Ipecac

IPECAC

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·       Ipecac, derived from the root of the plant Cephaelis ipecacuanha, is a medicinal substance traditionally used to induce vomiting.

·       It has been used in the treatment of certain types of poisoning to empty the stomach before the poison can be absorbed into the bloodstream.

·       However, its use has decreased significantly due to the development of more effective and safer methods.

Definition

·       Ipecac syrup is a pharmacological agent used to induce emesis (vomiting) in cases of certain types of poisoning.

·       It contains the active alkaloids emetine and cephaeline, which are responsible for its emetic properties.

Classification

1.     Emetic Agent: A substance used to induce vomiting.

2.     Expectorant: At lower doses, ipecac can act as an expectorant, helping to clear mucus from the respiratory tract.

Examples

1.     Ipecac Syrup: A liquid preparation containing standardized doses of the active components used primarily for inducing vomiting.

2.     Ipecac Powder: Rarely used in modern medicine, this form may be found in some herbal preparations.

Pharmacokinetics

·        Absorption: Ipecac syrup is absorbed from the gastrointestinal tract after oral administration.

·        Distribution: Once absorbed, the active components are distributed throughout the body.

·        Metabolism: The active alkaloid emetine is metabolized in the liver.

·        Excretion: The metabolites of emetine are excreted primarily via the urine.

Mechanism of Action

·       Ipecac's emetic effect is due to the alkaloids emetine and cephaeline, which stimulate the chemoreceptor trigger zone (CTZ) in the brain.

·       This leads to the activation of the vomiting center, resulting in emesis.

·       Additionally, it has a direct irritant effect on the stomach lining, further promoting vomiting.

Uses

·        Induction of Vomiting: In cases of certain types of poisoning where it is essential to remove the ingested substance from the stomach (though this use is now rare).

·        Expectorant: In some cough preparations, ipecac is used at low doses to help clear mucus.

Adverse Effects

·        Gastrointestinal: Nausea, severe vomiting, diarrhea, and abdominal pain.

·        Cardiovascular: In large doses, it can cause cardiotoxic effects, including arrhythmias and hypotension.

·        Respiratory: Bronchospasm in sensitive individuals.

·        Neurological: Drowsiness, dizziness, and in severe cases, seizures.

Contraindications

·        Corrosive Poisoning: Such as ingestion of strong acids or alkalis, as vomiting can exacerbate damage to the esophagus and oral mucosa.

·        Unconsciousness or Coma: Risk of aspiration of vomit into the lungs.

·        Pregnancy: Use with caution due to potential adverse effects on the fetus.

·        Cardiac Conditions: Due to its cardiotoxic potential.

Role of the Nurse

·        Assessment: Evaluate the patient's condition before administering ipecac to ensure that vomiting is appropriate. Assess for contraindications.

·        Administration: Provide the correct dose and monitor the patient closely after administration.

·        Monitoring: Observe for adverse effects, especially signs of dehydration, electrolyte imbalance, or cardiotoxicity.

·        Patient Education: Instruct the patient and family about the proper use of ipecac syrup, including when and when not to use it. Educate on the importance of contacting Poison Control or emergency services before administration.

·        Documentation: Record the administration, patient’s response, and any adverse effects observed.

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