Antiemetics, Antidiarrheals & Laxatives Flashcards
Bismuth Subsalicylate
- OTC antiemetic
- Liquid or chewable tablet
MOA:
- Adsorbs bacteria & toxins that are causing nausea
- Coats the wall of the GI tract
Indication:
- Nausea
Secondary Uses:
- Diarrhea & indigestion
Contraindication:
- Pregnancy (teratogenic)
- Never use for <19 because it can cause Reye’s Syndrome
- Avoid if allergic to ASA or NSAIDs
Side Effects:
- Slurred speech
- Hearing loss
- Vision problems
- AMS
- Muscle spasms
- Black discoloration of stool & tongue (harmless & temporary)
Nursing:
- Decreases absorption of other drugs so avoid taking other drugs with it
“Stop Having Visions About My Brother Tom”
Diphenhydramine
- First Gen Antihistamine
- PO, IV, IM
- Cross the BBB –> will affect the CNS
MOA:
- Inhibits vestibular stimulation in the inner ear
Indication:
- Nausea
Secondary Uses:
- Insomnia & motion sickness
Side effects:
- CNS: depressant, drowsiness, dizziness, fatigue, disturbed coordination (FALL RISK)
- PNS: anticholingeric effects (bear)
- Monitor for toxicity: excitation, hallucinations & seizures
Contraindications:
- pregnancy, lactation, newborns, children & older adults - - urinary retention, BPH, glaucoma & HTN also contraindicated because of bear effects
Nursing:
- assess breathing (CNS depressant = respiratory depression)
- VS (bear effects)
- I/Os (bear effect; urinary retention)
CNS depression:
- assess breath sounds
- avoid driving, watch for hangover effect, avoid other CNS depressants (ETOH, codeine)
- Warn against combination medications (decongestants)
Promethazine
- First Gen Antihistamine
- PO, IV, IM
- Cross the BBB –> will affect the CNS
MOA:
- Can act via ACh
- Inhibits vestibular stimulation in the inner ear
- Can also block dopaminergic receptors in the intestine & CTZ
Side effects:
- CNS: depressant, drowsiness, dizziness, fatigue, disturbed coordination (FALL RISK)
- Dopaminergic CNS: seizure, EPS, memory impairement (peds & geri)
- PNS: anticholingeric effects (bear)
- Monitor for toxicity: excitation, hallucinations & seizures
Indication:
- Nausea, Meniere’s Disease, allergies
- Nausea with chemo, opioids & anesthesia
Secondary Uses:
- Insomnia
- Motion sickness
Contraindications:
- pregnancy, lactation, newborns, children & older adults
- Urinary retention, BPH, glaucoma & HTN also contraindicated because of bear effects
- Other CNS depressants & stimulants
Nursing:
- assess breathing (CNS depressant = respiratory depression)
- VS (bear effects),
- I/Os (bear effect; urinary retention)
CNS depression:
- Assess breath sounds
- Avoid driving, watch for hangover effect, avoid other CNS depressants (ETOH, codeine)
- Warn against combination medications (decongestants)
- Vesicant: insure for IV patency
- Promethazine has high risk for extravasation
Scopolamine
- Anticholinergic
- Antiemetic
MOA:
- inhibits vestibular stimulation in the inner ear
Indication:
- Nausea
- Motion sickness
- Meniere’s Disease
- Allergies
Side Effects:
- CNS depressant = drowsiness
- memory impairment (caution in older adults & chronic respiratory diseases)
Ondansetron
- IV, IM, ODT
- Serotonin antagonist
- Antiemetic
MOA:
- Blocks CTZ center in the brain & visceral stimulation
Side Effects:
- HA
- Diarrhea
- Dizziness
- Fatigue
Adverse Reaction:
- Dysrhythmia
Nursing:
- Heart monitor
- Avoid with hx of dysrhythmia
- Well tolerated; drug of choice for nausea associated with chemo, opioids & anesthesia
“Frick Dan Had De-habilitating Diarrhea”
Lorazepam & Midazolam
- Benzos; CNS depressants
- PO, IM, IV
- Schedule IV
MOA:
- GABA stimulation
Indications:
- Most often for chemo related nausea
- Sedative (anxiolytic; prevents ETOH withdrawal symptoms)
- Epilepsy (anti epileptic)
- Spasms (muscle relaxant)
- Insomnia (hypnotic)
- Anesthesia induction (sedative/hypnotic)
Side Effects:
- Lethargy
- Poor balance
- Respiratory suppression
- FALL risk
- Much less risk of dependence
- Reversal Agent = Flumazenil
“Lets Play Real Football” & a lot of football players drive benz
Glucocorticoids
Drugs:
- Methylprednisolone (IV)
- Dexamethasone (PO)
Routes:
- IV & PO
MOA:
- Unknown
Indication:
- Nausea associated with chemo; “premedication”
Side Effects:
- Hyperglycemia
- Leukocytosis
- Immunosuppressant
- Water & Na retention –> hypokalemia, increased IOP (worse glaucoma)
- SubQ tissue loss
- Adrenal suppression
- Osteoporosis
Dronabinol
- Cannabinoid; active ingredient in marijuana
- Schedule III
Indication:
- N/V secondary to chemo
- Appetite stimulant for AIDS & failure to thrive
Contraindication:
- Psychiatric disorders
Side Effects:
- Mood changes, euphoria
- Drowsiness, dizziness
- HA
- Depersonalization
- Nightmares
- Confusion, incoordination, memory lapse
- Dry mouth
- Orthostatic hypotension
- Tachycardia
- FALL risk
Nursing for Antiemetics
- If able to tolerate PO intake, encourage clear liquids
- If not able to tolerate PO intake, call to replace with IV fluids & IV electrolytes
- Non-pharm always before & along with drugs
- Avoid polypharmacy with OTC & Rx
- Avoid ETOH with antiemetics (risk of over-sedation)
- Avoid antiemetics during pregnancy
Ipecac Syrup
- Emetic
MOA:
- Stimulates CTZ & acts directly on gastric mucosa
Indication:
- May induce vomiting if:
1) if <60 min after ingestion
2) if no antidotes available
3) if no risk of aspiration
4) if ingested substance is not caustic/erosive to the mucous membrane
Nursing:
- Risk for abuse in anorexia nervosa pts
“IpeYAK”
Activated Charcoal
- Used instead of inducing vomiting
- PO, via NG tube
- With or without sorbitol
MOA:
- Adsorbent
Side Effects:
- Constipation
- Bowel obstruction
- Can be used with gastric lavage (if toxin ingestion <60min & if indicated)
Opiate Related Agents
- Antidiarrheal
Medication:
- Diphenoxylate with Atropine (OTC, Rx)
- Loperamide (OTC)
MOA:
- dec peristalsis by activating opioid receptors in the GI
Indication:
- Antidiarrheal
Contraindication:
- Glaucoma/BPH (atropine)
- Using antidiarrheals > 2 days
- If fever with unknown etiology is present
- If the etiology of diarrhea is unknown
Side effects, Adverse reactions:
- CNS & respiratory depression (especially children, older adults, & polypharmacy)
- Physical dependence (short-term use only)
Interactions:
- ETOH
- Other CNS depressants
- Atropine added to discourage abuse since diphenoxylate is a synthetic opioid & for its anticholinergic effects on GI
Adsorbents
- Antidiarrheal
Drugs:
- Bismuth Subsalicylate (also an antiemetic)
- Cholestyramine (also an anti-hyperlipidemia)
- Activated charcoal
MOA:
- Coats the wall of the GI tract & absorbs bacteria & toxins
Lactobacillus Acidophilus
- PO
MOA:
- Replacing normal flora of the GI tract
- Reduces colonization by pathogenic bacteria
Indications:
- Abx use (loss of normal flora)
- IBS, UC, C.diff infection
Nursing:
- Administer at least 2 hours apart from abx
Nursing for Antidiarrheals
- Assessment: BM consistency, frequency & quantity
- Bowel sounds
- Prior to administering antidiarrheal collect stool sample to rule out C.diff, OB, C&S & O&P
- Monitor VS trend for hypovolemia & shock
Patient Education:
- Only for short term use (48 hours)
- Increase fluid intake (PO or IV)
Laxative Indications
Therapeutic/prophylactic treatments for constipation associated with
- Opioid use
- Pregnancy
- Prevent painful BM with hemorrhoid or post episiotomy
- Prevent straining (with aneurysm or MI)
- Evacuation of bowl (prep for colonoscopy, post-ingestion of poisons)
Laxative Contraindications
- With other enteral meds (separate for at least 2 hours)
- Abd cramping/pain, N/V
- Fecal impaction, bowel obstruction, ischemic bowel
- Biliary obstruction, appendicitis, diverticulitis, GI bleed
Hyperosmolar Saline
- Osmotic Laxatives
Medication
- Polyethylene glycol (PEG): PO drink
- Polyethylene glycol (PEG) with electrolytes: PO drink
- Magnesium hydroxide, PO drink, also antacid
- Saline Enema
MOA:
- Pull more water into the intestine (osmotic effect)
Indication:
- Quick treatment, results within 2 hours
- Colonoscopy prep
Contraindication:
- Polyethylene glycol (PEG): using > 1 week
- RF (need renal function renal function to excrete excess electrolytes)
- Children < 2
Side effects
- Hypermagnesemia: cardiac arrest (monitor serum Mg)
- Hypovolemia (monitor VS trends of low BP with tachycardia)
Nursing Interventions:
- Monitor for abnormally high level of electrolytes
Stimulants/Irritants
- Stimulants/Irritants
Medication:
- bisacodyl (OTC PO, suppository)
- senna (OTC PO)
- castor oil (OTC PO)
MOA:
- Increase peristalsis by irritating sensory nerve endings in intestinal mucosa
Side effects:
- Anorexia, N/V, cramps, weakness, reddish brown urine
- Dependence
- Suppository = proctitis: inflammation of the rectum and anus, burning sensation
Interactions:
- Avoid milk or antacid with PO form (at least 1 hour apart)
Nursing:
- Quick treatment
- PO: 6-12 hours
- PR: 15-60 minutes
“Nadia & Vlad Always Want Baked Cookies”
Soapsuds Enema
- Stimulant/Irritant
- Castile is a mild soap
MOA:
- Suds irritate the bowels increasing peristalsis
- The soap also works as an emollient
- The large volume of water increases water in the stool
- Used when other meds are not effective
Emollients (Stool Softeners)
Drugs:
- Docusate Sodium
- Docusate Sodium/Senna **
- Mineral Oil Enema (can be used for renal pts)
MOA:
- Lowers surface tension (works like surfactant)
- Promotes water penetration in the stool
- Emulsifies & lubricates feces for easier passage
- Maintenance: slow action
Psyllium
- Bulk forming
MOA:
- Natural fibers (non-absorbable) made from psyllium plant seed
- Identical action to dietary fiber
- Increases fecal bulk & softens fecal mass
Nursing:
- No risk for dependence
- Drink water to prevent bowel obstruction
- Maintenance: results in 8-24 hours
How to correct EPS?
Benztropine & Diphenhydramine
