Antiemetics & Oral

Rehydration Salts (ORS)

 OBJEKT
IF
• Menerangkan definisi dan
tindakan ubat ‘Anti-emetics’
dan ‘Oral Rehydration Salts’.
• Menerangkan kesan
sampingan ubat.
• Menyatakan contoh, dos dan
cara pemberian ubat.
• Menyatakan indikasi dan
kontraindikasi ubat.
• Menyatakan nasihat yang
relevan semasa penggunaan/
pemberian ubat.
 Nausea
• Sensasi perut yang tidak
menyenangkan biasanya sebelum 
muntah-muntah.

Vomiting
• Pengeluaran secara
paksa kandungan perut melalui
mulut
 Vomiting
• Berlaku
kerana rangsangan chemoreceptor
 pencetus zon (CTZ).
• CTZ is a group of nerve fibers
located in the brain and
stimulated by:
– Drugs
– Radiation
• pabila dirangsang, ia
akan menghantar impuls ke
pusat muntah terletak di medulla.
• Vomiting centre may also be
stimulated by disorders such
as:
– Gastrointestinal irritation
– Motion sickness
– Vestibular neuritis
 Antiemetics
• Drugs used to prevent or
stop vomiting.
 Tindakan
• Terutamanya menghalang rangsa
ngan CTZ dan mengurangkan
penghantaran impuls ke
pusat muntah di medula.
• Depress sensitivity of
vestibular apparatus of the
inner ear.
 General Indication

• Treat & prevent nausea &

vomiting:
– Gangguan GI
– Morning sickness
– Kesan sampingan ubat
• Treat & prevent nausea &
vomiting.
• After surgery (halang muntah
semasa & selepas surgery)
• After combination therapy
with antineoplastic drugs
(risiko tinggi untuk muntah)
• After radiation therapy
 Contoh ubat
• Prochlorperazine maleate/
mesylate (Stemetil)
• Metoclopramide (Maxolon/
Reglan)
• Meclozine HCl & Pyridoxine
(Navidoxine)
• Domperidone (Motilium)
1. Prochlorperazine
maleate 5mg tablet
(Stemetil tab)
Category: B

Indication
• Severe nausea & vomiting
 Dose
• Adult:
• Severe nausea & vomiting:
Initial: 20mg followed by
10mg after 2 hrs
• Prevention: 5-10mg bd/ tds
• Peads > 10kg:
• 250mcg/kg bd/ tds
2. Prochlorperazine mesylate
12.5mg/ml Inj
(Stemetil inj)
Category: B
 Dose
• Adult:
• 12.5mg deep IM PRN (repeat
after 6 hrs if necessary)
• Then followed by oral dose
• Peads:
• Not recommended
Kesan sampingan
• Drowsiness
• Sedation
• CNS depression
• Confusion
• CV collapse
• Leucopenia
• Liver damage
 Contraindications
• Allergic to drugs
• Coma
• Severe CNS depression
• Bone Marrow depression
• Blood dyscrasias
• Parkinson disease
• Liver damage
• CVS disease
 Cautious
• Glaucoma
• Respiratory disorders
• Hypotension
• Prostatic hypertrophy
• Epilepsy
• Pregnancy
• Lactation
• Child < 12 yrs
 Interactions
• Levodopa
• Mengurangkan kesan
levodopa
• Ethanol
• Meningkatkan kesan ‘CNS
depression’
• Tramadol
• Meningkatkan risiko sawan
 3. Metoclopramide
10mg tablet
(Maxolon)
Category: B

Indication
• Severe nausea & vomiting
4. Metoclopramide
10mg/2ml Inj
(Maxolon)
Category: B

Indication
• Severe nausea & vomiting
 Dose
• > 20yrs: 10mg tds PO
• 15-20 yrs: 5-10mg tds PO
• 5-14 yrs: 2.5-5mg tds PO
 5. Metoclopramide
5mg/5ml syrup
(Maxolon)
Category: B

Dose
• Peads:
• 0.12mg/kg/dose q 6-12 hr
Kesan sampingan
• Drowsiness
• Insomnia
• Anxiety
• Dizziness
• Hypertension
• Diarrhea
• Bronchospasm
• Depression
Contraindications

• Allergic to drugs
• GI hemorrhage
• Epilepsy
 Cautious
• Hepatic/ renal impairment
• Elderly
• Pediatrics
• Lactation
• Pregnancy
 Interactions
• Aspirin & Paracetamol
• Meningkatkan penyerapan ubat
di atas
• Opioid analgesics
• Meningkatkan aktiviti gastro-
usus
• Digoxin
• Mengurangkan penyerapan
digoxin
6. Meclozine HCl 25mg &
Pyridoxine 50mg tablet
(Navidoxine)
Category: B

Indication
• Nausea & vomiting of
pregnancy
 Dose
• Adult:
• 1-2 tabs bd or tds in
severe cases
Kesan sampingan
• Drowsiness
• Insomnia
• Anxiety
• Dizziness
• Hypertension
• Diarrhea
• Dry mouth
• Blurred vision
Contraindications
• Allergic to drugs
 Cautious
• Glaucoma
• Peptic ulcer
• Hepatic disease
• Severe heart failure
• Asthma
• Lactation
• Pregnancy
 Interactions

• CNS Depressants
• Meningkatkan kesan sedatif
7. Domperidone 10mg tablet
(Motilium)
Category: B

Indication
• Severe nausea & vomiting
 Dose
• Adult:
• 20mg tds-qid PO (before
meals)
8. Domperidone 1mg/ml
suspension (Motilium)

Category: B

Indication
• Severe nausea & vomiting
 Dose
• Peads:
• 5ml/10kg tds-qid
 Kesan sampingan

• Drowsiness
• Sedation
• CNS depression
• Confusion
• Headache/ migraine
• Menstrual irregularities
• Dry mouth
• Rashes
• Urticaria
• Conjunctivitis
Contraindications
• Allergic to drugs

Cautious
• Lactation
• Pregnancy
• Glaucoma
 Interactions
• MAOIs
• Antacids
• Antifungal (azole)
• Macrolides
 Soalan
1. Beri definisi ubat Anti-emetics?
2. Terangkan cara tindakan ubat
Anti-emetics?
3. Senaraikan contoh-contoh ubat
Anti-emetics?
4. Nyatakan kesan sampingan dan
kontraindikasi ubat Anti-
emetics?
 Electrolytes

• Electrically charged particles

(ions).
• Essential for
– Normal cell function
– Various metabolic activities
Oral Rehydration Salt ORS
Category: C

• Ubat atau larutan yang

digunakan untuk
menggantikan elektrolit yang
hilang semasa diarrhea atau
muntah.
 Tindakan

• Meningkatkan semula
kandungan ion-ion (elektrolit)
serta cecair badan ke paras
normal.
 General Indication

• Bagi merawat kehilangan

cecair (dehydration) semasa:
– Diarrhea
– Vomiting
– Physical exercise
 Kandungan ORS

• Sodium chloride 526mg

• Trisodium citrate 490mg
• Potassium chloride 373mg
• Glucose anhydrous 5.4mg
 Cara Penggunaan

• Bancuhkan kandungan 1
bungkusan dalam 250ml air
masak yang sejuk dan
diminum.
• Lanjutkan rawatan sehingga
diarrhea berhenti.
• Tahap dehidrasi sebelum &
selepas penggunaan ORS
dinilai.
 Dose

• Adult & Peads > 10 yrs:

– 250ml setiap kali selepas
diarrhea
– Max: 2000ml/day
• Peads 2-10 yrs:
– 100 - 200ml setiap kali
selepas diarrhea
– Max: 1000ml/day
• Peads < 2 yrs:
– 50 - 100ml setiap kali
selepas diarrhea
– Max: 500ml/day
 Peringatan

• Terangkan cara penggunaan

ORS kepada ibu sekiranya
kanak-kanak mengalami
diarrhea.
• Simpan bungkusan ORS
dibawah suhu 25°C
• Jangan masak bancuhan
ORS.
• Jangan tambah garam atau
gula dalam bancuhan ORS.
• Jangan gunakan bungkusan
ORS yang basah atau sudah
bertukar warna.
• Jumpa doktor untuk rawatan
seterusnya jika;
– diarrhea tidak berhenti
dalam masa 2 hari,
– punca diarrhea adalah
mikroorganisma (cth:
Cholera, dysentry, food
poisoning)
 Kesan sampingan

• Nausea, vomiting, diarrhea &

abdominal cramp
• GI disturbances (obstruction,
bleeding & ulceration)
• Hypertension & tachycardia
• Pulmonary edema &
respiratory arrest
• Hypernatremia
• Hyperkalemia
• ECG changes
 Contraindications
• Allergic to drug
• Hypernatremia
• Hyperkalemia
• Severe renal impairment
 Cautious
• Cardiac failure
• Hypertension
• Impaired renal function
• Peripheral / pulmonary
edema
• Pregnancy
 Interactions
• Potassium
sparing diuretics
 Soalan
1. Beri definisi dan terangkan cara
tindakan Oral Rehydration Salts?
2. Nyatakan dos serta peringatan
penggunaan Oral Rehydration
Salts?
3. Nyatakan kesan sampingan dan
kontraindikasi Oral Rehydration
Salts?