Book contents
- Frontmatter
- Contents
- List of contributors
- Preface to the first edition
- Preface to the second edition
- Preface to the third edition
- How to use this book
- Acknowledgements
- List of abbreviations
- Section 1 Clinical anaesthesia
- Section 2 Physiology
- Section 3 Pharmacology
- 1 Physical chemistry
- 2 Pharmacodynamics
- 3 Pharmacokinetics
- 4 Mechanisms of drug action
- 5 Anaesthetic gases and vapours
- 6 Hypnotics and intravenous anaesthetic agents
- 7 Analgesic drugs
- 8 Neuromuscular blocking agents
- 9 Local anaesthetic agents
- 10 Central nervous system pharmacology
- 11 Autonomic nervous system pharmacology
- 12 Cardiovascular pharmacology
- 13 Respiratory pharmacology
- 14 Endocrine pharmacology
- 15 Gastrointestinal pharmacology
- 16 Intravenous fluids
- 17 Pharmacology of haemostasis
- 18 Antimicrobial therapy
- 19 Clinical trials: design and evaluation
- Section 4 Physics, clinical measurement and statistics
- Appendix: Primary FRCA syllabus
- Index
- References
10 - Central nervous system pharmacology
from Section 3 - Pharmacology
- Frontmatter
- Contents
- List of contributors
- Preface to the first edition
- Preface to the second edition
- Preface to the third edition
- How to use this book
- Acknowledgements
- List of abbreviations
- Section 1 Clinical anaesthesia
- Section 2 Physiology
- Section 3 Pharmacology
- 1 Physical chemistry
- 2 Pharmacodynamics
- 3 Pharmacokinetics
- 4 Mechanisms of drug action
- 5 Anaesthetic gases and vapours
- 6 Hypnotics and intravenous anaesthetic agents
- 7 Analgesic drugs
- 8 Neuromuscular blocking agents
- 9 Local anaesthetic agents
- 10 Central nervous system pharmacology
- 11 Autonomic nervous system pharmacology
- 12 Cardiovascular pharmacology
- 13 Respiratory pharmacology
- 14 Endocrine pharmacology
- 15 Gastrointestinal pharmacology
- 16 Intravenous fluids
- 17 Pharmacology of haemostasis
- 18 Antimicrobial therapy
- 19 Clinical trials: design and evaluation
- Section 4 Physics, clinical measurement and statistics
- Appendix: Primary FRCA syllabus
- Index
- References
Summary
Many drugs act on the central nervous system (CNS), with specific aims in mind. While certain categories of drugs are considered elsewhere (anaesthetic gases and vapours in Section 3, Chapter 5, hypnotics and intravenous agents in Chapter 6) other drugs acting on the CNS have been grouped here. Anti-emetic agents are considered in detail, with specific pharmacology of individual agents to reflect their direct relevance to the practice of anaesthesia.
Anti-emetic agents
The causes of nausea and vomiting (NV) are legion, as illustrated by Figure CN1, and anti-emetic therapy is most effective when directed at the likely origin.
Postoperative nausea and vomiting (PONV) is a specific entity. Its treatment is more appropriately directed when other risk factors are considered, and these are summarised in Figure CN2.
Two distinct sites in the CNS, the vomiting centre and the chemoreceptor trigger zone, are implicated in the causes of NV. The chemoreceptor trigger zone lies in the area postrema outside the blood–brain barrier and possesses dopaminergic (D2) and serotonergic (5-hydroxytryptamine, 5-HT3) receptors. In contrast, the vomiting centre is a complex entity located in the dorsolateral reticular formation of the brain stem that possesses 5-HT3, D2 and muscarinic (M3) receptors. Histaminic (H1) and neurokinin (NK1) receptors are located in the nucleus of the tractus solitarius, which integrates afferent signals associated with emesis. The interaction of various drugs with these sites is shown in Figure CN3.
- Type
- Chapter
- Information
- Fundamentals of Anaesthesia , pp. 632 - 643Publisher: Cambridge University PressPrint publication year: 2009