central nervous system infection or imbalance, peritonitis, disorders of the liver, bile ducts, or gall bladder, adverse effects from radiation and chemotherapy, obstruction of gastrointestinal tract, and delayed colonic transit, among other conditions. Vomiting is the result of afferent input from a range of sources within the body. Nausea is an uneasiness of the stomach that often accompanies the urge to vomit, but doesn’t always lead to vomiting. Vomiting is the forcible voluntary or involuntary emptying (“throwing up”) of stomach contents through the mouth. Some triggers that may result in vomiting can come from the stomach and intestines (infection, injury, and food irritation), the inner ear (dizziness and motion sickness), and the brain (head injury, brain infections, tumors, and migraine headaches). Various stimuli that affect nausea and vomiting come together in an area in the brain known as the vomit (or emetic) center in the medulla. This “center” is not a discrete nucleus, but a complex array of coordinated neurons. The vomit center receives input from four major areas: the GI tract, the chemoreceptor trigger zone, the vestibular apparatus, and the cerebral cortex. Each of these four areas responds to certain types of stimuli, modulated by specific neurotransmitters that bind specific receptors. Identification of increasing numbers of neurotransmitters has been associated with the development of antiemetic agents that have affinity for specific receptors, with combinations causing a variety of different mechanisms, and effects. Ondansetron, granisetron, dolasetron are 5-HT3 antagonists approved for prevention and treatment of nausea and vomiting. Each has powerful antiemetic properties mediated primarily through peripheral 5-HT3 receptor blockade on intestinal vagal afferents, in the vomiting center, and chemoreceptor trigger zone. Ondansetron, granisetron and dolasetron have a half-life from 4 to 9 hours and undergo substantial hepatic metabolism. While all are excreted by renal and hepatic elimination, dose reduction for elderly individuals or those with renal insufficiency is generally not necessary. People with liver dysfunction may require dose reduction in the case of ondansetron. All agents tend to slow esophageal and gastric motility and increase colonic transit time. 5-HT3 receptor antagonists are increasingly being used to prevent and treat postoperative nausea and vomiting as well as nausea and vomiting in patients treated with radiation therapy due to their relative lack of serious adverse side effects. Symptoms may include headache and dizziness, as well as constipation, in some cases. Each of the three agents discussed above produce a small but significantly extended QT interval (an abnormality in the heart’s electrical system) that is most pronounced with dolesetron. These drugs should not be used by individuals experiencing prolonged QT intervals or with other medications that might also extend the QT interval. Research data shows no significant drug interactions. All three discussed above experience hepatic metabolism but do not seem to affect the metabolism of other drugs. Other drugs, however, may reduce hepatic elimination of the 5-HT3 receptor antagonists, changing the half-life value. Motion sickness While most anticholinergic and H1 antihistamine agents have weak antiemetic activity, they may be particularly useful in preventing motion sickness. Their use, however, may be limited by the presence of side effects, including sleepiness, dizziness, dry mouth or urinary retention. Diphenhydramine and dimenhydrinate are histamine H1 antagonists with both antiemetic and sedating effects. Meclizine is less sedating, and may be used for prevention of motion sickness and cases
of vertigo. Hyocine (scopolamine) is one of the most effective treatments for the prevention of motion sickness. Incidence of anticholinergic effects from oral administration are reduced significantly by administration in the form of a transdermal patch. Anti-inflammatory drugs used in gastrointestinal disease [Drugs used to treat inflammatory bowel disease (IBD)] Balsalazide (Colazal), budesonide (Entocort), hydrocortisone (cortenema), mesalamine (Asacol), olsalazine (Dipentum), sulfasalazine (Azulfidine), infliximab (Remicade). Inflammatory bowel disease (IBD) is the general name for diseases that cause inflammation in the small intestine and colon. Inflammatory bowel disease (IBD) refers to two distinct disorders: Crohn’s disease and ulcerative colitis . The cause and progression of both is still largely unknown. Crohn’s disease (regional enteritis) is a condition of inflammation of the mucosa in the large intestine, and more commonly, the ileum of the small intestine. Accumulation of scar tissue may lead to poor absorption of nutrients, with symptoms including abdominal pain, diarrhea, nausea, and fever. The cause is unknown, but there may be a genetic component or predisposition. Ulcerative colitis is a disease that causes inflammation and sores (ulcers) in the lining of the rectum and colon. Ulcers form where inflammation has killed the cells that usually line the colon, then bleed and produce pus. Inflammation in the colon also causes the colon to empty frequently, causing diarrhea. It can be difficult to distinguish between ulcerative colitis and Crohn’s disease. Crohn’s disease differs because it causes inflammation deeper within the intestinal wall and can occur in other parts of the digestive system including the small intestine, mouth, esophagus, and stomach. In cases of IBD, always require a doctor’s consultation and approval before massage; relaxing abdominal work may be beneficial. Aminosalicylates [5-aminosalicylic acid (referred to as 5 - ASA )] have been used effectively for years to treat IBD. For aminosalicytes to work, they must be absorbed topically, rather than systemically, into the diseased gastrointestinal areas. As much as 80 percent of 5-ASA may be absorbed from the small intestine, not reaching its target area. Four formulations have been developed that deliver the drug to specific segments of the small bowel or the colon. They are sulfasalazine, balsalazide, olsalazine, and a variety of types of mesalamine. Three of these drugs, sulfasalazine, balsalazide, and olsalazine contain 5-ASA bound by an azo bond. This characteristic significantly reduces absorption of the drug by the small intestine. Once it reaches the terminal ileum and colon, naturally occurring bacterial action releases active 5-ASA from the drug at concentrations powerful enough to be available to the terminal ileum and colon. There are also a number of 5-ASA compounds formulated to reach diseased areas in the small or large bowel, which are referred to as mesalamine . Pentasa, asacol, Rowasa, and Canasa target this area through oral coated formulations, enema, and suppositories. While these drugs have been successful inducing and maintaining remission in ulcerative colitis, their efficacy in Crohn’s disease is not as pronounced. Much of the benefit of the drug is tied to its ability to maintain high concentrations of the drug at the targeted site of action. Of the four, sulfasalazine has the highest incidence of adverse effects, with up to 40 percent of individuals using the drug unable to tolerate amounts necessary to be therapeutic. Common side effects include stomach upset, nausea, headaches, and myalgia. Hypersensitivity can result in fever, dermatitis, pancreatitis, and anemia, among a range of other serious conditions. The other 5-ASA compounds are far more easily tolerated, with adverse effects similar to individuals taking placebo. Olsalazine may stimulate diarrhea in 10 percent of users.
EliteLearning.com/Massage-Therapy
Book Code: MGA1224
Page 64
Powered by FlippingBook