N/V & GERD Meds

Question 1

Antihistamines

Answer 1

• -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

Question 2

Absorbents

Answer 2

• act directly on gastric mucosa to supress vomiting
• may change color of stool

bismuth subsalicylate (Pepto)

Question 3

Perscriptive Antihistamines

Answer 3

• promethazine (phenergan), hydroxyzine
• Don’t give w/ glaucoma

promethazine also dopamine antagonist

Question 4

Anticholinergics

Answer 4

• 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

Question 5

Phenothiazines

Answer 5

• 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

Question 6

Butyropheones

Answer 6

• 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

Question 7

Benzodiazepines

Answer 7

• -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)

Question 8

Serotonin antagonists

Answer 8

• -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

Question 9

Glucocorticoids

Answer 9

• -one
• used for chemo
• IV

dexamethasone, methylprednisolone

Question 10

Cannabinoids

Answer 10

• chemo n/v, appetite stimulant
• contraindicated w/ psych disorders

dronabinol

Question 11

Trimethobenzamide & Metoclopramide

Answer 11

• 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)

Question 12

Emetics & absorbants

Answer 12

• 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

Question 13

What should nurses monitor if pt is vomiting frequently?

Answer 13

electrolyte imbalances

Question 14

Types of peptic ulcers

Answer 14

• 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.

Question 15

Risk factors for peptic ulcers

Answer 15

• H. pylori
• mechanical issues
• genetics
• environment
• drugs (NSAIDs)
• stress
• diet

Question 16

Symptoms of peptic ulcers

Answer 16

• gnawing, aching pain
• alleviated with food

Question 17

Tests for H. pylori

Answer 17

• endoscopy w/ biopsy
• urea breath test
• blood test
• stool test

Question 18

Treatment for H. pylori

Answer 18

• 7-14 day regimen
• triple therapy: metronidazole, omeprazole, clarithromycin
• quadruple therapy: two antibiotics, proton pump inhibitor, and bismuth or H2 blocker

Question 19

GERD

Answer 19

• 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

Question 20

Classes of antiulcer drugs

Answer 20

• tranquilizers
• anticholinergics
• antacids
• proton pump inhibitors
• pepsin inhibitors
• prostaglandin analogs

Question 21

Tranquilizers

Answer 21

• reduce vagal stimulation, decrease anxiety
• S/E: edema, ataxia, confusion, EPS, agranulocytosis

chlordiazepoxide, clidinium bromide

Question 22

Anticholinergics

Answer 22

• 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

Question 23

Antacids

Answer 23

• 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

Question 24

How long do antiulcer drugs take to work?

Answer 24

1-2 weeks

Question 25

Histamine 2 Blockers

Answer 25

• -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

Question 26

Proton Pump Inhibitors

Answer 26

• -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

Question 27

painting purple puppy

Pepsin inhibitors

Answer 27

• 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

Question 28

Prostaglandin analog

Answer 28

• 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