GI

Question 1

Polyethylene Glycol (with or without electrolytes)
Osmotic Laxative

Answer 1

PO
Used for bowel preparation before medical labs and colon surgery
Safe for renal impairment
Need to drink 3-4L of the med in 3 hours
Onset is 1-2 hours

Question 2

Lactulose
Osmotic Laxative

Answer 2

Reduces serum ammonia levels with patients that have liver disease
Takes 24-28 hours to work

Question 3

Bisacodyl (Dulcolax)
Stimulant laxative

Answer 3

OTC drug
Given as a suppository
15-60 minute onset
Taken orally - 6 to 12 hour onset
For peristalsis
BUN and serum creatinine checked before administering - KIDNEYS

Question 4

Psyllium (Metamucil)
Bulk-forming laxative

Answer 4

Used to make large soft stools - enhances movement through bowels
Cannot be absorbed
BM happens within 18-24 hours
Peak 1-3 days
Onset 12-17 hours
Give with 8 oz of water. Don’t give with milk, antacids, or juices.
Sticky solution mixed with water.
Watch for bronchospasms and bloating

Question 5

Mineral Oil
Emollient Laxative

Answer 5

Can help reduce injury from exertion while pooping
Fat soluble vitamins A, D, E, K are absorbed by mineral oil
Take at bedtime

Question 6

Emollients/Stool Softeners

Answer 6

They are prescribed for patients after surgery, delivery of a baby, or myocardial infarction.
Mineral Oil and Docusate Sodium, Docusate Calcium.
Mineral oil is the first line of treatment.

Question 7

Lubiprostone
Selective Chloride Channel Activator

Answer 7

Activates small intestines. It is for treatment of chronic constipation, opioid induced constipation, and treatment of IBS constipation in women over 18 YO
Take with food and water
Can get UTI, URI, and severe diarrhea
Metabolizes in Jejunum

Question 8

Glycerin
Osmotic Laxative

Answer 8

Rectal only

Question 9

Bismuth Subsalicyate (Pepto Bismol)
Absorbent Antidiarrheal

Answer 9

Adverse Effects: constipation, confusion, metallic taste, BLUE GUMS, BLACK TONGUE, increases bleeding time.
Don’t give to children with viral illness. - contains aspirin
Turns stool black

Question 10

Absorbent Antidiarrheals

Answer 10

Don’t give absorbents with other medications

Question 11

Cholestyramine
Absorbent Antidiarrheal

Answer 11

Avoid any drugs or medication for 2 hours

Question 12

Absorbent Antidiarrheal Names and MOA

Answer 12

Destroys bacteria and toxins
Pepto-bismol, activated charcoal, aluminum hydroxide, cholestyramine, polycarbophil

Question 13

Anticholinergic Antidiarrheals

Answer 13

Dries and slows down movement
atropine, hyosycamine
Don’t give with antacids or milk
Increase fluid intake, chew sugarless gum.

Question 14

Antidiarrheals - general teaching

Answer 14

Report any pain or abdominal distention
Don’t give to pregnant women, patients with glaucoma, liver disorders, or ulcerative colitis.
Avoid CNS depressant medications.

Question 15

Probiotics

Answer 15

Lactobacillus acidophilus, lactobacillus GG, sachromyres boulardii
Usually found in cultured milk and yogurt products.

Question 16

Opiate Antidiarrheals

Answer 16

Slows motility, helps with pain and cramping. Increases absorption of water and electrolytes.
Opium tincture, paregoric, codeine, diphenoxylate HCL (lomotil), Loperamide hyroxychloride.

Question 17

Loperamide hydroxychloride
Opioid Antidiarrheal

Answer 17

OTC
Reduces electrolyte and fluid loss.
similar to diphenoxylate HCL.
Less CNS problems.
Onset:1 hour
Action: 24 hrs
Helps with acute and chronic diarrhea for IBS.
Also known as Immodium

Question 18

Atropine & Hyosycamine
Anticholinergic Antidiarrheals

Answer 18

Avoid driving
Side effects - can’t see, pee, shit, spit, tachycardia
monitor ECG and I&O
Atropine - BEERS. Given pre-op to decrease oral & respiratory secretions
Hyosycamine - Treats IBS symptoms

Question 19

Paragoric
Opioid Antidiarrheal

Answer 19

Amylase and Lipase levels elevate

Question 20

Vomiting - Emesis

Answer 20

Occurs when the chemoreceptor trigger zone in the brain sends neurotransmitter signals to the vomiting center in the brain.
The GI tract, inner ear, and the cerebral cortex can send the signal to the chemoreceptor.

Question 21

Meclizine hydrochloride (antivert)
Antihistamine Antiemetic

Answer 21

Well absorbed in the GI tract.
Associated with use for motion sickness
OTC
Blocks cholinergic stimulation of the vestibular and reticular system.
Onset: 1 hour
Duration: 8-24 hours
Treatment of vertigo
Take 1 hour before travel
PO 4 times daily
ADVERSE EFFECTS - rash, CNS depression
CANT’S - see, pee, spit, shit

Question 22

Scopolamine
Anticholinergic Antiemetic

Answer 22

Treats motion sickness and prevents postop nausea and vomiting.
Binds to acetylcholine receptors in the nuclei in the brain
Onset: 1-2 hours
Duration: 72 hours
Change every three days
Prescribed as transdermal patch.
Applied behind the ear, hairless area.
Absorbed through the skin
Start 4 hours before travel
Dry mouth, “CANTS”, accuse psychosis

Question 23

Prochlorperazine (compazine)
Promethazine Hydrochloride (phenergan)
Dopamine antagonist antiemetics

Answer 23

Antihistamine and anticholinergic properties - easily absorbed through the GI tract
Highly protein bound-Blocks dopamine in the chemoreceptors
Don’t use with hepatic impairment or myasthenia gravis
PO: Onset: 15-60
Have extrapyramidal effects
PROCLOREPERAZINE
Tachycardia, blurred vision, dry mouth
ADVERSE EFFECTS - hemolytic anemia, thrombocytopenia
PROMETHAZINE - high risk in peds and older adults - never administer intraterial route
IV, IM, PO, Rectal
Side effects: dizziness, dry mouth, blurred vision, tachycardia. Causes shuffling gait, facial grimacing, and changes in mental status.

Question 24

Ondansetron hydrochloride (Zofran)
Serotonin receptor agonist antiemetic

Answer 24

Postoperative for patients who have cancer
Easily absorbed
IV: 30 min onset, 6-12 hour duration
Blocks serotonin receptors in the chemoreceptor trigger zone and vagal nerve terminals in the GI tract.
Makes heart rate irregular
Single dose before anesthesia
30 minutes before chemotherapy
Side effects: dizziness, fever, constipation
Adverse effects: Bronchospams
Prolongs QT intervals leading to dysrhythmias

Question 25

Metoclopramide (Reglan)
Serotonin receptor agonist antiemetic

Answer 25

For patients with gastresophageal reflux disease
Adverse effect: Tardive dyskinesia
Promotes movement of food to GI tract
Take 30 minutes before meals

Question 26

Dexamethasone
Glucocorticoid antiemetic

Answer 26

IV - rapid onset short duration
Short term periods to suppress vomiting
Helps with chemotherapy induced N/V
Not FDA approved
15-30 minutes before chemotherapy

Question 27

Dronabinol
Cannabinoids

Answer 27

Treatment of severe N/V with chemotherapy
Last resort for an antiemetic
Causes weight gain - In AIDS patients there will be weight loss
Onset: 30-60 minutes
Duration: 4-6 hrs
PO
Side effects: dizziness, euphoria, dry mouth
Adverse effects: memory impairment, severe toxicity

Question 28

Aprepitant
Substance P/Nuerokin 1 Antagonist

Answer 28

For the prevention of postoperative N/V
Excreted predominately in the liver
PO
Take within 3 hours of induction of anesthesia
Side effects: headache, dizziness
Adverse effect: deep vein thrombosis
Check INR

Question 29

Antiemetics

Answer 29

Take vitals, document dehydration, be alert for tachycardia, have them wash their mouth out after they vomit.
Don’t drive
Try for non pharmacological methods such as cracks, cold compress, sips of liquids before taking antiemetics.
Don’t drink alcohol or take OTC meds
For Promethazine: report side muscle rigidity and facial grimacing to physician
For ondasteron: report palpations, flushing, confusion

Question 30

Antihistamine Antiemetics

Answer 30

Used for non productive cough and motion sickness
Hydroxyzine hydrochloride (Vistaril) - PO & IM only
Meclizine hydrochloride ( Antivert)
Dimenhydrinate (Dramamine)