Pharm GI Flashcards
cold and strep throat
pharnyx
Acute diarrhea
Lasts from 3 days to 2 weeks
Self-limiting
Resolves without sequelae
Chronic diarrhea
Lasts for more than 3 weeks
acute diarrhea - causes
Bacterial
Viral
Drug induced Nutritional factors Protozoa
chronic diarrhea - causes
Tumors
Diabetes mellitus Addison’s disease Hyperthyroidism
Irritable bowel syndrome AIDS
anti-diarrehal - adsorbents (add pepto)
coat walls, binds to bacteria and it is eliminated.
1) bismuth subsalicylate (Pepto) activated charcoal,
3) aluminum hydroxide, others
anti-diarrheals - Antimotility drugs: anticholinergics
Decrease intestinal muscle tone and peristalsis of GI tract
Result: slows the movement of fecal matter through the GI tract
anti-diarrheals - Antimotility drugs: anticholinergics = ex (anti-belladona)
belladonna alkaloids (atropine, hyoscyamine)
Antimotility drugs: opiates
Decrease transit time through the bowel, allowing more time
for water and electrolytes to be absorbed
Reduce pain by relief of rectal spasms
anti-diarrheal - Intestinal flora modifiers
Probiotics or bacterial replacement drugs. ex- L. acidophilus (Lactinex®)
adsorbents - adverse (add hearing loss and blue gums)
Hearing loss, tinnitus, metallic taste, blue gums. space out adsorbents to decrease side effects.
Anticholinergics - adverse
Urinary retention, hesitancy, impotence
Headache, dizziness, confusion, anxiety, drowsiness,
confusion
Dry skin, flushing
Blurred vision
Hypotension, bradycardia
Adsorbents cause (don’t ADD adsorbents w/ anticoagulants)
increased bleeding time and bruising when given with anticoagulants.
Antacids can decrease effects of (antacid is anti-anti)
of anticholinergic antidiarrheal drugs
Do NOT give bismuth subsalicylate to
children or teenagers with chickenpox or influenza because of
the risk of reye’s syndrome
Do not administer anticholinergics to patients with a history of (I’m not anti-graves or glaucoma)
narrow-angle glaucoma, GI obstruction, myasthenia gravis, paralytic ileus, and toxic megacolon
Use adsorbents carefully in
elderly patients or those with decreased bleeding time, clotting disorders, recent bowel surgery, confusion
constipation
Symptom, not a disease
Lactulose - hyperosmotic (lactulose levels ammonia)
also used to reduce elevated serum ammonia levels
stimulant - constipation (most popular one in hospitals)
senna (Senekot®)
bisacodyl (Dulcolax®)
Increases peristalsis via intestinal nerve stimulation
laxative adverse effects - bulk forming (think esophageus)
Impaction
Fluid overload
Electrolyte imbalances
Esophageal blockage
All laxatives can cause
electrolyte imbalances
laxative adverse effects - hyperosmotic
Abdominal bloating
Electrolyte imbalances Rectal irritation
laxative adverse effects - saline (salt and magnesium cause problems)
Magnesium toxicity (with renal insufficiency) Cramping
Electrolyte imbalances
Diarrhea
Increased thirst
laxative adverse effects - stimulants (moving too fast) and what about urine?
Nutrient malabsorption Skin rashes
Gastric irritation Electrolyte imbalances Discolored urine Rectal irritation
Inform patients not to take a laxative or cathartic if they are experiencing
nausea, vomiting, and/or abdominal pain
how to take laxatives
All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated. Patients should take all laxative tablets with 6 to 8 ounces of water
Patients should take bulk-forming laxatives as directed by the manufacturer with
at least
240 mL (8 ounces) of water
Give bisacodyl with water because of interactions with
milk, antacids, and juices
T. has been on warfarin therapy for 2 years and is experiencing severe diarrhea while on a visit to another country. She has a bottle of Pepto-Bismol and a package of loperamide (Imodium®). Which should she choose, if any?
loperamide (Imodium®) the pepto bismol will increase risk for bleeding
M., age 68, has renal insufficiency and tells you that he often uses milk of magnesia for quick relief of constipation. Is there a concern? Explain your answer.
Yes. Magnesium is excreted through the kidneys. If kidneys are not working magnesium can accumulate in the body
C., age 19, is experiencing severe abdominal pain and nausea, and has vomited twice. Her mother wants to give her a laxative to “clean her out.” Should she do this?
no risk of dehydration
antiacids - Aluminum Compounds - slow or fast? (the only one)
slow acting but long duration. Can cause constipation
antiacids - magnesium compound (fast or slow acting)
rapid acting and potent. can cause diahrrea.
antacids - calcium carbonate - fast or slow acting?
rapid acting and potent. can supplement dietary calcium.
antacids - sodium compounds - contraindicated in who? (think sodium and heart)
Rapid onset, short duration
Contraindicated in CHF, HTN, edema
antacid - nursing considerations - how long to separate from other drugs?
- Educate patients about s/s of GI bleeding
- Capsules and tablets should be swallowed
intact (not crushed or chewed) - Shake suspensions well
- Separate antacids from other meds by 1-2 hrs.
Magnesium Hydroxide - milk of magnesia - action (milk draws water)
Antacid, increase pH, Osmotic Laxative *
Magnesium Hydroxide - milk of magnesia - uses (milk helps GERD)
GERD, relief of hyperacidity Constipation
Cleanse the GI tract
Flush ingested toxins out
Magnesium Hydroxide - milk of magnesia - precautions
Renal Impairment
Bowel Obstructions
Fast Acting – within 6-12 hours
adverse effect - cramping
pancreatic enzymes are the
digestants most commonly used clinically
antiemetics
Determining the cause of gastric distress is essential because these drugs mask symptoms of more serious illnesses
emesis management
Serotonin Agonists
* Glucocorticoids
* Substance P, neurokinin antagonists
* Benzodiazepenes
* Dopamine Agonists
* Cannabioids
* Anticholinergics
* Antihistamines
seratonin agonists - anti-emetics (most popular one)
- Dolasetron
- Granisetron
- Ondansetron *
- Palanosetron
odansetron
Action
Serotonin receptor agonist blocks 5-HT3 receptors in vagal afferents and vomiting center
Uses
Acute emesis
Chemotherapy Postoperative
odansetron - precautions (glue dan together)
More effective when combined with
glucocorticoids (like Decadron)
odansetron - adverse effects
well tolerated
(maybe) headache / diarrhea
ipecac
Action
Stimulates CTZ and acts directly on gastric
mucosa
Use
Induces vomiting after toxic substance
Caution
Avoid vomiting if substance is caustic or petroleum
If vomiting contraindicated, activated charcoal is given
ipecac administration
Administration
◼Use ipecac syrup, not ipecac fluid extract. ◼Take with a glass of water, not with milk or
carbonated beverage.
◼Vomiting occurs in 15 to 30 minutes.
◼If vomiting does not occur, give activated
charcoal.
◼Gastric lavage may be needed if vomiting does
not occur.
treatment for uclers and GERD
Cytoprotective agents, which act locally to promote healing
* Proton pump inhibitors, which suppress gastric acid secretion and increase pH of stomach
* H2 receptor agonists, which prevent histamine from stimulating the H2 receptor
peptic ulcers - hypersecretion
Hypersecretion ◼ HCl
◼ Pepsin
◼pH of 1.5 – 3.5
peptic ulcer treatment - Mucosal Protectant
sucralfate
(Carafate ® - forms a paste to cover ulcer