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Pharmacology > 42. GI Meds > Flashcards

42. GI Meds Flashcards

1
Q

3 physiologic causes of vomiting

A
  • activation of chemoreceptor trigger zone CTZ (pregnancy) -> triggered by dopamine
  • inner ear receptors (motion sickness)
  • vomiting center in medulla in stimulated -> triggered by dopamine
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2
Q

most common adverse effect of drug therapy

A

N/V

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3
Q

non pharmacological techniques for N/V

A
  • herbal supplements
  • acupuncture and acupressure
  • flat soda/white soda
  • weak tea
  • ginger
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4
Q

nonprescription drugs for N/V

A
  • antihistamine antiemetics: meclisine and diphenhydramine for N/V and dizziness
  • bismuth subsalicylate (peptobismol) acts on gastric mucosa to suppress vomiting
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5
Q

what type of drug is promethazine

A

phenothiazine or antihistamine

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6
Q

MOA of promethazine

A

blocks dopamine from H1 receptor sites in brain and inhibits CTZ (works better for prevention than to actually prevent vomiting)

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7
Q

uses for promethazine

A
  • motion sickness
  • nausea
  • sedation induction
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8
Q

adverse effects of promethazine

A
  • EPS
  • blurred vision
  • urinary retention
  • dry mouth
  • photosensitivity
  • drowsiness
  • confusion
  • agranulocytosis
  • leukopenia
  • respiratory depression
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9
Q

black box warning for promethazine

A
  • can cause fatal respiratory depression in children under 2 y/o
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10
Q

cautions for promethazine

A
  • contraindicated for subQ infection, avoid IV if available (irritating to skin)
  • more commonly given IM
  • use caution in pt’s w/ liver disease
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11
Q

describe 2 type of histamines

A
  • H1 receptor blockers are classic antihistamines used to as antiemetics
  • H2 receptor blockers such as cimetidine
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12
Q

what type of drug is hydroxyzine

A

antihistamine

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13
Q

MOA of hydroxyzine

A

competes w/ histamine for receptor sites in GI tract, blood vessels, and respiratory tract

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14
Q

uses of hydroxyzine

A
  • N/V
  • motion sickness
  • seasonal allergies
  • anxiety
  • anesthesia
  • vertigo
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15
Q

adverse effects of hydroxyzine

A

anticholinergic effects such as

  • drowsy/dizzy
  • confusion
  • dry mouth
  • thickened respiratory secretions
  • blurred vision
  • urinary retention
  • tachycardia
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16
Q

T/F: hydroxyzine is not appropriate to give older adults due to the sedating effects

A

True

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17
Q

what type of drug is ondansetron

A

5-HT3 receptor antagonist

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18
Q

MOA of ondansetron

A

serotonin antagonist suppresses N/V by blocking serotonin (5HT3) receptors in the CTZ and blocking afferent vagal nerve terminals in upper GI tract

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19
Q

uses of ondansetron

A

moderate to severe N/V particularly in chemo, radiation, and post-op

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20
Q

adverse effects of ondansetron

A
  • diarrhea
  • headache
  • dizziness
  • constipation
  • fatigue
  • transient elevation of liver enzymes
  • pain at injection site
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21
Q

administration

A
  • can be given IV

- PO (SL)

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22
Q

what type of drug is scopolamine

A

anticholinergic

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23
Q

MOA of scopolamine

A

inhibits action of ACh at muscarinic receptors

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24
Q

uses of scopolamine

A

motion sickness and IBS

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25
Q

adverse effects of scopolamine

A
  • urinary retention
  • constipation
  • dry mouth
  • fatigue
  • dizziness
  • drowsiness
26
Q

administration of scopolamine

A
  • PO

- transdermal (apply patch behind ear and switch ears if using longer than 3 days

27
Q

when are emetics used

A

if patient has consumed toxic substance

28
Q

when should emetics not be used

A
  • if caustic substances such as ammonia, chlorine, lye, toilet cleaners, or battery acid have been ingested
  • if petroleum distillates are ingested including gasoline, kerosine, paint thinners, and lighter fluid
  • activated charcoal is given when emesis is contraindicated
29
Q

nursing interventions for antiemetics

A
  • assess pt’s condition and report to HCP if N/V occur
  • suggest pregnant women eat dry crackers before rising in morning and ingestion of small frequent protein meals to help prevent N/V
  • avoid administering oral intake food, fluids, and drugs during acute episodes of N/V
  • minimize activity during N/V (lying down and resting are often helpful)
  • help pt rinse mouth after vomiting (decrease bad taste and corrosion of tooth enamel)
  • provide requested home remedies when possible (cold wash cloth on face)
  • provide education for drug therapy
30
Q

when to administer antiemetics

A
  • 30-60 minutes before a nausea producing event when possible
  • adjust the timing of any oral drugs that cause gastric irritation, N/V by taking w/ or just before food
31
Q

what foods to resume eating after N/V

A
  • BRAT diet (bananas, rice, applesauce, and toast)

- foods not spicy or fatty

32
Q

characteristics of diarrhea

A
  • acute or chronic; mild or severe
  • most episodes are the body trying to rid itself of irritants, toxins, and infectious agents
  • usually self-limiting 24-48 hours
  • severe or prolonged may lead to fluid and electrolyte depletion
  • chronic diarrhea can have exacerbations and remissions
33
Q

nonpharmacologic interventions for diarrhea

A
  • increase clear liquids (gatorade or pedialyte)

- may need IV fluids

34
Q

what type of drug is diphenoxylate w/ atropine

A

opioid antidiarrheal agent (schedule 4)

35
Q

MOA of diphenoxylate w/ atropine

A

inhibits gastric motility by exerting effect on smooth muscle cells of GI tract

36
Q

uses of diphenoxylate w/ atropine

A
  • treats diarrhea by slowing intestinal motility

- not given if diarrhea caused by infectious agents)

37
Q

adverse effects of diphenoxylate w/ atropine

A
  • paralytic ileus
  • toxic megacolon
  • anaphylaxis
  • pancreatitis
  • tachycardia
  • drowsy/dizzy
  • confusion and restless
  • flushing
  • rash
38
Q

what type of drug is bismuth subsalicylate

A

absorbent

39
Q

MOA of bismuth subsalicylate

A

coating the wall of the GI tract and absorbing bacteria or toxins that cause diarrhea

40
Q

uses of bismuth subsalicylate

A

travelers diarrhea and can be used as an antacid for gastric comfort

41
Q

adverse effects of bismuth subsalicylate

A
  • dizzy/drowsy
  • weakness
  • anxiety
  • confusion
  • tinnitus
  • tongue discoloration
  • stool discoloration
42
Q

contraindication for bismuth subsalicylate

A
  • people w/ allergy to ASA
43
Q

what is the medical definition of constipation

A

3 or fewer bowel movements per week

44
Q

nonpharmacologic interventions for constipation

A
  • increase activity and exercise
  • increase dietary intake of fiber
  • drink at least 2000mL of fluid per day (if not contraindicated)
  • establish and maintain routine for bowel elimination
45
Q

what type of drug is lactulose

A

osmotic

46
Q

MOA of lactulose

A
  • draws water into intestines to form a soft stool

- decreases serum ammonia levels

47
Q

use of lactulose

A

constipation and hepatic encephalopathy

48
Q

adverse effects of lactulose

A
  • belching
  • flatulence
  • N/V/D
  • ABD pain
  • metabolic acidosis
  • hypokalemia
  • hypernatremia
49
Q

what type of drug is bisacodyl

A

stimulant

50
Q

MOA of bisacodyl

A

increase peristalsis by direct effect on smooth muscle of intestine

51
Q

use of bisacodyl

A
  • bowel prep
  • prevention and short-term treatment of constipation
  • over the counter
52
Q

adverse effects of bisacodyl

A
  • dependence
  • fluid and electrolyte imbalance
  • dizziness
  • anorexia
  • N/V
  • rectal burning and diarrhea
53
Q

contraindications of bisacodyl

A
  • fecal impaction
  • intestinal obstruction
  • GI bleeding
  • appendicitis
54
Q

what type of drug is docusate sodium

A

emollient: stool softener

55
Q

MOA of docusate sodium

A

decrease surface tension by mixing liquid w/ bowel contents

56
Q

use of docusate sodium

A

constipation or prevent constipation (postpartum or while taking opioids)

57
Q

side effects of docusate sodium

A
  • throat irritation
  • diarrhea
  • ABD cramps
58
Q

contraindications for docusate sodium

A
  • pregnancy

- inflammatory disorders of GI tract

59
Q

what type of drug is psyllium

A

bulk-forming

60
Q

MOA of psyllium

A

acts as a bulk-forming laxative by drawing water into intestines (acts like fiber)

61
Q

use of psyllium

A
  • to control constipation

- to reduce serum cholesterol levels (fiber prevents absorption of cholesterol)

62
Q

adverse effects of psyllium

A
  • ABD cramping
  • diarrhea
  • flatulence
  • esophageal or intestinal obstruction
  • bronchospasm
  • anaphylaxis

Pharmacology (22 decks)

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