GI Flashcards
Polyethylene Glycol (with or without electrolytes)
Osmotic Laxative
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
Lactulose
Osmotic Laxative
Reduces serum ammonia levels with patients that have liver disease
Takes 24-28 hours to work
Bisacodyl (Dulcolax)
Stimulant laxative
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
Psyllium (Metamucil)
Bulk-forming laxative
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
Mineral Oil
Emollient Laxative
Can help reduce injury from exertion while pooping
Fat soluble vitamins A, D, E, K are absorbed by mineral oil
Take at bedtime
Emollients/Stool Softeners
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.
Lubiprostone
Selective Chloride Channel Activator
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
Glycerin
Osmotic Laxative
Rectal only
Bismuth Subsalicyate (Pepto Bismol)
Absorbent Antidiarrheal
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
Absorbent Antidiarrheals
Don’t give absorbents with other medications
Cholestyramine
Absorbent Antidiarrheal
Avoid any drugs or medication for 2 hours
Absorbent Antidiarrheal Names and MOA
Destroys bacteria and toxins
Pepto-bismol, activated charcoal, aluminum hydroxide, cholestyramine, polycarbophil
Anticholinergic Antidiarrheals
Dries and slows down movement
atropine, hyosycamine
Don’t give with antacids or milk
Increase fluid intake, chew sugarless gum.
Antidiarrheals - general teaching
Report any pain or abdominal distention
Don’t give to pregnant women, patients with glaucoma, liver disorders, or ulcerative colitis.
Avoid CNS depressant medications.
Probiotics
Lactobacillus acidophilus, lactobacillus GG, sachromyres boulardii
Usually found in cultured milk and yogurt products.
Opiate Antidiarrheals
Slows motility, helps with pain and cramping. Increases absorption of water and electrolytes.
Opium tincture, paregoric, codeine, diphenoxylate HCL (lomotil), Loperamide hyroxychloride.
Loperamide hydroxychloride
Opioid Antidiarrheal
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
Atropine & Hyosycamine
Anticholinergic Antidiarrheals
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
Paragoric
Opioid Antidiarrheal
Amylase and Lipase levels elevate
Vomiting - Emesis
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.
Meclizine hydrochloride (antivert)
Antihistamine Antiemetic
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
Scopolamine
Anticholinergic Antiemetic
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
Prochlorperazine (compazine)
Promethazine Hydrochloride (phenergan)
Dopamine antagonist antiemetics
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.
Ondansetron hydrochloride (Zofran)
Serotonin receptor agonist antiemetic
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
Metoclopramide (Reglan)
Serotonin receptor agonist antiemetic
For patients with gastresophageal reflux disease
Adverse effect: Tardive dyskinesia
Promotes movement of food to GI tract
Take 30 minutes before meals
Dexamethasone
Glucocorticoid antiemetic
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
Dronabinol
Cannabinoids
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
Aprepitant
Substance P/Nuerokin 1 Antagonist
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
Antiemetics
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
Antihistamine Antiemetics
Used for non productive cough and motion sickness
Hydroxyzine hydrochloride (Vistaril) - PO & IM only
Meclizine hydrochloride ( Antivert)
Dimenhydrinate (Dramamine)
