Drugs affecting the Gastrointestinal System Flashcards
Antiemetics Ondansetron
Ondansetron (brand: Zofran)
Given for nausea and vomiting
Blocks serotonin receptors to stop nausea
Can cause serotonin syndrome: Agitation, tachycardia, hypertension, muscle rigidity
Antiemetics Ondansetron Side effects
Headache
Dizziness
Priority side effect: Torsades de pointes
Antiemetics Ondansetron Key points
Give before chemo
before or with pain meds that may cause nausea
During chemo infusion child reports nausea and vomits. Priority nursing action?
Stop the chemo, flush the line and administer ondansetron
Antiemetics Metoclopramide
Metoclopramide (brand: reglan)
Given for nausea and vomiting
Delayed gastric emptying gastroparesis
Contraindicated GI bleed
Antiemetics Metoclopramide Adverse Side effects
Dyskinesia
Question order and report to HCP if..
Lip smacking
puffing of cheeks
Blinking of eyes
Pertruding tongue
Antiemetics Metoclopramide Common Side effects
No need to report
Sedation
Fatigue
Restlessness
Headache
Sleeplessness
Dry mouth
Constipation
Diarrhea
Constipation: Stool softeners and laxatives
Contraindicated for Bowel obstruction huge risk for death
Psyllium Husk
Milk of magnesia
Sodium Docusate Colace - increased water content in the bowel
Teaching: increase fluid, fibre and walking
Lactulose
Loosens the bowels to lower ammonia levels
Laxative
Ammonia levels decrease
Cognition returns - improved mental status
Given to decrease ammonia levels in cirrhosis patients
Treats hepatic encephalopathy
poops out ammonia (explosive diarrhea)
ammonia levels decrease via bowel not urine
Does not decrease portal HTN
Abdominal distention will not improve with lactulose
2-3 stools per day
Improved mental status
Diarrhea ad loose stools are not indicators that ammonia levels are decreasing only indicator is improved mental status
Sodium polystyrene sulfonate
Brand: Kayexalate
Given for Hyperkalemia
Helps the large intestine to remove excess K+ within the body
PO is most effective
Sodium polystyrene sulfonate Nursing caree e
Insure proper bowel function before administration to prevent
intestinal necrosis
Assess the abdomen
Recent bowel patterns and frequency of stools
Potassium within normal limits if drug is effective
Monitor for hypokalemia
Drink fluids after administration
Bowel function is top priority
Loperamide
Brand: Imodium
Opioid Anti-diarrheal
given for active diarrhea
makes bowels low and slow, watch for constipation
Dicyclomine
Brand: betyl
Given for IBS
Helps to give bowels on regular schedule
Side effect: constipation, dry mouth, urinary retention
Anticolligeric
Dicyclomine Contraindication
Not paralytic ileus or bowel obstruction
Not for narrow angle glaucoma, cataracts are okay
Not for someone with urinary retention
Sulfasalazine
Given for Inflammatory bowel disease
Crohn’s disease
Colitis
Decreases colon inflammation
Immunosuppressant to help the body stop attacking itself
Yellow/orange discolouration of the skin and urine = normal
Sulfasalazine Adverse effects
Photosensitivity
Kidney stones
Low urine output - dehydration, elevated urine specific gravity
Drink 8 glasses of water
Take folic acid supplements
Acid Prevention
Antacids
PPI
H2 Blocker
Used for fast immediate relief
Dont mix with other meds
Antacids
Sodium Bicarbonate (brand: alka-seltzer)
Calcium carbonate (brand: tums)
Aluminum Hydroxide
both may cause constipation
Magnesium Hydroxide (brand: milk of mag)
May cause diarrhea
Used for fast immediate relief
Don’t mix with other meds
1 hour before or after other meds
H2 Blockers
Histamine 2 receptors antagonist
Turns down the volume of acid production
Ranitidine (brand: Zantac)
Famotidine (brand: Pepcid)
Take 30min before meals
Given for Gerd and ulcers
Blocks H2 receptors in the stomach
Don’t overeat
Avoid stress
No smoking
No NSAIDS
Sucralfate
Mucosal Protectant
Treat and prevent small intestine ulcers
Thick layer off the ulcer
Take on empty stomach 1-2 hours before or after food and meds
DONT take with any other meds
Best at bedtime
Misoprostol
Mucosal Protectant
Not for pregnant risk
Helps against gastric ulcers
Patients on long term NSAID therapy
Always pregnancy test on this drug, drug increases cervical ripening
Reliable birth control is a must
if pregnancy is suspected stop the med and report to HCP
Do not take with antacids
Proton Pump Inhibitor
Omeprazole (brand: Prilosec)
Esomeprazole (brand: Nexium)
Pantoprazole (brand: protonix)
Key points PPI
Prazole
Prevents holes “stress ulcer prophylaxis”
Porous bones - regular bone density tests
Possible GI infection - C-diff
Indication: heart burn and Gerd
prevents development off ulcer due to stress of surgery or hospital stays
Take 30min before meals
Activated Charcoal
initial treatment of salicylate toxicity (aspirin)
Aspirin overdose
binds to aspirin and inhibits absorption
Signs and symptoms of aspirin toxicity
Altered mental status with disorientation and restlessness
Vomiting
Hyperventilation
Pancrelipase
Helps break down food
Replace digestive enzymes in cystic fibrosis
Must be eaten with every meal and snack or med is not effective
Open capsule and sprinkle contents soon food without chewing
Reduction of fatty stools is an expected outcome
IRON
Ferrous sulfate (oral)
Iron Dextran (IV/IM)
Treatment for anemia and iron dificency
Dark and black stool = normal and expected
Take on empty stomach 1 hour before medication, because it blocks absorption of other meds
B12
Cyanocobalamin
Prenicious anemia
Folic Acid
Anemia
Alcoholics that lack nutrients
patients that are taking sulfasalzine
Pregnant patients: pevents neural tube defects
Herbal Supplements Bleed risk
Vitamin E
Ginger
Garlic
Ginkgo biloba
Ginseng
Omega 3
Glucosamine
watch for hypoglycaemia
Treats joint and arthritic pain
Hawthorn Extract
Treats HF and hypertension
Evening Primrose
Eczema/skin irritation
Saw palmetto
Treats BPH
not used for hot flashes
Black cohosh
Menopause
Hot flashes
All supplements nursing care
Assess for interactions with clients other meds
Priority drug to drug interactions
Stop 2-3 weeks before surgery
Valerian
Mental - depression and insomnia
Valium effects
St John wort
Serotonin, mental depression and insomnia
Caution: for serotonin syndrome
Stay away from other antidepressants
Do not mix: antidepressants, SSRI’s, MAOIs, TCAs
Decreases INR and effectiveness of digoxin
Serotonin Syndrome Signs and Symptoms
Mild: shivering/diarrhea
Severe signs:
Muscle rigidity/fever
Seizures
Death
