Chapter 83: Other GI Drugs Flashcards
antiemetics are given
to supress nausea and vomitng
ematic response
complex reflex that occurs after activation of vomiting center in the medulla oblongata
what receptors are involved in the emetic response
- seratonin glucocorticoids, substance P, neurokinin, dopamine, acetylcholine, histamine
dopamine D2 antagonists examples
prochlorperazine
seratonin antagonists example
ondansetron
antihistamines (h1 antagonists) example
dimenhydrinate
glucocorticoids examples
dexamethasone
neurokinin 1 receptor antagonists examples
aprepitant
cannabinoids examples
- dronabinol
antiemetic drug classes
- dopamine antaginists
- seratonin antagonists
- antihistamines
- anticholinergics
- benzodiazepine (GABA)
- glucocorticoids
- neurokinin 1 receptor antagonists
- somatostatin analogues
- cannabinoids
Seratonin receptor antagonists is used for
chemotherpay induced nausea and vomiting (aka antineoplastic induced)
- associated with radiotherapy and anesthetia
- severe morning sickness in pregancy
Serotonin receptor antagonists MOA
blockes 5-HT3 on afferent vagal nerve
seratonin receptor adverse effects
headache, constipation, prolonged Qt interval, seratonin syndrome
Glucocorticoids are used for
short term for more serious nausea and vomiting
- post opp
Neurokinin receptor antagonists are used for
prevention of postperative nausea and vomiting and CINV
neurokinin receptor antagonists –> Aprepitant [emend] side efects
fatigue, dizziness, GI upset, possible liver injury
neurokinin receptor antagonists –> Aprepitant [emend] drug interactions
oral contraceptives become ineffective , warafarin
three primary benefits of Benzodiazepines –> lorazepam [Ativan]
- sedation
- supression of anticipatory emesis
- production of antrograde amnesia
Dopamine antagonists –> prochlorperazine [Stemetil] side effects
- extrapyramidal reactions
- anticholinergic effects
- hypotension and sedation
Dopamine antagonists –> metoclopramide [Reglan, Maxeran] is used for
postoperative nausea and vomiting, opiods, toxins, radiation therapy. SOmetimes used in hyperemesis gradivarum
Cannabinoids
- Dronabinol [Marinol]
- nabilone [cesamet]
is used for
CINV or for appetite stimualtion
Cannabinoids
- Dronabinol [Marinol]
- nabilone [cesamet] adverse effects
drowsiness, tachycardia, hypotension
Cannabinoids
- Dronabinol [Marinol]
- nabilone [cesamet]
adminstration
oral capsules
what are the three types of CINV emesis
- anticipatory
- acute
- delayed
anticipatory
occurs before drugs are given
acute
- onset within minutes to a few hours
delayed
onset 1 day or longer after drug adminstration
hyperemesis gravidarum
- dehydration, ketonuria, hypokalemia, loss of 5% or more of body weight
first line therapy drugs for nausea and vomiting in pregancy
Doxylamine plus vitamin B
drugs used in nasuea and vomiting in pregnancy
Doxylamine
- prochlorperazine, metoclopramide, and andoansetron
drugs for motion sickness
Scoplamine [Teansderm-V]
Scoplamine [Teansderm-V] side effect
- dry mouth
- blurred vision
- drowsiness
Scoplamine [Teansderm-V] administration
transdermal patch
antihistamines
- Dimenhydrinate [gravol]
- meclizine [bonamine]
side effects
- sedation
- dry mouth, blurred vision, urinary retention, constipation
what is the most commonly used anti-emetic
dimenhydrinate
diarrhea causes
- infection, maldigestion, inflammation, functional disorders of the bowel
diarrhea complications
dehydration and electrolyte depletion
what are the two major groups of antidiarrheals
- specific antidiarrheal drugs
- nonspecific antidiarrheal drugs
opiods
- loperamide [imodium] is used for
diarrhea and to reduce the volume of discharge from ileostomies
Nonspecific antidiarrheal agents
- paregoric
- opium tincture
- bismuth subsalicylate [pepto bismol]
- bulk forming agents (fibre)
- anticholinergic antispasmodics (atropine)
travellers diarrhea is mainly caused by
ingestion of food/beverages contaminated with pathogens
- escherichia coli
escherichia coli
- usually self limiting
- symptoms include nausea and vomiting, fever, cramps
travelers diarrhea treatment
- ciprofloxacin
- norfloxacin
- bismuth subsalicylate
IBS is characterized by
cramping and abdominal pain, nausea; bloating and heartburn
IBS red flags
- fever
- weight loss over 10lbs
- bleeding rectal / stools
- new symptoms in clients under 50
- severe symptoms
IBS differential diagnosis
- IBD
- infectious diarrhea
- colorectal polyp/cancer
- CBC, ESR, CRP, Celiac stool occult blood
what are the 4 groups of drugs used for IBS
- antispasmodics
- bulk forming agents
- antidiarrheals
- tricyclic antidepressants
IBS cause
unknown casue
Linaclotide [constella] use
IBS
Linaclotide [constella] MOA
- gaunylate cyclase agonist
- induces intestinal and bicarbonate secretion resulting in increased intestinal motility
Linaclotide [constella] adverse effect
diarrhea, abdominal pain
Linaclotide [constella] dose
72-290mcg daily teken 30 mins before first meal of the day
eluxadoline [viberzil] use
IBS-D in adults
eluxadoline [viberzil] MOA
mixed mu opioid receptor agonist and delta antagonist
eluxadoline [viberzil] adverse effects
Gi (constipation), dizziness, fatigue
eluxadoline [viberzil] warnings
pancreatitis in glients without gullbladder
eluxadoline [viberzil] dose
100 mg BID with food
Inflammatory Bowel Disease (IBD)
- crohns disease
- ulcerative colitis
crohns disease
- characterized by transdermal inflammation
- usually affects terminal ileum
- severity diffrences: pain level, types of meds
Ulcerative colitis
- inflamamtion of mucosa and submucosa of the colon and rectum
- may cause rectal bleeding
- severity diffrences: <4 to >10 stools per day
Drugs for IBD
- 5 Aminosalicylates (sulfasalazine; 5-ASA)
- glucocorticoids (hydrocortisone; prednisone)
- immunosuppressant (azathioprine)
- Immunomodulators (infliximab)
- antibiotics
5 aminosalicylates example
Sulfasalazine [Salazopyrin]
Sulfasalazine [Salazopyrin] is used for
acute episodes of mild to moderate ulcerative colitis; also used during admission
Sulfasalazine [Salazopyrin] adverse effects
nausea, fever, rash, hematological
budesonide [entocort] is used for
mild to moderate crohns disease that involves the ileum and ascending colon
prolonged use of glucocorticoids can cause
severe adverse effects, including adrenal suppression, osteoporosis, increased susceptibility to infection, and a cushingoid syndrome
immunosuppressants example
Azathioprine [Imuran]
Azathioprine [Imuran] is used for
induce and maintain remission in both ulcerative colitis and crohns disease
Azathioprine [Imuran] adverse effects
pancreatitis and neutropenia
immunomodulators examples
Infliximab [Remicade]
Infliximab [Remicade] is used for
moderate to severe crohns disease and can be used for ulcerative colitis
Infliximab [Remicade] adverse effects
infections, infusion reactions, increased risk of lymphoma
antibiotics is crohns disease
can help control symptoms
antibiotic use in ulcerative colitis
antibiotics largely ineffective
antibiotics example
- metronidazole [flagyl]
- ciprofloxacin [cipro]
metronidazole [flagyl]
- long term therapy is required
- prolonged use of high dose risk of peripheral neuropathy
Ciprofloxacin [Cipro]
highly effective in patients with mild or moderate crohns disease
prokinetic agents
increase tone and motility of GI tract
supress emesis
prokinetic agents examples
Metoclopramide [Reglan, Maxeran]
Metoclopramide [Reglan, Maxeran] uses PO
diabetic gastroparesis and suppression of gastroesophageal reflux
Metoclopramide [Reglan, Maxeran] therapeutic uses IV
supression of postoperative nausea and vomiting, supression of CINV, faciliation of small bowel intubation and facilitation of radiologic examination of GI tract
Metoclopramide [Reglan, Maxeran] adverse effects
- high dose therapy: sedation, diarrhea common
- long term high dose therapy: can cause irreversible tardive dyskinesia (TD)
pancreatic enzymes is used for
deficency of digestive enzymes
Pancrelipase mixture
lipase, amylases, and proteases prepared from hog pancreas
pancreatic enzyme example
Pancrelipase
Pancrelipase adverse effects
abdominal discomfort, flatulence, headache, diarrhea, cramping
Pancrelipase administration
dose individually; taken with every meal and snack
Anorectal preparations
- symptomatic relief of hemorrhoids and other anorectal disorders
anorectal preperations examples
- local anesthetics (pramoxine)
- anti inflammatory (hydrocortisone)
- emollients (glycerin)
- astringents (witch hazel)
