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43 Cards in this Set
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Cimetidine (Tagamet)
Histamine H2 receptor antagonists Uses Mechanism of Action |
Uses: gastric and duodenal ulcers, GERD, zollinger-ellison syndrome (hypersecretion), aspiration pneumonitis (preop)
MOA: blocks H2 receptors on parietal cells of stomach → reduces secretion of gastric juice and its H+ concentration (65%) |
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Cimetidine (Tagamet)
Histamine H2 receptor antagonists Adverse Effects Drug Interactions |
AE: Serious side effects uncommon, antiandrogenic: gynecomastia, reduced libido, impotence (reversible)
Some CNS Effects on elderly DI: inhibits hepatic enzymes: causes levels to rise in warfarin, phenytoin, theophylline and lidocaine; antacids decrease absorption of cimetidine → admin 1 hr apart |
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omeprazole (Prilosec)
Proton Pump inhibitors Therapeutic Uses Mechanism of Action Pharmacokinetics |
Uses: Short: duodenal ulcers, gastric ulcers, erosive esophagitis, GERD. Long: hypersecretory conditions. Prevent stress ulcers in hospitals
MOA: uppress acid secretion by inhibiting H+, K+ -ATPase(proton pump), the enzyme that makes gastric acid Pharm: prodrug--converts to active form in the stomach, 50% of drug reaches circulation, undergoes hepatic metabolism & then renal excretion |
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omeprazole (Prilosec)
Proton Pump inhibitors Adverse Effects Drug Interactions |
AE: Short: Headache, D/N/V. Pneumonia (reduced gastric acid), rebound acid hypersecretion, hypomagnesemia (reduce absorption of Mg), C. diff, gastric cancer, fractures (decrease Ca absorption: osteoporosis)
DI: reduce abs. of HIV/AIDS meds, reduced abs. of antifungals, plavix (may reduce beneficial effects as well as its adverse effects & thus promote gastric bleeding b/c of reduced platelet aggregation) |
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Sucralfate
Cytoprotectants Therapeutic Uses Mechanism of Action Pharmacokinetics |
Uses: prevent gastric ulcers
MOA: aluminum salt of sulfated sucrose reacts with gastric acid to form a thick paste which selectively adheres to ulcer Pharm: PO & systemic absorption is minimal. About 90% is eliminated in feces. |
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Sucralfate
Cytoprotectants Adverse Effects Drug Interactions |
AE: constipation. No known serious side effects.
DI: minimal drug interactions; antacids may interfere (take 30 minutes apart); may inhibit absorption of phenytoin, theophylline, digoxin, warfarin, fluoroquinolone antibiotics--administer 2 hrs apart. |
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Misoprostol
Cytoprotectants Therapeutic Uses Mechanism of Action Pharmacokinetics |
Uses: prevent gastric ulcers (caused by long term NSAID therapy)
MOA: suppresses secretion of gastric acid & increases production of protective mucus Pharm: well absorbed with PO administration |
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Misoprostol
Cytoprotectants Adverse Effects Drug Interactions |
AE: early termination of pregnancy (category X), dose related diarrhea, abdominal pain.
DI: increased risk of diarrhea with magnesium containing antacids |
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Aluminum/magnesium hyroxide
Maalox Antacid therapeutic uses adverse effects interactions |
uses: mainly PUD ( although not the mainstay anymore). Pre-op to prevent aspiration pneumonitis, prophylaxis of ulcers, GERD but only provide relief not healing
AE: constipation (aluminum), diarrhea(magnesium), can have high sodium content ( ! HTN), possibly hypophosphatemia I: affect absorption of many med's ( take1hour apart), |
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Bulk forming laxatives
psyllium - Metamucil mechanism of action administration |
MOA: much like dietary fiber, produce soft formed stool in 1-3 days. Swell in water > softening > increased bulk
A: full glass of water and juice |
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Bulk forming - laxatives
psyllium - Metamucil adverse effects interactions monitoring |
AE: generally none, esophageal and intestinal obstruction or impaction possible but rare
I : may decrease absorption of warfarin, salicylates and digoxin M: bowels, may be used for long term management |
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Surfactant - laxatives
docusate sodium Colace mechanism of action administration |
MOA: Inhibit fluid absorption and stimulates secretion of water and lytes into intestine, b/c of this they resemble stimulant laxatives
A: full glass of water, not within 2 hours of other lax. |
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Surfactant - laxatives
docusate sodium Colace adverse effects interactions monitoring |
AE: none really, rarely throat irritation, rash, cramps, diarrhea
I: no significant M: bowel, abdomen |
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stimulant - laxative
bisacodyl - dulcolax mechanism of action safe use administration |
MOA: stimulate intestinal motility, increase the amount of water and electrolytes within the intestinal lumen
SU: opioid-induced constipation and treatment of constipation r/t slow intestinal transit. Potential for abuse A : rectal/po, Milk may remove enteric coating of tablets, resulting in gastric irritation/dyspepsia (administer 1 hr after) |
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stimulant - laxative
bisacodyl - dulcolax adverse effects interactions monitoring |
AE: cramps, n/d, rectal burning. chronic use > hypo K, muscle weakness, tetany
I: Antacids, histamine H2-receptor antagonists, and gastric acid–pump inhibitors M: Only for short-term therapy, increase fluid intake and bulk in diet, don’t strain with bowel movement if u have cardiac disease (Valsalva maneuver) |
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stimulant - laxative
senna - senakot mechanism of action safe use administration |
MOA: Contains anthraquinones which act as an irritant on the colon to produce a soft or semifluid stool in 6-12 hrs
SU: treatment of opioid-induced constipation and treatment of constipation resulting from slow intestinal transit. Potential for abuse A: Administer with a full glass of water or juice preferably in the evening. Do not administer within 2 hr of other laxatives, especially mineral oil. |
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lubracant - laxatives
mineral oil Mode of action safe use administration |
MOA: only laxative that acts on small intestine, quickly in 2-6hr, produces watery stool. belongs to group 1
SU: limited to use where rapid and thorough evacuation is desired. not for bedtime A: unpleasant taste so chill and mix with fruit juice |
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osmotic - laxatives
magnesium salts milk of magnesia mechanism of action administration |
MOA: poorly absorbed salts whose osmotic action draws water into lumen. works in 6-12. High doses for quick evacuation.
A: oral, shake well, increase fluids |
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osmotic - laxatives
magnesium salts milk of magnesia adverse effects monitoring |
AE: dehydration, renal impairment> toxic magnesium levels, diarrhea, flushing sweating (for sodium phosphate no diuretics, ace inhibitors, ARB's, things that alter renal function)
M: bowels |
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osmotic - laxative
polyethylene glycol Miralax mechanism of action safe use side effects |
MOA: non-absorbable compound that retains water in intestinal lumen
SU: superior to lactulose, but side effects are the same SE: nausea, bloating, cramping, flatulence, high doses>diarrhea |
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consequences of laxative abuse
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loss of defecatory reflexes, electrolyte imbalance, dehydration, colitis.
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anti-emetics
serotonin / 5-ht3 receptor antagonist zofran - ondansetron mechanism of action indicated/contraindicated |
MOA: block type-3 serotonin receptors located in the CTZ and on afferent vagal neurons in upper GI
I/C: for n/v from chemo, radiation, anesthesia, viral gastritis, pregnancy. not for long QT syndrome, caution in electrolyte abnormalities, HF, bradydysrhythmia's, ones taking QT drugs |
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anti-emetics
serotonin / 5-ht3 receptor antagonist zofran - ondansetron adverse effects monitor |
AE: headache, diarrhea, dizziness, prolongs qt intervals (torsades de pointes)
M: use before surgery or chemo, monitor n/v |
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anti-emetics
dopamine receptor antagonist/ phenothiazine compazine - prochlorperazine mechanism of action indicated/contraindicated |
MOA: blocks dopamine 2 receptors in the CTZ
I/C: for surgery, chemo, toxins. not for |
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anti-emetics
dopamine receptor antagonist/ phenothiazine compazine - prochlorperazine adverse effects monitor |
AE: extrapyrimidal, sedation, anticholinergic SE, hypotension
M: level of sedation, risk of falling r/t hypotension |
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anti-emetics
prokinetic agent metoclopramide / reglan mode of action indicated/contraindicated |
MOA: blocks receptors for dop. and ser. in CTZ and increases GI motility by enhancing acetylcholine
I/C: po for diabetic gastroparesis, gerd, IV post-op n/v, CINV, facilitate small bowel intubation, radiologic exam of GI. not for GI obstruction, perforation, or hemorrhage, parkinsons. |
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anti-emetics
prokinetic agent metoclopramide / reglan adverse effects monitor |
AE: sedation, diarrhea, long-term high dose therapy can cause irreversible tar dive dyskinysia(elderly are more vulnerable, so use low-brief dose)
M: admin 30 min a.c. and at h.s., may cause drowsiness, no alcohol, extrapyramidal symptoms |
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anticholinergics
scopolamine patch mode of action indicated/contraindicate |
moa: suppressing traffic from vestibular apparatus (inner ear) to the vomiting center.
I/C: most effective drug for prevention and treatment of motion sickness, most effective prophylactically. not for tachycardia, glaucoma. |
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anticholinergics
scopolamine patch side effects monitoring |
SE: (anticholinergic) dry mouth, blurred vision, drowsiness. less commonly, urinary retention, constipation, disorientation.
M: Assess for signs of urinary retention Monitor heart rate during IV therapy Assess for pain, Scopolamine may act as a stimulant in the presence of pain, producing delirium if used without opioid analgesics. Assess for N/V |
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antihistamine agent
hydroxyzine / dimenhydrinate mode of action indication/contraindications side effects |
moa: Block H1 receptors and muscarinic receptors in pathway from inner ear to vomiting center. subclass of anticholinergic
I/C: less effective than scopolamine. for motion sickness, not for 3rd trimester, nursing mother, newborn se: sedation, anticholinergic |
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Benzodiazepine
lorazepam Indications for Use Contraindications |
Use: used to suppress chemotherapy induced nausea & vomiting (CINV). It has 3 benefits: sedation, suppression of anticipatory emesis, & production of anterograde amnesia
C: previous/preexisting CNS depression |
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Benzodiazepine
lorazepam Adverse Effects Monitoring |
AE: well tolerated & adverse effects are rare. Common S/E’s: dizziness, drowsiness, lethargy
M: assess for effectiveness of treatment--is this working for the CINV? Evaluate for adverse side effects, dependence on drug. |
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Neurokinin(NK1)receptor antagonists
Aprepitant Indications/Contraindications |
I: preventing postop N/V, and CINV; can be used to enhance other antiemetic drugs since MOA is unique.
C: Use with caution in patients taking warfarin and ethinyl estradiol (found in oral contrceptives). |
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Neurokinin(NK1)receptor antagonists
Aprepitant Adverse Effects Monitoring |
AE: fatigue, dizziness, hiccups, and diarrhea
M: monitor levels of CYP3A4 inhibitors and inducers since they can lower and raise aprepitant levels respectively; glucocorticoid levels if used as chemotherapy adjunct; monitor warfarin levels if used concurrently. |
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Cannabinoids
dronabinol Indications/Contraindications |
I: Suppressing CINV and stimulating appetite in AIDS-induced patients
C: Use with caution in patients with cardiovascular diseases |
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Cannabinoids
dronabinol Adverse Effects Monitoring |
AE: Temporal disintegration, dissociation, depersonalization, dysphoria, tachycardia, and hypotension.
M: Watch for drowsiness. Educate about potential for abuse |
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Natural products
Ginger Action Caution |
Supplements, teas, actual ginger. There is good evidence that ginger root has benefits in preventing motion sickness, morning sickness, general anesthesia. In addition has antiinflammatory effects.
Action= Unclear but good possibility it blocks serotonin receptors. Caution = anticoagulants, insulin |
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diphenoxylate (Lomotil)
opioid antidiarrheal agents Uses Administration |
Uses: treat diarrhea and reduce the volume of discharge from ileostomies. Suppresses bowel motility and fluid secretions into the intestinal lumen
Admin: Risk of dependence increases with high-dose, long-term use. Atropine has been added to discourage abuse, may be administered with food if GI irritation occurs. Tablets may be crushed and administered with patient's fluid of choice |
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diphenoxylate (Lomotil)
opioid antidiarrheal agents Contraindications |
Hypersensitivity, severe liver disease, infectious diarrhea, diarrhea associated with pseudomembranous colitis, dehydrated patients, angle-closure glaucoma, children <2 yr, known alcohol intolerance
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loperamide (Imodium)
non-opioid antidiarrheal agents Uses Administration |
Uses: Adjunctive therapy of acute diarrhea, chronic diarrhea associated with inflammatory bowel disease, decreases the volume of ileostomy drainage.
Admin: Assess frequency and consistency of stools and bowel sounds, assess fluid and electrolytes and skin turgor for dehydration, administer with clear fluids to help prevent dehydration |
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loperamide (Imodium)
non-opioid antidiarrheal agents Contraindications |
Hypersensitivity, patients in whom constipation must be avoided, abdominal pain of unknown cause, especially if associated with fever, alcohol intolerance (liquid only).
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Nonpharmacologic
therapies for IBS |
Pt ed/therapeutic relationship
Lactose/gluten restrictions Fiber supplementation Low FODMOP diet Regular exercise Cognitive behavioral therapy |
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Pharmacologic
therapies for IBS |
Antispasmodics
Probiotics Antidepressants(TCAs,SSRIs) Loperamide(IBS-D or M) Polyethylene glycol(IBS-C) Alosetron(women,IBS-C or M) |
