C7- Upper GI Medications Flashcards
Anti-Emetics:
Reduce Nausea
Prevent vomiting
ID cause first
Serotonin antagonist Generic medication name
Odansetron
Ondansetron mechanism of action
Prevent emesis by blocking serotonin (5HT) receptors in the chemoreceptor trigger zone
Ondansetron therapeutic effects
chemotherapy
radiation
postoperative recovery
Ondansetron administration:
Give 30mins prior to chemotherapy or anesthesia emergence
Ondansetron Side effects:
Headache
Constipation/diarrhea
Dizziness/sedation
Ondansetron Nursing Considerations (contraindications)
Pregnancy category B
Dopamine Antagonist (generic name) (2)
Prochlorperazine
Promethazine
Prochlorperazine/Promethazine mechanism of action:
Prevent emesis by blocking dopamine receptors in the CTZ
-also by blocking histamine (H1)
Therapeutics associated with Prochlorperazine/Promethazine:
Prevent emesis after:
chemotherapy
opioids
postop recovery (anesthesia)
Prochlorperazine/Promethazine administration guidelines:
Give 30min prior to
chemotherapy
anesthesia emergence
Prochlorperazine/Promethazine side effects
Extrapyramidal Symptoms
restlessness
anxiety
spasms of face and neck
Hypotension
Sedation
Respiratory depression
IV infiltration
causes tissue necrosis
Prochlorperazine/Promethazine Nursing considerations (side effects)
Extrapyramidal Symptoms
Hypotension
Sedation
Prochlorperazine/Promethazine Contraindications
Children and older adults
increased risk of Extrapyramidal symptoms
Extrapyramidal Symptoms (define)
Involuntary movements such as
lip smacking, frowning/scowling
blinking, sticking out tongue
shaking of arms and legs
Pro-Kinetic Agents Generic name
Metoclopramide
Metoclopramide mechanism of action
Block dopamine and serotonin in CTZ
Augment action of acetylcholine to increase GI motility
Accelerates intestinal transit and promotes gastric emptying
Metoclopramide Side effects
Extrapyramidal symptoms
Diarrhea/constipation
Sedation
Insomnia
Metoclopramide Contraindications
GI bleeding/perforation
Bowel obstruction
Metoclopramide Interactions
Opioids
Anticholinergics
Metoclopramide and tube feedings
Promote gastric motility with tube feedings
Anticholinergic antiemetic generic name
Scopolamine
Scopolamine mechanism of action
Interferes with transmission of impulses from vestibular apparatus to the vomit center
Blocks
vagus nerve
Scopolamine Route of administration
Transdermal patch (3-day patch)
Give 30 mins prior to motion
Scopolamine Therapeutics:
Best for motion sickness
Scopolamine Side effects:
Sedation
Anticholinergic effects
Constipation
Dissociation/dysphoria
avoid using in clients w/ mental health disorders
Hypotension
use cautiously with cardiovascular disorders
Scopolamine Contraindications
Mental health disorders
Cardiovascular disorders
Antihistamine generic name
Meclizine (Dramamine) — over the counter
Meclizine mechanism of action
Inhibit vestibular stimulation IN THE INNER EAR
Meclizine Therapeutics
Relieve nausea symptoms of
motion sickness
vertigo
dizziness
*Minimal effect on chemotherapy nausea
Meclizine Side effects
Sedation
Fatigue
Dry mouth
Dissociation/dysphoria
avoid w/ mental health disorders
Hypotension
use caution cardiovascular disorders
Nausea Nursing interventions: Teaching
-use with caution (especially OTC)
-consult MD if pregnant
-avoid alcohol
-avoid hazardous tasks
Nausea nursing interventions: Nurse actions
Respect
client’s requests for alternative methods for treating nausea and vomiting
Monitor
bowel sounds
hydration input/output (I/O)
Nausea Non-pharmacologic Measures
Fresh air
Slow deep breathing
Carbonated soda
Tea
Crackers
Ginger
Peppermint
Lavender
Acupressure
High flow O2
Hydration/Fluids
Frequent oral care
What is a Peptic Ulcer?
A circumscribed lesion i the mucosal membrane
developing in
lower esophagus
stomach
duodenum
Jejunum
Common causes of peptic ulcers
GERD
acid reflux
Common cause of gastric ulcer is the breakdown of the gastric mucosal barrier
Secretory Functions of the Stomach lining:
Parietal cells secrete HCl acid
Chief cells secrete pepsinogen
Mucoid cells secrete mucous
Aggressors of Peptic ulcers:
H. Pylori
NSAIDS/steroids
take with food
Acid
Pepsin
Smoking
Defensive factors of Peptic Ulcers
Mucus
Bicarbonate
Blood flow
Prostaglandins
Production of gastric acid is stimulated by three endogenous compounds:
Acetylcholine acting at muscarinic receptors
Histamine acting at histamine 2 receptors
Gastrin acting at gastrin receptors
Anti ulcer drug therapy
Antibiotic
Antisecretory agents
Mucosal protectants
Antacids
Histamine (H2) receptor antagonist generic names:
Famotidine
Cimetidine
Famotidine action
Suppress secretion of gastric acid by blocking histamine 2 receptors
Famotidine side effects
Pneumonia/aspiration
Headache
Diarrhea
Nausea
Decreased libido
Impotence
Famotidine Interactions
Antacids reduce absorption
(Take 1-2 hours apart)
Famotidine administration
Take with or immediately following meals
3X/day
before each meal
before bedtime
Famotidine Onset
30-60 mins
Famotidine peak
1-3 hours
Famotidine Duration
6-12 hours
Famotidine pregnancy category
B
H2 blockers end in
_____TIDINE
Proton Pump Inhibitors Generic Name(s):
Pantoprazole
Omeprazole
Lansoprazole
Proton Pump Inhibitors end in
___PRAZOLE
Pantoprazole/omeprazole/lansoprazole action
Irreversible inhibition of the H+K+- ATPase (proton pump)
Pantoprazole/Omeprazole/Lansoprazole Side effects:
Headache
Diarrhea
Nausea
Pneumonia
Pantoprazole/Omeprazole/Lansoprazole long term side effects
Gastric cancer
Hip fractures/osteoperosis
reduced absorption of Ca++ ions
Pantoprazole/Omeprazole/Lansoprazole administration:
Once a day dosing
Pantoprazole/Omeprazole/Lansoprazole Drug interactions
Highly protein bound
use caution with other protein bound drugs
Pantoprazole/Omeprazole/Lansoprazole pregnancy category
C
Goal of antacid therapy
Neutralize the acid
Inhibit pepsin activity
Increase resistance of the stomach lining
Increase tone of lower esophageal sphincter
Ulcers & GERD Non-pharmacologic Measures:
Avoid tobacco
Weight loss
Take NSAIDS and glucocorticoid with food or decreased dosage
Sit upright
Do not eat before bedtime
Do not recline after eating
Wear loose fitted clothing
Ulcers & GERD Eating Pattern:
5-6 small meals can reduce fluctuations in gastric pH
Avoid hot/spicy/greasy food
Avoid alcohol
Pepsin Inhibitor generic name
Sucralfate
Sucralfate Action
Coats & creates protective barrier over ulcer
prevents pepsin from digesting stomach wall
Sucralfate administration
1 hour before meals
on an empty stomach
acid environment necessary
1-2 hours between other drugs
Sucralfate Side Effects
Constipation
Sucralfate Interactions
Decreases absorption of other medications
give 2 hours before or after
Antacid- Aluminum compounds
Aluminum hydroxide
Antacid- Magnesium Compounds:
Magnesium hydroxide
Antacid- Calcium Compounds
Calcium carbonate
Antacid- Combinations (Al-Mg-OH)
Magaldrate
Maalox
Antacid Action
Neutralize stomach acid
Antacid dosing
1-3 hours after meals & bedtime
Antacid- Side effects
Constipation
aluminum and calcium
White streaks in stool
aluminum
Diarrhea
magnesium
Hypernatremia/fluid retention and alkalosis
sodium bicarbonate
Antacid- Interactions
Alter absorption to many medications!!
Antacid- Teaching
Do not take indiscriminately or switch antacids without prescriber’s consent
Antacids can hide symptoms of more serious nature
Don’t take other medications at same time as antacids
Shake suspension form well before taking it
Some antacids may color stools white or cause white streaks
