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CBRNE - Vomiting Agents - Dm, Da, Dc Medication

  • Author: Christopher P Holstege, MD; Chief Editor: Zygmunt F Dembek, PhD, MPH, MS, LHD  more...
 
Updated: Aug 06, 2015
 

Medication Summary

Medical therapy focuses on controlling the emesis induced by vomiting agents. Initial antiemetic therapy may begin with routine doses of drugs commonly used to combat vomiting, such as promethazine, prochlorperazine, or droperidol. High doses of metoclopramide may be administered. If these agents are unsuccessful, 5-HT3 receptor antagonists may be administered to control nausea and vomiting. This class of drugs is comparatively expensive but well tolerated with few adverse effects. These agents include dolasetron, ondansetron, and granisetron.

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Antiemetics

Class Summary

A common effect of diphenylchlorarsine (Da), diphenylcyanoarsine (Dc), and diphenylaminearsine (Dm, adamsite) is emesis. Consider antiemetics in patients with persistent vomiting.

Prochlorperazine (Compazine)

 

May relieve nausea and vomiting by blocking postsynaptic mesolimbic dopamine receptors through anticholinergic effects and depressing reticular activating system. In addition to antiemetic effects, has advantage of augmenting hypoxic ventilatory response, acting as a respiratory stimulant at high altitude.

Promethazine (Phenergan)

 

For symptomatic treatment of nausea in vestibular dysfunction. Antidopaminergic agent effective in treating emesis. Blocks postsynaptic mesolimbic dopaminergic receptors in brain and reduces stimuli to brainstem reticular system.

Droperidol (Inapsine)

 

Neuroleptic agent that may reduce emesis by blocking dopamine stimulation of chemoreceptor trigger zone.

Metoclopramide (Reglan, Clopra, Maxolon)

 

Dopamine antagonist that stimulates acetylcholine release in myenteric plexus. Acts centrally on chemoreceptor triggers in floor of fourth ventricle, which provides important antiemetic activity.

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5-HT3 receptor antagonists

Class Summary

A more expensive drug category compared to the other available antiemetics noted above. These agents typically are reserved for severe cases of emesis not responsive to the above medications.

Ondansetron (Zofran)

 

Selective 5-HT3 receptor antagonist that blocks serotonin both peripherally and centrally.

Dolasetron (Anzemet)

 

Selective 5-HT3 receptor antagonist that blocks serotonin both peripherally and centrally.

Granisetron (Kytril)

 

At chemoreceptor trigger zone, blocks serotonin peripherally on vagal nerve terminals and centrally.

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Bronchodilators

Class Summary

Acute bronchospasm may result when exposure occurs to aerosolized chemicals. Bronchodilators are administered to attempt to alleviate bronchospasm that causes decreased pulmonary airflow and wheezing.

Albuterol (Ventolin, Proventil)

 

Beta-agonist for bronchospasm refractory to epinephrine. Relaxes bronchial smooth muscle by action on beta2-receptors with little effect on cardiac muscle contractility.

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Cycloplegics

Class Summary

Eye muscarinic antagonists that cause mydriasis and alleviate ciliary spasm. May alleviate symptoms in patients who develop a chemical conjunctivitis caused by eye exposure.

Cyclopentolate (Cyclogyl, AK-Pentolate)

 

Prevents muscle of ciliary body and sphincter muscle of iris from responding to cholinergic stimulation. Induces mydriasis in 30-60 min and cycloplegia in 25-75 min.

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Contributor Information and Disclosures
Author

Christopher P Holstege, MD Professor of Emergency Medicine and Pediatrics, University of Virginia School of Medicine; Chief, Division of Medical Toxicology, Center of Clinical Toxicology; Medical Director, Blue Ridge Poison Center

Christopher P Holstege, MD is a member of the following medical societies: American Academy of Clinical Toxicology, Medical Society of Virginia, Society of Toxicology, Wilderness Medical Society, European Association of Poisons Centres and Clinical Toxicologists, American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Zygmunt F Dembek, PhD, MPH, MS, LHD Associate Professor, Department of Military and Emergency Medicine, Adjunct Assistant Professor, Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: American Chemical Society, New York Academy of Sciences

Disclosure: Nothing to disclose.

Additional Contributors

Fred Henretig, MD Director, Section of Clinical Toxicology, Professor, Medical Director, Delaware Valley Regional Poison Control Center, Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital

Disclosure: Nothing to disclose.

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