Medications Flashcards
Cytoprotective/ anti ulcer (sucralfate)
Non-absorbable drug that in the presence of acid undergoes chemical reaction that forms a sticky substance that forms protective acid resistant lining in ulcer crater
Responsibilities- give on empty stomach, do not crush, separate administration time by 30mins
Side effects- nausea, indigestion, constipation, diarrhoea, dry mouth,
Education- take 30min before antacids, don’t drive
Proton pump inhibitors (omeprazole)
Suppress gastric secretion by inhibiting proton pump at the secretory surface of the gastric parietal cells. They are converted to thiophillic sulfenamide that interacts covalently (permanent) with the proton pump involved in hydrogen ion transportation and inhibits acid production
Responsibilities- administer before breakfast or before bed, do not crush tablets, monitor LFT’s and magnesium, monitor for GI infections
Side effects- headache, dizziness, diarrhoea, constipation, flatulence
Contraindications- increases absorption of digoxin and serum levels of methotrexate
Education- take full course even if symptoms relieves, do not crush, avoid cigarettes and alcohol, NSAIDS/aspirin, report black stools or abdo pain
Antacid (gavascon)
Buffer or neutralise hydrochloric acid in stomach raising the pH
Side effects- constipation/diarrhoea, chalk taste, flatulence
Responsibilities- Interfere with many drugs, give 2 hours post other meds, monitor for constipation/diarrhoea, monitor electrolyte
Contraindications- antacids with magnesium not with hypoglycaemic- increases absorption
Education- avoid if constipated (aluminium makes worse), diarrhoea (magnesium makes worse), separate 2 hrs from other meds
H2 receptor antagonist (ranitidine)
Block histamine from stimulating receptors on gastric parietal cells, reducing gastric acid secretion
Responsibilities- monitor for pneumonia (can suppress acid in lungs too)
Side effects-
Contraindications- hypersensitive you other H2, caution in kidney impairment
Education- continue 4-6weeks, take antacids 1 hr apart, avoid driving, limit alcohol
Antiemetic
Block neurotransmitter pathways to the emetic centre in the medulla and CTZ
Dopamine (metoclopramide)- blocks dopamine receptors in CTZ and accelerated gastric emptying, reduces reflux, enhances motility of GIT
Muscarinic/anticholinergic (hyoscine)- blocks acetylcholine at muscarinic receptors, prevents motion sickness by depressing conduction in the labyrinth of the inner ear
5-HT (ondansetron)- selective 5-HT receptor antagonist (blocks serotonin) located peripherally on vagus nerve terminal and centrally in CTZ. In chemo 5-HT that is stored is released and binds with receptors in GIT and induces vomiting. Giving before chemo then 5-HT has no receptor to bind too
Substance P (aprepitant)
Substance P is a Neurotransmitter that acts on neurokinin 1 receptors. Control chemotherapy induced vomiting by blocking NK-1 receptors
Responsibilities- give 30mins before meals, correct electrolyte imbalances, pulse and ECG before
Side effects- headache, dizziness, fatigue, diarrhoea, constipation, dry mouth
Contraindications-
Education- avoid alcohol, contact doctor if involuntary movement of face/eyes/limbs
Bulk forming laxative (psyllium)
Polysaccharide polymers that are not broken down by normal digestive process they absorb water and increase volume, bulk and moisture of non-absorbable content, distending bowel and initiating reflex bowel activity
Responsibilities- increase fluids, mix with water
Side effects- flatulence, bulky stools
Contraindications- bowel obstructions or impaction, dehydrated or fluid restricted
Education- drink 2ltrs water day, may not be effective for 2-3days, take in morning
Faecal softening agents (docusate)
Facilitate mixing of water and fatty substances within faecal mass, producing soft stools. May also inhibit water absorption from bowel and stimulate water secretion into GI tract
Responsibilities- increase fluids, not within 1-2hours of other drugs, do not crush
Side effects-
Contraindications- caution with cardiac failure, HT
Education- take 1-3 days, not for more than 1 week, adequate fluid, take in morning
Stimulant laxative (bisacodyl)
Promote accumulation of water and increase peristalsis in the colon by irritating intramural sensory nerve plexi endings in the mucosa
Responsibilities- administer on empty stomach, do not crush
Side effects- cramping, fluid and electrolyte imbalance
Contraindications- breastfeeding, cramping, nausea, vomiting
Education- takes 6-12 hrs, not in breastfeeding, report dizziness, difficulty breathing, rash
Osmotic and saline laxative (lactulose)
Not absorbed, exert osmotic effect, increase volume of fluid in lumen. Increased volume accelerates transfer of gut contents and increases defecation
Responsibilities- monitor fluid and electrolyte status
Side effects- cramping, diarrhoea, thirst, flatulence
Contraindications- sodium salts in congestive cardiac failure, intestinal obstructions, lactose intolerance
Education- works 3-6hours, take in morning, some abdominal cramping, chilling improves palatability, notify if excessive dryness, bloody stools or rapid wt loss
Anti diarrhoea (loperamide)
Active opioid receptors in gut reducing secretions and inhibition of propulsive movements in the gut. Slows passage of contents and allows reabsorption of water and electrolytes
Responsibilities- observe for abdominal distension, observe for effects on CNS depressants if given
Side effects- nausea, abdo pain, flatulence, abdo distension
Contraindications- MAOI’s
Education- take when diarrhoea starts, no more than 48hrs as habit forming, avoid alcohol, avoid driving
