N/V & GERD Meds Flashcards
Antihistamines
- -ine
- non-perscriptive antiemetic
- inhibit vestibular stimulation in middle ear to prevent motion sickness
- S/E: like anticholinergics, drowsiness, dry mouth, constipation
diphenhydramine (benadryl), cyclizine, meclizine
Absorbents
- act directly on gastric mucosa to supress vomiting
- may change color of stool
bismuth subsalicylate (Pepto)
Perscriptive Antihistamines
- promethazine (phenergan), hydroxyzine
- Don’t give w/ glaucoma
promethazine also dopamine antagonist
Anticholinergics
- work against action of PSNS to suppress N/V, motion sickness
- S/E: drowsiness, dry mouth, blurred vision, tachycardia, constipation
- Don’t give w/ glaucoma
scopolamine
Phenothiazines
- dopamine antagonists
- act on chemo trigger zone and block dopamine receptors
- used for surgery, anesthesia, chemo/radiation therapy
- S/E: moderate sedation, hypotension, EPS, CNS effects, mild anticholinergic symptoms
- do not give w/ glaucoma, intestinal obstruction, liver dysfunction, COPD
promethazine, prochlorperazine
Butyropheones
- dopamine antagonists
- act on chemo trigger zone to block dopamine receptors
- for post-op, chemo, radiation
- smaller doses for antiemetic purposes than psychiatric purposes
- S/E: moderate sedation, hypotension, EPS
haloperidol (haldol), droperidol
droperidol contraindicated in pts w/ QT prolongation
Benzodiazepines
- -am
- dopamine antagonists
- not preferred for just N/V
- antiemetic, sedation, antianxiety, amnesia w/ certain meds
- used for chemo
- S/E: sedation, blurred vision, dependence/tolerance, hypotension
- antidote: flumazenil
lorazepam (ativan), diazepam (valium), alprazolam (xanax)
Serotonin antagonists
- -setron
- block serotonin receptors in chemo trigger zone
- block afferent vagal nerve terminals in upper GI tract
- used for chemo, postop
- S/E: headache, diarrhea, dizziness, fatigue
granisetron, ondansetron (zofran), palonosetron
Glucocorticoids
- -one
- used for chemo
- IV
dexamethasone, methylprednisolone
Cannabinoids
- chemo n/v, appetite stimulant
- contraindicated w/ psych disorders
dronabinol
Trimethobenzamide & Metoclopramide
- T: suppresses impulses to chemo trigger zone
- M: blocks dopamine receptors in chemo trigger zone
- postop, chemo, radiation, peristalsis promotion
- S/E: drowsiness, anticholinergic effects, hypotension, diarrhea, EPS (more common in kids w/ metoclopramide)
Emetics & absorbants
- stimulate chemo trigger zone and acts directly on gastric mucosa to induce vomiting after toxic substance ingestion
- avoid using if ingested substance is caustic or petroleum
- if vomiting is contraindicated, can use activated charcoal or gastric lavage
ipecac, apomorphine
What should nurses monitor if pt is vomiting frequently?
electrolyte imbalances
Types of peptic ulcers
- esophageal –> d/t incompetent cardiac sphincter
- gastric –> d/t breakdown of gastric mucosal barrier
- duodenal –> d/t hypersecretion of acid or incompetent pyloric sphincter
- stress (curling’s) –> d/t major trauma, burns, major surgery, etc.
Risk factors for peptic ulcers
- H. pylori
- mechanical issues
- genetics
- environment
- drugs (NSAIDs)
- stress
- diet
Symptoms of peptic ulcers
- gnawing, aching pain
- alleviated with food
Tests for H. pylori
- endoscopy w/ biopsy
- urea breath test
- blood test
- stool test
Treatment for H. pylori
- 7-14 day regimen
- triple therapy: metronidazole, omeprazole, clarithromycin
- quadruple therapy: two antibiotics, proton pump inhibitor, and bismuth or H2 blocker
GERD
- inflammation of esophageal mucosa d/t reflux of gastric acid into esophagus
- caused by incompetent lower esophageal (cardiac) sphincter
- accelerated by smoking
- treated w/ antiulcer drugs
Classes of antiulcer drugs
- tranquilizers
- anticholinergics
- antacids
- proton pump inhibitors
- pepsin inhibitors
- prostaglandin analogs
Tranquilizers
- reduce vagal stimulation, decrease anxiety
- S/E: edema, ataxia, confusion, EPS, agranulocytosis
chlordiazepoxide, clidinium bromide
Anticholinergics
- inhibit ACh, block histamine and HCl to delay gastric emptying
- S/E: palpitations, urinary retention, constipation, blurred vision
- no for glaucoma, hx of retention, cardiac issues
glycopyrrolate, propantheline
Antacids
- neutralize HCl and reduce pepsin activity
- sodium bicarbonate (baking soda) S/E: hypernatremia, water retention, metabolic alkalosis, acid rebound; not good for heart pts
- calcium carbonate (tums) S/E: acid rebound, hypercalcemia
- magnesium hydroxide S/E: diarrhea
- aluminum hydroxide S/E: constipation; binds to phosphate and excretes in stool, good for end-stage renal disease
all can cause electrolyte issues, choose based on disease process
How long do antiulcer drugs take to work?
1-2 weeks
Histamine 2 Blockers
- -dine
- block H2 receptors of parietal cells in stomach to reduce gastric acid secretion
- promote healing of ulcer by treating cause
- give 30-45 min before eating
- S/E: constipation, sexual dysfunction, gynecomastia, blood dyscrasias
cimetidine, ranitidine, famotidine
S/Es may go away, but not always, esp if on high or prolonged dose
Proton Pump Inhibitors
- -zole
- reduce gastric acid by inhibiting hydrogen/potassium ATPase pumping that keeps acid in gut
- works quickly
- S/E: headache, dizziness, edema, GI distress
omeprazole (prilosec), pantoprazole (protonix), esomeprazole
painting purple puppy
Pepsin inhibitors
- combines with protein to form thick paste covering mucosa, protecting ulcer from acid and pepsin
- give 30 min before meals and bedtime– on empty stomach!
- promote increased fluids and exercise
- may cause constipation
sucralfate
Prostaglandin analog
- suppress gastric acid secretion, cause moderate decrease in pepsin secretion, and protect mucosa
- can also be given to change cervical mucous during labor –> do not give to non-full term pregnant pts
- S/E: diarrhea, abdominal pain, chills, shivering, hyperthermia
misoprostol
