Stimulant ipecac

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. 

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... 

Mucous airway obstruction. Mu-colytics, such as acetylcysteine, split disulfide bonds in mucus, hence reduce its viscosity and promote clearing of bronchial mucus. Other expectorants (e.g., hot beverages, potassium iodide, and ipecac) stimulate production of watery mucus. Acetylcysteine is indicated in cystic fibrosis patients and inhaled as an aerosol. Whether mucolytics are indicated in the common cold and whether expectorants like bromohexine or am-broxole effectively lower viscosity of bronchial secretions may be questioned. 

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. 

Emesis can be induced with ipecacsyrup (never extract of ipecac), and this method is sometimes used to treat childhood ingestions at home under telephone supervision of a physician or poison control center personnel. Ipecac should not be used if the suspected intoxicant is a corrosive agent, a petroleum distillate, or a rapidly acting convulsant. Previously popular methods of inducing emesis such as fingertip stimulation of the pharynx, salt water, and apomorphine are ineffective or dangerous and should not be used. 

During the period from 1983 to 1991 there has been a continual decline in the use of syrup of ipecac to induce emesis. Ipecac contains a number of plant alkaloids including emetine. It induces emesis through stimulation of the chemoreceptor trigger zone in the brain and local irritation of the gastrointestinal tract. The latency period for... 

There is no antidote for azathioprine toxicity. Treatment for an overdose entails ipecac within 30 min or lavage within 1 h, followed by activated charcoal. Side effects may be minimized with adequate monitoring of peripheral blood count and liver enzymes. Asymptomatic leucopenia, as well as most other side effects, may be treated with dose reduction or drug cessation (and changing to 6-MP) however, a life-threatening leucopenic episode may require administration of granulocyte colony-stimulating factor as well as other supportive care. 

If ingested, syrup of ipecac-induced emesis should be avoided since seizures or lethargy can occur rapidly. Activated charcoal should be administered. Seizures should be treated with diazepam or phenytion. Atropine can be used to control signs of excess parasympathetic stimulation. If hypotension does not respond to intravenous fluids, dopamine or norepinephrine may be indicated. Antacids should be avoided since nicotine has greater absorption in an alkaline media. Vital signs and level of consciousness should be monitored closely. Further care is... 

Pharmacological method is by administering an emetic. The mostly commonly use emetic is Ipecac syrup. Ipecac stimulates the CTZ in the medulla and acts directly on the gastric mucosa. However, Ipecac is somewhat controversial. Administer Ipecac with at least 8 ounces of water or juice. Do not use milk or carbonated beverages. Administer Ipecac again if vomiting does not occur in 20 minutes. If vomiting still does not occur, then administer activated charcoal. 

Ipecac is a mixture of the alcohol-soluble alkaloid that is obtained from the South American plant Cephaelis ipecacuanha and is used solely in the form of syrup of ipecac. Apomorphine hydrochloride and copper sulfate are also emetics. Syrup of ipecac and copper sulfate cause emesis by locally irritating the stomach, whereas apomorphine stimulates the chemoreceptor trigger zone for emesis located in the caudal portion of the fourth ventricle (area postrema), which in turn stimulates the vomiting center in the lateral reticular formation of the medulla (see also Figure 73). 

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 root has been used in therapy since the beginning of the XVIIth century as an emetic and expectorant its use against dysentery, already recommended by Helvetius in the eighteenth century, was found to be therapeutically correct in 1912, when emetine, the most important of its alkaloids, was successfully used by L. Rogers (80) in the treatment of amebic dysentery. This very important application has stimulated many investigations of Ipecac root and has shown emetine to be an almost indispensable alkaloid. 

A. Mechanism of action. Ipecac causes vomiting In two phases by direct irritation of the gastric mucosa and by systemic absorption and stimulation of the central chemoreceptor trigger zone. 

I. Pharmacology. Ipecac syrup is a mixture of plant-derived alkaloids, principally emetine and cephaeline, that produce emesis by direct irritation of the stomach and by stimulation of the central ohemoreceptor trigger zone. Vomiting occurs in 90% of patients, usually within 20-30 minutes. Depending on the time after ingestion of the toxin, ipecac-induced emesis removes 15-50% of the stomach contents. There is no evidence that the use of ipecac improves the clinical outcome of poisoned patients. 

The parent compound of the secoiridoids is secologa-nin (see secoiridoids), the most important intermediate in the biogenesis of alkaloids that are not derived from an amino acid. This includes most indole alkaloids, the ipecac, the Cinchona, and the pyrroloquinoline alkaloids as well as simple monoterpene alkaloids The best known biological property of the I. is their bitter taste. However, bitter principles are mostly not used as pure substances, instead alcoholic extracts are preferred to stimulate appetite (increased secretion of gastric juice). Furthermore, bitter substances are used to modify the taste of pharmaceutical products. Some I. exert various effects on the central nervous system as a consequence of their volatility and lipophilicity, e.g., nepetalactone, iridodial, teucrium lactones, and valepotriates. 

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