Antianemics

Anemia is caused by the deficiency of 'Haemoglobin', the red colour pigment in the blood, which carries oxygen to various parts of the body. The blood cells which contain haemoglobin are called the red blood cells (RBCs). The formation of the RBCs is affected if a person is suffering from deficiency of proteins, iron, folic acid or Vitamin B-12. This leads to deficiency of haemoglobin in the blood resulting in anemia.

The commonest cause of anemia is the deficiency of iron (with or without folic acid) which arises due to various reasons such as:

-	Excessive blood loss during menstruation in some women
-	Repeated pregnancies
-	Bleeding piles
-	Blood loss due to ulcers in the gut
-	Hookworm infestation (since hookworms suck blood from the intestines).
-	Blood loss due to chronic diarrhoea
-	Blood loss due to injury or accident
-	Inadequate diet.

Symptoms and Signs of Anemia

-	Tiredness and weakness
-	Pale tongue and nails
-	Shortness of breath on usual exercise/work
-	Palpitations
-	Irritability
-	General pallor

General Guidelines

-	It is far better to prevent anemia by using iron supplements in a patient who is likely to develop
	anemia rather that treating it later when developed.
Supplements are therefore given:
-	throughout pregnancy
-	to patients with excessive blood loss (because of causes mentioned above)
-	to premature babies, twins and infants delivered by caesarian section

Patients of anemia should be advised to eat foods which are good source of iron such as green leafy vegetables, bajra, ragi, beans and pears and jaggery. Non-vegetarians can eat meat, fish and chicken which are also rich in iron content.

Besides iron-deficiency anemia, there are other types of anemia also. Iron supplements can prove harmful if given alone to patients with anemias other than those due to iron deficiency. Thus different types of anemia require different types of drug treatment.

Antiemetics

Antiemetics are drugs used to suppress vomiting and nausea.

Vomiting (emesis) is a process by which the body throws out harmful substances or a symptom of some disease/disorder.

Vomiting can result due to various causes and the treatment varies with the cause.

The common causes of vomiting include:

1.	Ingestion of nauseating or irritating material including spoilt food.
2.	Infection due to some disease/disorders of the digestive tract.
3.	High fever
4.	Pregnancy
5.	Motion sickness
6.	Vertigo (reeling sensation)
7.	Migraine
8.	Serious illnesses such as painful fracture, heart attack, stomach pain, brain disease, head
	injury, closed stomach injuries with internal organ damage, stomach ulcer, etc.
9.	Side-effect of a drug/radiation therapy/general anaesthesia.

Treatment

When the vomiting is due to ingestion of spoilt food or irritating substances, it helps to throw out the irritating material and hence is beneficial. However, excessive vomiting causes loss of salt and water and exhausts the patient. Hence the patient should take sips of cold water and dehydration fluid. Food be avoided as far as possible. Such type of vomiting is self-limiting.

Anti-emetics are usually taken to prevent motion sickness (dimenhydrinate can be used), to suppress nausea due to drug treatment (domperidone, phenothiazine can be used), to suppress nausea in vertigo and to relieve severe vomiting in pregnancy (phenothiazine can be used).

An antiemetic should not be taken for longer than a couple of days without consulting the doctor. A doctor usually diagnoses the cause of vomiting because vomiting can require other treatments (e.g., vomiting due to infection may require surgery), instead of antiemetic treatment. Suppressing vomiting in such cases may delay treatment and recovery. One must always consult the doctor in the following cases of vomiting.

Remember:

· A patient who is vomiting should not eat solid food. He/she must take sips of ice-cold water, cold weak tea, lime juice or dehydration fluid/ORS especially if diarrhoea is also present. Addition of a pinch of ginger powder would help.

· Take a sample of vomit, if available for examination by the doctor when you go for consultation.

· A pregnant lady suffering from vomiting should not take any antiemetic without consulting her gynaecologist (some antiemetics can be harmful to the unborn baby).

· If decreased urine output is noticed, increase the fluid intake.

How do antiemetics work?

Vomiting occurs when the vomiting centre in the brain is triggered by signals which arise from the stomach, the inner ear or in other parts of the brain.

Antiemetic drugs may act at one or more of these places in the body, and prevent vomiting. They may also promote the normal emptying of the stomach contents into the intestine thus preventing the expulsion of the stomach contents.

Precautions

Antiemetics like phenothiazines and metoclopramide should not be taken by patients who suffer from movement disorders such as 'Parkinsonism', as they can aggravate such conditions.

Antiemetics which are also antiallergics, e.g., promethazine, diphenhydramine, etc., produce many other actions such as dry mouth, blurred vision, difficulty in passing urine and drowsiness. It is advisable not to drive while taking such antiemetics.

Combination Products

Combination products containing (a) more than one antiemetic or (b) an antiemetic with analgesic have got no special beneficial effects over a single product containing only one antiemetic.