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Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists01:29

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Histamine H2 receptors, which are intricately located on the basolateral membrane of parietal cells, play a crucial role in modulating gastric acid secretion. When released from enterochromaffin-like cells, histamine engages H2 receptors, initiating the cyclic AMP (cAMP) pathway. In this pathway, adenylyl cyclase converts ATP into cAMP, elevating intracellular cAMP levels. The activation of protein kinase A follows, stimulating the proton pump. This stimulation prompts the secretion of hydrogen...
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Cholinergic antagonists—such as antimuscarinics—are available in oral, topical, ocular, parenteral, and inhalational formulations. Most antimuscarinics are oral formulations,  while scopolamine is available as a topical patch, and ipratropium and tiotropium are available as inhalation aerosols or powders. Atropine, tropicamide, and cyclopentolate are topically instilled in the eye. Most antimuscarinics are lipid-soluble and readily absorbed from the gastrointestinal tract and...
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Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
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5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
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Antimuscarinic drugs have various therapeutic applications by inhibiting parasympathetic stimulation in different systems. Here are the key therapeutic uses of antimuscarinics:    
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Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
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Oesophageal spasm, vomiting and hyoscine hydrobromide patch.

Fay Murray-Brown1, I Llion Davies2

  • 1Department of Palliative Medicine, Hospiscare, Exeter, Devon, UK.

BMJ Supportive & Palliative Care
|December 16, 2015
PubMed
Summary

A hyoscine hydrobromide (scopolamine) patch effectively managed intractable nausea and vomiting in a metastatic breast cancer patient. This treatment relieved symptoms by relaxing the lower esophageal sphincter, addressing underlying esophageal spasm.

Keywords:
Clinical assessmentDrug administrationHospice care

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Area of Science:

  • Oncology
  • Gastroenterology
  • Pharmacology

Background:

  • Metastatic breast cancer can cause intractable nausea and vomiting.
  • Esophageal spasm is a potential, though less common, cause of upper gastrointestinal symptoms.

Observation:

  • A 60-year-old woman with metastatic breast cancer presented with severe, intractable nausea and vomiting.
  • Contrast swallow imaging identified esophageal spasm as the underlying cause of her symptoms.

Findings:

  • Treatment with a transdermal hyoscine hydrobromide (scopolamine) patch provided effective symptom management.
  • The antimuscarinic action of scopolamine likely induced lower esophageal sphincter relaxation, alleviating the spasm and associated nausea/vomiting.

Implications:

  • This case highlights a novel mechanism for scopolamine in managing chemotherapy-induced or cancer-related nausea and vomiting.
  • Transdermal scopolamine may be a viable therapeutic option for patients with refractory nausea and vomiting secondary to esophageal dysfunction.
  • Further research into the role of esophageal motility disorders in cancer-related nausea is warranted.