Anästhesie (Fach) / Pharmakologie (Lektion)

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Anticholinergika

Antihistaminika (H1): Cyclizin, Promethazin

Serotoninantagonisten (5-HT3): Ondansetron

Dopaminantagonisten (D2): MCP, Domperidon, Propofol, Prochlorperazin

sulphonylurea: chlorpropramide

Bluthirnschranke ist nur schwach ausgeprägt in Cemorezeptortriggerzone > Antiemetika müssen nicht bluthirnschrankengängig sein

Ansatzorte:

The highest densities of 5HT3 receptors: chemorezeptortrigger-Zone und Ncl tractus solitarius.

Vestibular nucleus: histamine (H1) and acetylcholine receptors (ACh)

Antiemetika bei Parkinson (PD)

Cyclizine is a histamine (H1) and acetylcholine (Ach) receptor antagonist and can be used to target the vestibular nucleus, nucleus tractus solitarii and the vomiting centre. It is not contraindicated in PD.

Also possible: ondansetron for postoperative nausea and vomiting (PONV): 4 mg.

Metoclopramide is contraindicated in PD, as it is blocks central dopamine (D2) receptors in the chemoreceptor trigger zone (CTZ) but also in the substantia nigra. It has the potential for causing extrapyramidal side effects particularly in young people. It can exacerbate the symptoms of PD and has been associated with prolonged encephalopathy.

Droperidol (DHBP) and the phenothiazine, prochlorperazine, are also powerful D2 receptor antagonists and should also be avoided. If a D2 antagonist is chosen for the treatment of PONV in patients with PD then domperidone is the agent of choice as it does not cross the blood brain barrier.

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