Module 8-10 Drugs

Question 1

Ondansetron

Answer 1

antiemetic; serotonin recepter antagonist; first approved for chemotherapy induced n/v; and for radiotherapy, anesthesia, pregnancy, etc; more effective when used with dexamethasone

Question 2

Side Effects/Adverse Effects of Ondansetron

Answer 2

headache, diarrhea, dizziness, prolonged, QT interval, risk of torsades de pointes

Question 3

Glucocorticoids

Answer 3

in terms of aniemetics; include methylprednisolone and dexamethasoe; MOA not known; used to suppress CINV but not approved by FDA for this;

Question 4

Metoclopramide

Answer 4

antiemetic; brand Reglan; blocks dopamine receptors in CTZ; postoperative n/v, anticancer drug, opioids, toxins, radiation therapy

Question 5

Scopolamine

Answer 5

used for motion sickness; muscarinic antagonist;

Question 6

Side effects of Scopolamine

Answer 6

DRY MOUTH, blurred vision, drowsiness

Question 7

Antihistamines

Answer 7

in terms of motion sickness; include dimenhydrinate, meclizine, cyclizine; anticholinergic; SE: sedation (H1), dry mouth, blurred vision, urinary retention, constipation

Question 8

Opioids

Answer 8

nonspecific antidiarrheal agent; MOST effective antidiarrheal agent; activate opioid receptors in GI: reduce intestinal mobility, slow transit, allow more fluid to be absorbed

Question 9

Diphenoxylate

Answer 9

opioid but formulated with atropine to discourage abuse, antidiarrheal; opioid only used for diarrhea; high doses can elicit typical morphine like subjective responses

Question 10

Loperamide

Answer 10

opioid; structural analong of meperdine; used to treat diarrhea and to reduce the volume of discharge from ileostomies; little or no potential for abuse

Question 11

Contraindications to Laxative Use

Answer 11

abd pain, nausea, cramps or other symptoms of appendicitis, regional enteritis, diverticulitis or ulcerative colitis, acute surgical abdomen, fecal impaction or bowel obstruction, habitual use, caution in pregnancy and lactation

Question 12

Group I Laxative

Answer 12

act rapidly; within 2-6 hours; give stool watery consistency; useful for preparing bowel for diagnostic procedures or surgery

Question 13

Group II Laxatives

Answer 13

intermediate latency; 6-12 hours; produce a semifluid stool; most frequently abused by the general public

Question 14

Group III Laxative

Answer 14

act slowly; 1-3 days; produce a soft formed stool; uses include treating chronic constipation and preventing straining

Question 15

Psyllium

Answer 15

same as metamucil; bulk forming laxative; function simiraly to dietary fiber (swell with water that forms a gel and increases fecal mass); preferred temp treatment of constipation; AE- esophageal obstruction

Question 16

Docusate Sodium

Answer 16

surfactant laxative; produce soft stool several days after tx; lowers surface tension which facilitates PENTRATION of water in feces

Question 17

Bisacodyl

Answer 17

stimulant laxative; two effects- stimualte intestinal motility; increase amounts of water and electrolytes in intestinal lumen; widely used and abused; legitametly used for opioid induced constipation and for constipation from slow intestinal transit

Question 18

Milk of Magnesia

Answer 18

osmotic laxative; laxative salts; draw water in intestinal lumen, fecal mass softens and swells, wall stretches and peristalsis is stimulated; low does- results in 6-12 hrs; high dose 2-6 hrs; AE- dehydartion, acute renal failure, sodium retention

Question 19

Lubiprostone

Answer 19

selective chloride channel activator; promotes secretion of chlroide rich fluid into the intestive and enhances motility in the small intestine and colon; result is spontaenous evacuation of semi soft stool usually within 24 hrs

Question 20

Mineral Oil

Answer 20

laxative action is produced by lubrication; especially useful when administered by enema to treat fecal impaction AE- lipid pneumonia, anal leakage, and deposition of mineral oil in the liver

Question 21

Glycerin Suppository

Answer 21

osmotic agent that softens and lubricates hardened impacted feces; may also stimulate rectal contraction; evacuation occurs about 30 mins after insertion; useful for reestablishing normal bowel function after termination of chronic laxative use

Question 22

Sodium Phosphate Products

Answer 22

osmotic laxatives that draw water in intestinal lumen, which softens and swells fecal mass which streathces intestinal wall to stimulate peristalsis

Question 23

Sodium Phosphate Products AE

Answer 23

nausea, bloating, abd discomfort, risk of dehydration, electrolyte disturbance, and kidney damage; hyperphosphatemia **

Question 24

Furosemide

Answer 24

loop; for edema, hepatic impairment, renal disease HTN, emergent need for rapid fluid excretion; AE/SE- dehydration, hyponatremia, hypochloremia, hypotension, OTOTOXICITY, HYPOKALEMIA, hyperglycemia; avoid admin late in day to prevent nocturia, monitor bg, avoid use with other ototoxic drugs (aminoglycosides)

Question 25

Hydrochlorothiazide

Answer 25

thiazide; similar effect to loop; max diuresis is lower than loop, not effective when urin flow is scant; first choice for essential HTN, AE/SE- dehydration, hyponatremia, hypokalemia, hypochloremia, hyperglycemia,

Question 26

Mannitol

Answer 26

osmotic; promotes diuresis by creating osmotic force within lumen of the nephron; MUST BE GIVEN PARENTERLLY, uses- prophylaxis of renal failure, reduction of intracranial and intraocilar pressure; SE/AE- HF, pulmonary edema, fluid electrolyte imbalnce, rebound increased ICP (intracranial pressure) (change in LOC, pupils, HA, n/v)

Question 27

Spironolactone

Answer 27

potassium sparing aldoesterone antagonists; modest increase in urine production, decrease in potassium excretion; used mainly for HTN and edema; effects may take up to 12-48 hours after admin; AE/SE- hyperkalemia, drowsiness, metabolic acidosis,