Nutrition Flashcards
Metoclopramide (Reglan) Route
IV,PO
Metoclopramide (Reglan) Indications
GERD resistant to other treatments; Diabetic gastroparesis; promotility, chemo-induced nausea/vomiting
Metoclopramide (Reglan) MOA
Exact MOA unknown. Sensitizes tissues to Ach, stimulating upper GI tract motility; antagonizes central and peripheral dopamine receptors, producing antiemetic effects
Metoclopramide (Reglan) SE
Common:drowsiness,restlessness,fatigue,anxiety,insomnia,headache,confusion,dizziness, extrapyramidal sx, galactorrhea, amenorrhea, fluid retention, hypo/hypertension, nausea, diarrhea, urinary frequency/incontinence, rash, urticaria
Severe: dystonia, parkinsonism, tardive dyskinesia (US Boxed Warning), seizures, suicidality, hallucinations, acute CHF
Metoclopramide (Reglan) CI
pheochromocytoma,seizuredisorder,GIbleedingorobstruction
Metoclopramide (Reglan) Pearls
Used off-label for post-op nausea/vomiting that is unresponsive to other meds (ie. Zofran)
May result in an earlier tolerance to solid foods in patients exhibiting signs/sx of ileus
Can also be used for patients experiencing GERD and is safe for the pregnant patient
Use short term only (4-12 weeks), usually on inpatient basis. Increased duration of use is associated with tardive dyskinesia.
Erythromycin route
IV, PO
Erythromycin indications
a macrolide antibiotic that can be used off-label for gastroparesis/prokinetic agent. Generally used for persons who are intolerant of Reglan
Erythromycin MOA
Erythromycin evokes powerful, lumen-occluding antral contractions via action on neural and smooth muscle receptors for motilin, the physiologic regulator of fasting gastroduodenal motility
Erythromycin SE
Abdominal pain, N/V, rare QT prolongation and ventricular arrhymias, long-term use associated with superinfection (c.diff), caution in liver disease
Erythromycin CI
Hypersensitivity to macrolide drug class, pts with prolonged QT interval
Erythromycin Pearls
Can induce diarrhea
Does not alleviate N/V
Should be used for short-term only
“Banana Bag” indications
Alcohol use disorder (AUD)/ETOH withdrawal, magnesium deficiency in ICU patients
Thiamine Deficiency: Wernicke’s encephalopathy and Korsakoff syndrome
Folate Deficiency: Megaloblastic anemia, confusion, sleep disturbances, depression, and psychosis
Magnesium Deficiency: QT prolongation, torsades de pointes, altered mental status, seizures, tremors, hyperreflexia
“Banana Bag” MOA
Corrects vitamin and nutrient deficiencies through the following intravenous infusion: 1L NS or D5W, 100 mg Thiamine, 1 mg Folic Acid, 1-2 g Magnesium Sulfate, and 1 amp Multivitamin
“Banana Bag” SE
Anaphylaxis due to parenteral administration of nutrients
“Banana Bag” CI
none
“Banana Bag” pearls
The use of “banana bags” has not been well studied, and may not meet the specific nutritional requirements for patients. The 100-mg dose of thiamine is thought to be insufficient in the treatment of patients with suspected or confirmed Wernicke’s; furthermore, it should be dosed every 8-12 hours to optimize levels for blood-brain barrier transport. In addition, it may serve a better purpose to evaluate for specific nutritional deficiencies (A, C, phosphorus, potassium, zinc, etc.) based on symptoms and laboratory evaluation. This would allow clinicians to provide more definitive treatment for isolated nutritional deficiencies rather than give low, ineffective doses provided in the multivitamin supplement.
