Emetics ipecac

An emetic (ipecac) should be administered to induce vomiting and prevent further absorption. Gastric lavage can be performed to remove metaldehyde from the gastrointestinal tract. If hyperthermia is noted, a cool-water bath can be given to lower body temperature. Sedatives, e.g., diazepam, can be given to control anxiety, seizures, and tremors. Intravenous fluids should be given to correct dehydration and acidosis. 

Z ) Nauseant Expectorants These act as expectorants in small doses and nauseant and emetic in large doses, e.g., tartar emetic, ipecac, etc. These are usually mixed with sweet-tasting cough syrups that help to cure croupous bronchitis in children. 

Pharmacological treatment involves administering an emetic to induce vomiting. Ipecac is the most commonly used emetic. Ipecac, available over the counter, should be purchased as a syrup—not a fluid extract. The symp induces vomiting by stimulating the CTZ in the medulla and acts directly on the gastric mucosa. 

Ipecac is prepared from the dried roots and rhizomes of Cephaelis ipecacuanha (Brot.) A. Rich, and contains the alkaloids emetine [483-18-1] (17) and cephaeJine [483-17-0] (18) in a ratio between 2 1 and 4 1. It has been used extensively in cough preparations and is beheved to act by gastric reflex stimulation. Toxic effects include vomiting, irritation of the gastrointestinal tract, and cardiac arrhythmias (19). Ipecac symp is available over-the-counter in the United States only in 30-mL containers for use as an emetic in treating poisonings. 

CociEana, the dried bark of Guana rusbji (Britt.) Rushy, was probably first used by the natives of the BoUvian Andes as an emetic—cathartic. It is often prescribed as an alternative to ipecac in the treatment of cough, and the emetic side effects at high doses suggest a mechanism of action similar to that of ipecac. 

Brechungs-ebene, /. (Optica) plane of refraction. -exponent, m. refractive index, -ge-setz, n. law of refraction. -Index, m. refractive index, -k effizient, m. coefficient of refraction. -kraft, /. refractive power, -messer, m. refractometer. -verhaltnis, n. refractive index, -vermfigen, n. refractive power, -winkel, m, angle of refraction, Brech-walzwerk, n. crushing rolls (or rollers), crushing mill. >weln, m. (Pharm.) wine of antimony, antimonial wine, -weiustein, m. tartar emetic, -werk, n. crusher, -wurzel, -wurz,/. ipecacuanha, ipecac. 

The most widely used emetic is syrup of ipecac, containing the alkaloids, emetine and cq haeline. Emetine induces vomiting by activation of sensory neurons in the vagus and sympathetic nerves to the stomach and centrally in the medulla, possibly at the CTZ. The release of serotonin and SP may be involved as 5-HT3 and NKi receptor antagonists prevent emesis induced... 

The emetic (a drug that induces vomiting) ipecac causes vomiting because of its local irritating effect on the stomach and by stimulation of the vomiting center in the medulla... 

There are no apparent adverse reactions to ipecac. Although not an adverse reaction, a danger associated with any emetic is the aspiration of vomitus. 

Treatment — As with other toxin therapies, treatment is limited mainly to supportive management. Mechanical respiration support may be required in severe cases. An antitoxin has shown success in animal models, but no human data are available to date. No vaccine has been developed. Induction of vomiting may prove to be useful as part of the treatment program. Ipecac syrup is a good emetic that could be used to induce vomiting.3... 

The most commonly used emetics are ipecac and apo-morphine. Induced emesis is the preferred means of emptying the stomach in awake patients who have ingested a toxic substance or have recently taken a drug overdose. Emesis should not be induced if the patient has central nervous system depression or has ingested certain volatile hydrocarbons and caustic substances. 

B. Two medicines, ipecac and apomorphine, induce vomiting. Metoclopramide is a prokinetic with antiemetic properties and therefore would have the opposite of the desired effect. Morphine is an opioid with analgesic and sedating properties. Promethazine and ondansetron are also antiemetics, not emetics. 

Emetics are used to induce vomiting and are frequently administered to help empty the stomach of poisons or ingested toxins. The two primary emetics are apo-morphine and ipecac. Both agents seem to work by stimulating the medullary emetic center, and ipecac also exerts a direct emetic effect on the stomach. 

In the U.S., syrup of ipecac has long been valued as an emetic OTC agent in the treatment of poisonings, and it has been the primary form of decontamination in pediatric cases, both at home and in health-care facilities (see Chapter 55). 

Ipecac is the root of Cephaetis ipecacuanha, or of C. acuminata, a perennial shrub growing in Brazil and other South American states (Figure 44.1). It contains three alkaloids — emetin, cephaelin, and psychotrin. The dose of the powdered drug as an expectorant is from 1/2 to 2 grain (0.03 to 0.13 g) as an emetic, 15 to 30 grain (1.0 to 2.0 g) (Table 44.1). 

The most useful household emetic is syrup of ipecac (not ipecac fluid extract, which is 14 times more potent and may cause fatalities). Syrup of ipecac is available in 0.5- and 1-fluid ounce containers (approximately 15 and 30 ml), which may be purchased without prescription. The drug can be given orally, but it takes 15 to 30 min to produce emesis this compares favorably with the time usually required for adequate gastric lavage. The oral dose is 15 ml in children from 6 months to 12 years of age and 30 ml in older children and adults. Because emesis may not occur when the stomach is empty, the administration of ipecac should be followed by a drink of water. 

Emetics, when administered in small doses, act as expectorants and are used in inflammatory conditions of the respiratory tract to increase the bronchial secretion and render it less tenacious. The most commonly used expectorants are ipecac, ammonium chloride, and apomorphine. The last named is administered in doses of 1 mg in the form of an elixir or syrup. Apomorphine injected in subemetic doses of 1 to 2 mg is also used as a sedative in the delirium following anesthesia, in acute alcoholic psychosis, and in patients manifesting severe agitation prior to anesthesia. 

Apart from specific antidotes (if they exist), the treatment of poisonings also calls for symptomatic measures (control of blood pressure and blood electrolytes monitoring of cardiac and respiratory function prevention of toxin absorption by activated charcoal). An important step is early emptying of the stomach by gastric lavage and, if necessary, administration of an osmotic laxative. Use of emetics (saturated NaCl solution, ipecac syrup, apomorphine s.c.) is inadvisable. 

I have had turned over to me the debris of Medical Stores of the three months [volunteer] troops. And each a mess. Had Dr. Lawson [probably a reference to Surgeon General Thomas Lawson, who had died some four months earlier] been about come in when I was unpacking he would have caused a hole in the ground. The medicine chests are in the finest condition of aU. The stoppers have come out of many of the bottles and ipecac, quinine, tartar emetic. .. have made a most strange and curious compound. In tmth none of them, save one, which has never been opened, are in condition to use again without sending them back to N. York to be re-filled.37... 

Ext. Ipecacuanhs (extract of ipecac) A powerful emetic. In smaller doses, it was used as a diaphoretic and expectorant. 

The monoterpene isoquinoline alkaloids are constituents of the genus Cephaelis and selected other Rubiaceae species. C. ipecacuanha (ipecac) is a powerful emetic whose active principle is emetine, derived through the condensation of dopamine and secologa-nin (Fig. 33). Emetine is also a powerful amebicide, antiviral, and inhibitor of protein synthesis. It is now largely replaced by synthetic dehydroemetine. 

Krenzelok EP, Freedman GE, Pasternak S. Preserving the emetic effect of syrup of ipecac with concurrent activated charcoal administration a preliminary study. J Toxicol Chn Toxicol 1986 24(2) 159-66. 

The root of the ipecac is commonly used as an expectorant in the treatment of bronchitis, croup, asthma amoebacide and whooping cough, as an emetic in cases of poisoning, and an amoebacide in amoebic dysentery. It has appeared in the Japanese Pharmacopoeia (2001) as ipecac, powdered ipecac and ipecac S)nxip [6]. The ipecac is rich in isoquinoline alkaloids such as emetine, cephaeline, psychotrine. 

Numerous emetics have been advocated in the past for the treatment of the poisoned patient. Past emetics have included apomorphine, egg whites, saltwater, copper sulfate, and household dish-washing liquid. However, the use of these agents is fraught with ineffectiveness and potential harm to the patient. The only acceptable emetic that may be considered is syrup of ipecac. 

Syrup of ipecac is available as a nonprescription product in many countries. It is derived from the dried rhizome and roots of the Cephaelis ipecacuanha or Cephaelis acuminata plant. These plants contain the potent emetic alkaloids emetine and cephaeline, which induce vomiting by both direct local gastrointestinal effects and central nervous system actions. Emesis following syrup of ipecac ingestion typically occurs within 20 min of ingestion and persists for 30-120 min. 

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