GI Meds Comp 9 Flashcards
Antihistamine action and AE(3)
- acts on vomiting center
- AD: dizziness, drowsiness, urinary retention
Anticholinergic (ACh blockers) example, action and AE(3)
- ex. scopolamine- treat motion sickness
- blocks transmission of nauseating stimuli to CTZ (chemoreceptor trigger zone)
- AD: dizziness, drowsiness, urinary retention
Anticholinergic (ACh blockers) contraind
glaucoma
Anticholinergic (ACh blockers) patch, who long they last and when to give it
lasts 72 hours, give 4 hours before event
phenothiazine drugs action and indication
- blocks dopamine receptors in CTZ
- used for psych disorders, intractable hiccups, LOWER DOSES USED FOR ANTIEMETIC
phenothiazine drugs AE
- OH
- extrapyramidal symptoms EPS (restless, anxiety, spasms of face and neck)
Serotonin blockers (5-HT3) drug prefix, action, indication
- setron
- block serotonin receptors in CTZ and GI
- used for NV in PTs RECEIVING CHEMOTHERAPY AND FOR POSTOPERATIVE
cannabinoids example and indication
- dronabinol (Marinol)
- used for NV r/t CHEMOTHERAPY AND ANOREXIA linked to weight loss in AIDS and cancer PTs
cannabinoids AE
- mood changes
- OH
Prokinetic drug example, action, indication
-metaclopramide (Reglan)
-cause CTZ to be desensitized to impulses from GI
+ stimulates peristalsis in GI –enhances gastric emptying
Prokinetic drug indication and AE
- used as antiemetic and GERD and delayed gastric emptying
- AE: sedation, diarrhea, EPS
Antiemetic Trimehtobenzamide (Tigan) action and SE
- suppresses impulses to CTZ
- SE: OH and EPS
Antiemetic critical assessments
assess complete NV history + precipitating factors
Antiemetic NI(3)
- many drugs cause drowsiness, don’t drive
- don’t drink alcohol - CNS depression
- move slowly - HoTN affects
- for chemo PT, antiemetics given 1-3 hours before chemo
Emetic Ipecac (OTC) use and admin
- induces vomiting after toxic substances
- Admin: take with water, VOMITING OCCURS IN 15-30 min, if no vomit take activated charcoal
acute vs chronic diarrhea time frame
- acute: 3 days - 2 weeks
- chronic: 3 weeks+
non-pharm treatment of diarrhea
- ID underlying cause
- fluid replacement
- no milk and fatty foods
- wash fruit, no raw veggies and well done meat while traveling
Antidiarrheals : opiates action
decrease intestinal motility, decreases peristalsis (more water and electrolytes absorbed)
opiates AE
- drowsiness
- sedation
- respiratory depression
- HoTN
- urinary retention
Anti-diarrheals: absorbants example
bismuth subsalicylate (Pepto-bismol)
Anti-diarrheals: absorbants action
- coat the walls of the GI tract
- bind to the causative bacteria or toxin, is then eliminated through stool
Anti-diarrheals: absorbants AE
- tarry black stools
- tinnitus
- metallic taste
- blue gums
Octeotride (Sandostatin ) treats ….
severe diarrhea from cancer
absorbants decrease absorption of…
- digoxin
- clindamycin
- quinidine
- hypoglycemic drugs
absorbants increase …..
bleeding time and bruising with anticoagulants
antacids can decrease effects of ….
anticholinergic antidiarrheal drugs
antidiarrheals critical assessments
Last BM and COCA, abdominal assessment (pain, NV, bowel sounds)
antidiarrheals NI
- DO NOT give bismuth subsalicylate to children or teenagers with chicken pox- risk of Reye’s syndrome
- use with caution in elderly, decreased bleeding time, clotting disorders, recent bowel surgery, confusion
- avoid fried foods. milk, sedatives
Most gentle to strongest laxatives
- emollient (stool softener)
- bulk forming
- stimulant (Contact)
- Osmotic (Saline)
- Chloride channel activators
laxative: emollient example and action
- docusate salts (Colace)
- promote more water and fat in stools
- gently soften the stool
Laxative: bulk-forming example and action
- psyllium (Metamucil)
- high fiber- absorb water to increase bulk
- results on 8-12 hrs
- only L that can be taken long term
Laxative: Stimulant examples
- bisacodyl (Dulcolax)
- senna (Senokot)
- castor oil
Laxative: Stimulant action and AE
- increases peristalsis via intestinal nerve stimulation
- oral 6-12 hrs, supp 15-60 min
- AE: reddish brown urine
laxatives: osmotic (Saline) examples
- magnesium salts- Milk of Mag, mag sulfate
- sodium salts-Fleet enema
- lactulose (reduce ammonia levels)
- glycerin (supp)
- Polyethylene glycol (Miralax) -PEG
PEG with electrolyte solution (GoLYTELY) used for.. and how much…
bowel evacuation prior to GI procedures (colonoscopy) or GI surgery
-2-3 L
laxatives: osmotic (Saline) action and AE
- more water enters intestine >bowel distention>peris. and BM
- AE: magnesium toxicity (with renal insufficiency)
All Laxatives AE
- rectal irritation
- diarrhea
- electrolyte imbalances
laxatives contraindications
- undiagnosed abdominal pain
- inflammatory disorders of the GI tract
- spastic colon
- bowel obstruction
- pregnancy
laxatives critical assessments
- last BM and COCA
- abdominal assessment (bowel sounds, pain, NV)
laxatives NI
- assess PT history: allergies, BM pattern, fluid and electrolytes before therapy
- do not take if experiencing NV, abdom. pain, suspected acute abdom.
- high fiber, lots of fluid in diet
- **PT should take all lax tablets with 6-8oz of water- esp. bulk-forming
Laxatives, call doc if….
- severe abdominal pain
- muscle weakness
- cramps
- dizziness
(fluid and electrolyte loss)
HCL secretion triggered by….
- food
- large fatty meals
- a lot of alcohol
- emotional stress
acid-related diseases caused by..
imbalance of the three cells of the gastric gland and their secretions
- most common hyperacidity (indigestion, sour stomach, heart burn)
Acid-related disorders
- Peptic Ulcer disease (PUD)
- gastroesophageal reflux disease (GERD)
- Helicobacter pylori (treat with proton-pump inhibitors and antibiotics)
proton pump inhibitors (216)
completely block production of acid , alters absorption of drugs
Peptic ulceration patho
- mucosal lining erosion (esophageal, gastric, duodenal)
- hypersecretion (HCL, Pepsin, pH of 2-5)
Peptic ulcer risk factors and symptoms
- H. pylori
- mechanical
- genetic
- environment
- drugs
- symptom: aching pain
antiulcer drugs
- tranquilzers
- anticholinergic drugs
- histamine 2 blockers
- proton pump inhibitors
- antacids
- prostaglandin E analog
- pepsin inhibitor
tranquilizer glycopyrrolate (Robinul) action
reduces vagal stimulation , decreases anxiety
anticholinergic Propantheline (Pro-Banthine) action
inhibits release if HCL by blocking ACh and histamine
antacids action
- neutralize stomach acid and reduces pain
- DO NOT prevent overproduction of acid
- DO neutralize the acid once it is in stomach
antacids can be used with..
- aluminum salts
- calcium salts
- magnesium salts
- sodium bicarbonate
Antacid : Aluminum salt use and AE
- have constipating effect, used with Mg to reduce
- used for PT with renal disease, easy excrete
- AE: constipation, hypercalcemia
Antacid: Calcium salt example and SE
- Tums (calcium carbonate)
- may cause constipation, kidney stones
- not recom. for PT with renal disease- toxic
Antacid: Magnesium Salts SE and caution
- commonly cause DIARRHEA, use with other drugs to counter
- dangerous with renal failure, accumulates
Antacids: Sodium Bicarbonate caution
-sodium content may cause problems in PT with HF, HTN, or renal insufficiency
Critical assessments for Antacids
appropriate electrolyte level
Antacids NI
- assess for allergies, contrandications
- not for PT with HF or HTN
- MOST MEDS SHOULD BE GIVEN 1-2 HOURS AFTER GIVING ANTACID
- may cause premature dissolve of enteric coated meds
histamine type 2 H2 blockers examples
- most popular:
- cimetidine (Tagamet)
- famotidine (Pepcid)
- ranitidine (Zantac)
histamine type 2 H2 blockers action and SE
- reduce gastric acid by blocking H2 receptors of parietal cells in stomach
- SE: HA, dizziness
H2 blockers NI
- smoking decreases effect
- All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption
- contact doc if prolonged HA occurs
- 1 hour before or after meals
- caution with PT who are confused, disoriented, or elderly
Proton pump inhibitors (PPI) suffix and action and result and
-“prazole”
-reduce gastric acid by
inhibiting hydrogen/K+ ATPase
-result: achlorhydria- ALL gastric acid secretion is temporarily blocked
PPI SE
- HA
- insomnia
- dizziness
PPI NI
- works best taken 30-50 min before meals
- capsules swallowed whole
- may open and mix with apple sauce, eat immed
- may increase levels of DIAZEPAM, PHENYTOIN, and more bleeding with WARFARIN
Sucralfate (Carafate) action and admin
- attracted to ulcer base, and forms a protective barrier
- give 30 min before meals and bedtime
- impairs other drug absorption ( give 2 hrs before sucra.)
