gastrointestinal medications Flashcards
types of antacids
aluminum compounds, magnesium compounds, calcium compounds, sodium bicarbonate
antacids (general)
MOA:
I:
CI:
INT:
MOA: neutralize HCl = increase pH
I: any GI disease and as a calcium supplement
CI: renal disease/pregnant; hypercalcemia/magnesemia
INT: do not give with other meds
kinetics of antacids (general)
O:
D:
O: immediate
D: with food = 3hrs, without food 20-60min
side effects of antacids (general)
systemic imbalance (high Mg, low Phos)
Na retention
osteomalacia
diarrhea
pt education with antacids
take 2 hrs after other meds
1-3 hrs after meals
no max dose for >2weeks
keep hydrated to flush out
aluminum carbonate
C:
I:
CI:
SE:
C: antacid; aluminum compound
I: use with magnesium to counter laxative effect
CI: CHF, HTN, renal disease
SE: constipation
alka-seltzer
C:
I:
CI:
K:
SE:
C: antacid, sodium bicarbonate
I: inc urinary pH = excretion
CI: CHF, HTN, renal disease
K: onset quick, duration short
SE: metabolic alkalosis
TUMS, Rolaids
C:
I:
K:
SE:
C: antacid; calcium carbonate
I: source of dietary calcium
K: duration long
SE: constipation, belching, flatulence, kidney stone
magnesium hydroxide
C:
I:
CI:
SE:
C: antacid; magnesium compounds
I: laxative
CI: renal failure (kidney can’t rid Mg)
SE: diarrhea
omeprazole (Prilosec)
C:
MOA:
I:
CI:
INT:
SE:
C: proton pump inhibitor (PPI)
MOA: irreversible bind H+/K+/ATPase enzyme = block all HCl prod
I: most effective to dec acid
CI: crushed/opened caps, liver dis/preg/breastfeeding
INT: benzos, phenytoin, iron, dig
SE: HA, PNA, inc fx risk, malabs of calcium
what are other proton pump inhibitors ?
esomeprazole, lansoprazole, pantoprazole
t/f: omeprazole is high PB and has good bioavailability
true
education with omeprazole (Prilosec)
take 1hr before meals
long term = calcium citrate supplement
swallow whole
sucralfate (Carafate)
C:
MOA:
I:
INT:
SE:
C: pepsin inhibitor
MOA: no pepsin = no breakdown of stomach lining = protective barrier for 6hrs
I: PUD, stress ulcers
INT: not with other drugs
SE: constipation, nausea
frequency to take sucralfate (Cerafate)
QID before meals
ondansetron (Zofran)
C:
MOA:
I:
SE:
C: antiemetic; serotonin receptor antagonist
MOA: inhib type 3 serotonin receptors on afferent vagal nerve
I: prevent n/v in chemo + anes
SE: HA, prolonged QT int, torsades de pointes, dizzy
what is the first approved drug for chemo induced n/v and is better taken with dexmethasone (corticosteroid)
ondansetron (Zofran)
metoclopramide (Reglan)
C:
MOA:
I: + off label?
SE:
C: antiemetic
MOA: blocks dopamine receptors in CTZ
I: inc upper GI motility, post op n/v, off label GERD
SE: sedation, diarrhea
misoprostol (Cytotec)
C:
MOA:
I:
CI:
SE:
C: synthetic prostglandin
MOA: protect gastric mucosa = inc mucus and bicarb = inc cell regen
I: prevent NSAID ulcers
CI: pregnancy category X
SE: cramps, diarrhea
what to tell female patients with giving misoprostol (Cytotec)
take other forms of BC, drug is in pregnancy category X
cimetidine (Tagamet)
C:
MOA:
I:
CI:
INT:
SE:
C: histamine 2 receptor antag. (H2 blocker)
MOA: displace histamine from H2 receptor = no proton pump stim = no HCl
I: prevent ulcer, GERD, esophagitis, upper GI bleed
CI: elder, COPD, immunocomp = risk PNA
INT: alc, warfarin, CCB, caffeine (inc)
azoles, smoke, dig (dec)
SE: thrombocytopenia, dizziness, HA, PNA, leukemia
why is PNA a side effect of cimetidine (Tagamet)
cimetidine = H2 blocker = no HCl prod = nothing to kill bacteria from food = bacteria climbs up to resp tract = PNA
education for cimetidine (Tagament)
takes 4-6wks for ulcer to heal; continue to take
don’t use OTC bc diff potency
IV slow infusion (prev hypotension and cardiac dysrhyth)
other H2 blockers
famotidine, nazotidine
polyethylene glycol (MiraLax)
C:
MOA:
I:
SE:
C: laxative: milder osmotic
MOA: retain water + soften/swell fecal mass
I: peds and geri
SE: BM in 1-3 days, bloating, cramp, flatulence, nausea
when to expect a BM after taking polyethylene glycol (MiraLax)
after 1-3 days
lactulose
C:
MOA:
I:
does it work fast or slow?
C: laxative: milder osmotic (hyperosmotic)
MOA: breakdown by flora and CO2 = inc osmotic pressure = fluid –> stool + ammonia evacuation
I: tx of hepatic encephalopathy (gets rid of ammonia)
works fast
other hyperosmotic laxatives
glycerin
magnesium hydroxide (Milk of Magnesia)
C:
MOA:
I:
CI:
INT:
SE:
C: laxative: saline
MOA: salt –> int = retain water to inc pressure = stim stretch receptors = inc peristalsis
I: constipation, bowel prep for surgery, antacid
CI: kidney pts (can’t get rid of Mg)
INT: take other meds 2hrs apart
SE: overactive bowel #1 (cramps, diarrhea), electrolyte imb
kinetics of magnesium hydroxide (Milk of Magnesia): low dose vs high dose onset?
low dose onset = 6-12 hrs
high dose onset = 2-6 hours
when taking magnesium hydroxide (Milk of Magnesia), other meds should be taken ____ apart
2 hrs apart
what are some other saline laxatives
magnesium sulfate (Epsom Salts), magnesium citrate
mineral oil
C:
MOA:
I:
CI:
SE:
C: laxative: emollient/lubricant
MOA: lubricates int/stool = help with passage
I: peds patients
CI: warfarin
SE: malabsorption of fat sol. vitamins; oily stools
education when taking mineral oil
take on empty stomach, mix with juice
polycarbophil (FiberCon)
C:
MOA:
I:
CI:
what to remind the pt?
C: laxative: bulk forming
MOA: fibers attracts water to int = soften + stim peristalsis
I: constipation, diarrhea (forms stools)
CI: CHF, HTN
remind pt to inc water intake
kinetics of polycarbophil (FiberCon): onset?
O = 12-24hrs
docusate sodium (Colace)
C:
MOA:
I:
how to admin?
C: laxative: stool softener/surfactant
MOA: add fat + water = stool soften and build (DOES NOT STIM PERISTALSIS)
I: prevent constipation, for pts who shouldn’t strain
admin with full glass of water
what are other stool softener/surfactant laxatives?
docusate calcium (Surfak)
stimulants/irritant laxatives
name some:
MOA:
I:
CI:
SE:
cascara, senna (Senokt), castor oil, biscodyl (Dulcolax)
MOA: direct effect on nerves = inc peristalsis
I: short term use
CI: long term use, fecal obs/impaction
SE: high risk dependency, pt can’t have BM without it
polyethylene glycol - electrolyte solution (Peg-Es, Golytely)
C:
MOA:
I:
CI:
SE:
C: bowel evacuant
MOA: ostmotic agent + electrolyte = bowel evac w/o fluid + electrolyte imb
I: bowel prep for surgery
CI: constipation
SE: cramps, diarrhea, anal irritation, epigastric distress, bloating
how to tell if bowel prep has been successful?
all fecal output is clear (no traces of brown)
drugs that can increase or stimulate peristalsis
stimulants/irritants (cascara, senna, castor oil, biscodyl)
magnesium hydroxide (MoM) - saline laxative
polycarbphil (FiberCon) - bulk forming laxative
drug that does NOT stim peristalsis?
docusate sodium (Colace)
