Nausea/Vomiting, Diarrhea and Intestinal Gas Flashcards
Describe the pathophysiology of Nausea and Vomiting
different areas in the body provide input to the central nervous system (CNS), specifically the lateral reticular formation of the medulla oblongata in the brain stem (vomiting center) and send signals to the GI tract
Define: Nausea
subjective feeling of a person’s need to vomit
Define: Retching
involuntary contraction of the diaphragm and abdomen
Define: Vomiting
physical expulsion of stomach, esophageal and oropharyngeal contents
What are the complications of nausea and vomiting?
particularly concerned about complication in pediatric and geriatric populations. dehydration, aspiration, electrolyte and/or acid-base disorders, malnutrition, mallory-weiss syndrome
Name the exclusions for self-care of nausea and vomiting in adults:
-diabetic pt with urine ketone or high blood glucose with signs of dehydration
-food poisoning that does not resolve in 24 hours
-nausea and vomiting w/ fever and/or diarrhea
-severe abdominal pain (possible appendicitis)
-blood in vomit
-yellow skin/eye discoloration and dark urine
-stiff neck w/ or w/o headache and sensitivity to light
-head injury
-pt w/ glaucoma, BPH, chronic bronchitis, emphysema, or asthma (bc we cannot give antihistamines)
-nausea and vomiting causes by health issues and disorders
-nausea and vomiting that is drug-induced
What patients can we treat with symptoms of nausea and vomiting?
motion sickness, pregnancy (mild-moderate), acute viral gastroenteritis (mild-moderate dehydration), food poisoning (within 24 hours), nausea associated with overeating and indigestion
Describe: Motion Sickness
occurs when there is a neural mismatch between visual and vestibular stimuli. most common in children 2-12 and more common in women than men
What are drug targets to treat motion sickness?
acetylcholine and histamine
What are nonpharmacological treatment options for motion sickness?
-avoid reading during travel
-keep line of vision fairly straight forward
-avoid excess food or alcohol before and during travel
-stay where motion is least experienced (ex.front of car)
-avoid strong odor (food or tobacco smoke)
-be in control of the vehicle if possible
-acupressure
MOA: Acupressure
places direct pressure on pericardium-6 point on either wrist
Indication: Antihistamines
prevention and treatment of nausea, vomiting, or dizziness associated with motion sickness
MOA: Antihistamines
depress labyrinth excitability caused by increased histamine levels in the hypothalamus, pons, and medulla as a result of certain motions
Side Effects: Antihistamines
-drowsiness
-anticholinergic effects (dry mouth, blurred vision, urinary retention, constipation= especially in elderly)
-paradoxical stimulatory reaction = restlessness, alertness
Warning/Precautions: Antihistamines
-avoid drinking alcohol, driving a vehicle, or operating heavy machinery
-caution in children and elderly due to increased risk of side effects
-avoid in patients with glaucoma or BPH and use caution in patients with respiratory conditions
-avoid in lactating women
What are nonpharmacological treatment options for nausea/vomiting associated with overeating and upset stomach?
avoid known disagreeable foods such as coffee, tea, alcohol, smoking, and NSAIDs, also reduce stress, and weight loss
What OTC products can be used to treat nausea and vomiting associated with overeating and upset stomach?
histamines, antacids, bismuth subsalicylate, phosphorated carbohydrate solution
Indication: Bismuth subsalicylate (Pepto-Bismol)
nausea associated with indigestion, heartburn, and fullness caused by overindulgence in food and drink, and diarrhea
Dosing: Bismuth subsalicylate (Pepto-Bismol)
adults (children <12 yo not recommended): 262-525 mg every 30 mins-1 hour AS NEEDED. max 8 doses per day for 2 days max
Contraindications: Bismuth subsalicylate (Pepto-Bismol)
children <12 years old, history of severe GI bleeds, and pt with salicylate allergy, avoid in pregnancy and lactation, not recommended for patients on long-term aspirin regimen
Side Effects: Bismuth subsalicylate (Pepto-Bismol)
discoloration of tongue (darkening) and greyish-black stools
MOA: Phosphorated Carbohydrate
direct local action of GI tract wall that may decrease smooth muscle contractions and delay gastric emptying time
Contraindications: Phosphorated Carbohydrate
pt with hereditary fructose intolerance or diabetes
Dosing: Phosphorated Carbohydrate
-adults: 15-30 mL every 15 minutes until vomiting ceases
-children (2-12 yo): 5-10 mL every 15 minutes until vomiting ceases
Counseling Points: Phosphorated Carbohydrate
-should not take for more than 1 hour and do not exceed 5 doses
-solution should not be diluted
-do not take any other liquids for 15 minutes after taking dose
What should the actions of the pharmacist be in the case of suspected food poisoning?
-eat bland foods
-explain risks of food poisoning and food storage
-EXPLAIN SIGNS AND SYMPTOMS OF DEHYDRATION
-oral rehydration
-antidiarrheal products if appropriate
What are the signs and symptoms of mild-moderate dehydration?
heart rate may be increases, may have rapid breaths, extremities are cool to the touch, dry mouth, fatigued
What are the signs/symptoms of severe dehydration?
tachycardia (rapid heart rate), deep-rapid breaths, extreme dry mouth, extremities are cold to the touch, lethargic
What is suggested to use for oral rehydration?
for pediatric patients: enfalyte, Pedialyte, rehydralyte, but for older children and adults: sports drinks and pretzels, Do not give drinks that are high in sugar
Describe the administration of rehydration solution based on weight loss
- <3%: up to 240 mL for each vomiting episode, but up to 120mL for <10 kg weight loss and up to 120 mL for >10 kg
- 3-9%: initial 50-100mL/kg for 2-4 hours and replace ongoing losses as above
- > 9%: medical emergency!
What are nonpharmacological treatment options for nausea/vomiting associated with pregnancy?
-fresh air
-eat crackers before getting out of bed
-arise slowly
-eat smaller and more frequent meals
-small sips of liquids throughout the day
-avoid greasy, fatty, spicy, or acidic foods
-acupressure bands
What is the pharmacological treatment for nausea/vomiting related to pregnancy?
pyridoxine or pyridoxine + doxylamine
Describe: Ginger
- MOA: works at the digestive tract to inhibit nausea and vomiting
-side effects (@large doses): heartburn, diarrhea, and mouth irritation
-drug interactions: warfarin and antiplatelets
-generally viewed as safe and effective
Define: Diarrhea
increase in stool frequency, liquidity, or weight @ more than 3 bowel movements per day
What are the classifications of diarrhea?
acute= <14 days
persistent= >14 days but less than 4 weeks
chronic= >4 weeks
What infections can cause diarrhea?
viral (norovirus, rotavirus) or bacterial
What medications can cause diarrhea?
antacids containing magnesium, antibiotics, colchicine, misoprostol, chemotherapy
Name the exclusions for self-care for treatment of diarrhea:
-young age (<6 months)
-visible blood, pus, or mucus in the stool
-signs of severe dehydration
-persistent vomiting
-PREGNANCY
-severe abdominal pain
-chronic or persistent diarrhea
What are the treatment goals of diarrhea?
THE GOAL IS NOT ALWAYS TO ELIMINATE DIARRHEA
-prevent or correct fluid loss, electrolyte loss, and acid-base disturbances
-provide symptomatic release
-identify and treat the cause
-prevent acute morbidity and mortality
What OTC medications can be used to treat diarrhea?
loperamide (Imodium), bismuth subsalicylate (Pepto-bismol), lactase enzyme (Lactaid), probiotics
Indications: Loperamide
acute and chronic diarrhea, traveler’s diarrhea
Dosing: Loperamide
-pediatric: 2 mg following loose stool, then 1 mg after each subsequent loose stool (max 4-6 mg a day)
-adult (>12 yo): 4 mg following first loose stool then 2 mg after subsequent loose stool (max 8 mg a day)
MOA: Loperamide
agonist of peripheral mu opiate receptors in GI tract slowing motility
Side Effects: Loperamide
dizziness, constipation, abdominal cramps, nausea
Interactions: Loperamide
substrate of P-glycoprotein (PGP) which may decrease serum concentrations of other PGP substrates and agents which prolong QTC interval, also not recommended in pregnancy
Who would be recommended lactase enzyme (Lactaid)?
lactose intolerant patients to prevent osmotic diarrhea
Describe: Probiotics and use for diarrhea
probiotics (lactobacillus, bifidbacterium, saccharomyces) may be able to treat mild acute uncomplicated diarrhea. very effective for rotavirus and antibiotic induced diarrhea. can be used in infants and children and is shown to be safe in a majority of patients.
Name the exclusions for self-care for intestinal gas:
-symptoms that persist for several days or occurs several times per month
-severe or debilitating symptoms
-rapid change in location of abdominal pain or increase in frequency/severity of symptoms
-symptoms coupled with significant discomfort or sudden change in bowel movements
-symptoms accompanied by severe persistent diarrhea or constipation, GI bleed, fatigue, unintentional weight loss, or frequent nocturnal symptoms
-rapid onset of symptoms in patients >40 yo
What are nonpharmacological treatment options for intestinal gas?
-eat slowly and thoroughly
-smoking cessation
-avoid foods associated with gas production (carrots, brussel sprouts, whole grains, ect.)
-avoid caffeinated beverages
-avoid anticholinergic agents
MOA: lactase enzyme (Lactaid)
breaks down lactose into glucose and galactose for ease of absorption
Describe: alpha-galactosidase
taken before consumption of oligosaccharides-containing foods. MOA= breaks down indigestible carbohydrates
Describe: simethicone (GAS-X)
given after meals and before bedtime. not systemically absorbed and well tolerated so preferred in babies.
