The Gastrointestinal System (Pharm Made Easy 3.0)

Front 1

Drugs that treat Peptic ulcers

Back 1

-Histamine 2 receptor antagonists

-Proton pump inhibitors

-Mucosal protectant

-Antacids

-Prostaglandin E analogs

-Antibiotics

Front 2

Histamine 2 receptor antagonists

Back 2

•Treat: gastric + duodenal ulcers, heartburn, dyspepsia, erosive esophagitis, G.E.R.D, prevents aspiration pneumonitis and hyper-secretory disorders (zollinger-Ellison syndrome (gastrin) and systemic mastocytosis (histamine)

•Examples:

-Cimetidine

-Famotidine

•BLOCK histamine 2 receptors on parietal cells in the stomach (which DECREASES amount of stomach acid + INCREASES pH of stomach acid)

•Side effects

-Impotence, reduced libido (cimetidine)

-CNS effects (lethargy, restlessness, seizures); common with cimetidine

-Nausea, vomiting, diarrhea or constipation

•Report any signs of G.I bleeding (blood in emesis + black tarry stools to the provider)

•Take antacid 2 hours after taking a histamine 2 receptor blocker

•Do NOT give to children younger than 12 years old

•Do NOT give to patients with acute porphyria

Front 3

Proton Pump inhibitors

Back 3

•Treats: Gastric + duodenal ulcers, prolonged dyspepsia, GERD, erosive esophagitis, hyper-secretory disorders (Zollinger-Ellison syndrome, system mastocytosis)

•Examples:

-Pantoprazole

-Lansoprazole

-Esomeprazole

•Inhibit hydrogen, potassium- ATPase enzyme system in parietal cells (this suppressed gastric acid production)

•Side effects:

-Bone loss (OSTEOPOROSIS; perform weight bearing exercises; consume vitamin D + calcium)

-Nausea, vomiting and diarrhea

•Administered DAILY before first meal of the day

•Do NOT give to children younger than 18 years old

•Do NOT give if allergic to the drug

Front 4

Mucosal Protectant

Back 4

•Treats: acute duodenal ulcers

•Example:

-Sucralfate

•COATS ulcers + CREATES a BARRIER between the stomach and gastric secretions

•Side effects

-Constipation (monitor bowel movement; administer stool softener; increase fluids, increase activity)

-Nausea

-Diarrhea (report worsening diarrhea to provider)

-Dyspepsia

•Give on an empty stomach!

•Give 1 hour before meals (4 times a day)

•Do not give antacids within 30 to 60 minutes of administration of sucralfate

•Do NOT give within 2 hours of administering:

-Fluoroquinolones (like ciprofloxacin)

-Warfarin (Coumadin)

-Phenytoin

-Theophylline

-Digixon

-Tetracycline (like doxycycline)

-Diazepam

•Do NOT give to children

Front 5

Antacids

Back 5

•Treats: peptic ulcer disease + GERD

•Example:

-Aluminum hydroxide (Amphojel)

-Magnesium hydroxide (milk of magnesia)

-Calcium carbonate

•NEUTRALIZES gastric acid

•Side effects

-Constipation (increase fluid, fiber and activity to prevent constipation)

-Diarrhea

-HYPOphosphatemia, HYPOmagnesemia (low phosphate and magnesium in the blood; monitor these electrolytes when giving aluminum based antacids because aluminum lowers these electrolytes) ☆

•Report muscle weakness, muscle cramps, difficulty swallowing or tremors (while on aluminum antacid)

•Do NOT give antacid if there is G.I perforation or obstruction

•Do NOT give aluminum antacid if patient has HYPOphosphetemia (low serum phosphate)

Front 6

Prostaglandin E analogs

Back 6

•Treats: prevention of gastric ulcers from long term use of NSAIDs

•Example:

-Misoprostol (Cytotec)

•DECREASES gastric acid secretion, INCREASES secretion of bicarbonate (a base), INCREASES stomach protective mucus and INCREASES vasodilation of submucosal blood flow in gastric wall

•Side effects

-Diarrhea

-Abdominal pain

-Nausea

-Dyspepsia

-Spotting

-Dysmenorrhea (painful menses) ☆

-Uterine cramps

•Monitor for excessive menstrual pain or midcycle bleeding (spotting)

•Report menstrual changes + post menopausal bleeding

•Do NOT give to pregnant women because it will cause a miscarriage (pregnancy category X)

Front 7

Drug Therapy for nausea

Back 7

•Serotonin antagonist

•Antihistamine

•Prokinetic

Front 8

Serotonin Antagonist

Back 8

•Treats: nausea + vomiting from chemotherapy, radiation therapy and post-operative recovery

•Examples:

-Granisetron

-Palonosetron

-Ondansetron

•BLOCK 5-HT3 serotonin receptors (blocks the CTZ trigger zone in the brain and afferent vagal nerves that innervate stomach and small intestine

•Side effects:

-Headache (monitor for persistent headaches)

-Dizziness (implement FALL precautions)

-Diarrhea (monitor for severe diarrhea + dehydration)

•Chemotherapy induced vomiting: Give I.V slowly (over 15 minutes) starting 30 minutes before chemotherapy administration and then 4 to 8 hours later

•Anesthesia induced vomiting: Give the drug 1 hour before anesthesia induction or postoperatively, then every 8 hours as needed

•Radiation induced vomiting: Give the drug orally 1 to 2 hours prior to radiation therapy; then every 8 hour as needed

•Do NOT give to children younger than 4 years old

Front 9

Antihistamine

Back 9

•Treats: motion sickness and vomiting/nausea

•Examples:

-Dimenhydrinate

-Scopolamine

•Block H1 receptors (inner ear + chemoreceptor trigger zone CTZ)

•Side effects

-Sedation

-Drowsiness

-Dizziness

-Anticholinergic effects (dry mouth, constipation,urinary retention) ☆

•Administer 30 to 60 minutes before the activity that triggers nausea

•Give subsequent doses BEFORE MEALS and at BEDTIME

•Do NOT give to patients with conditions or specific age:

-Children younger than 2 years old

-Angle/closure glaucoma

-Prostatic hypertrophy

-G.I or urinary tract obstruction

-CNS depression

-Jaundice

Front 10

Prokinetic

Back 10

•Treat: nausea, vomiting from chemotherapy, opioids, radiation therapy, gastrointestinal reflux disease (GERD) and diabetic gastroparesis

•Examples:

-Metoclopramide

•Dopamine receptor blocker (Increases tone of lower esophageal sphincter, Increases peristalsis, Increases chemoreceptor trigger zone threshold in the brain

•Side effects:

-Sedation

-Dry mouth (suck on candy, chew gum, and sip water)

-Diarrhea (report severe diarrhea and treat dehydration)

-Extrapyramidal symptoms, TARDIVE DYSKINESIA (long term, high doses, irreversible; report restlessness, anxiety or spasm of the face and neck, lip smacking, writhing motions and involuntary movements ☆

•Do NOT give to patients with these conditions:

-G.I obstruction

-Hemorrhage + perforation

-Uncontrolled seizures disorders

-Pheochromocytoma (tumor that releases excessive epinephrine)

-Breast cancer

Front 11

Drugs for constipation:

Back 11

•Fiber supplements

•Stool softeners

•Stimulant laxatives

Front 12

Fiber supplements

Back 12

•Treat: constipation, diverticulosis, irritable bowel syndrome, stool regulation for diarrhea and fecal ostomies

•Examples:

-Psyllium

-Calcium polycarbophil

-Methylcellulose

•Bulk forming laxatives

•Side effects:

-Esophageal or intestinal obstruction (When taken with too little fluid with psyllium)

-Diarrhea (with excessive use)

•Monitor for retrosternal pain which indicates the pain too insufficient fluid with supplement

•Monitor for diarrhea + dehydration ☆

•EMPHASIZE importance of taking at least 8 oz of fluid with each dose of fiber supplement

•EXPECT soft stool after 1 to 3 days after initiating therapy

•Do NOT give to patients with these conditions:

-Esophageal or G.I obstruction

-Narrowing or INTESTINAL OBSTRUCTION!

-Fecal Impaction

-Dysphagia

-Nausea + vomiting

-Appendicitis ☆

-Undiagnosed abdominal pain

Front 13

Stool softeners

Back 13

•Treats: constipation, prevents fecal Impaction, straining during defecation, painful elimination of hard stools

•Examples:

-Docusate sodium (Colace)

-Docusate sodium and senna (Peri-Colace)

•Increase absorption of water into the stool, increases secretion of water + electrolytes from the intestinal wall

•Senna (stool softener): stimulates intestinal motility, decreases fluid absorption through intestinal wall and increases secretion of water + electrolytes from the intestinal wall

•Side effects

-Diarrhea

-Mild abdominal cramps

•Give stool softener with at least 8 oz of water

•EXPECT soft stools several days after initiating therapy

•STOP taking the drug if diarrhea develops

•Do NOT give to patients with these conditions:

-G.I obstruction, perforation

CONCURRENT use of mineral oil

-Fecal Impaction

-Nausea + vomiting

-Undiagnosed abdominal pain

Front 14

Stimulant laxatives

Back 14

•Treats: constipation from opioid use or from slow intestinal transit + use for colon evacuation for elective procedures

•Examples:

-Senna

-Castor oil

-Cascara sagrada

•STIMULATES intestinal motility, DECREASES fluid absorption through intestinal wall + INCREASES secretions of water + electrolytes from intestinal wall

•Side effects

-Diarrhea (monitor for severe diarrhea + dehydration)

-Mild abdominal cramps

-Burning sensation (SUPPOSITORIES; Tell patient to EXPECT rectal or anal burning)

-Proctitis (prolonged use of suppositories; monitor for rectal discomfort, bleeding or discharge of mucus or pus (proctitis) REPORT ☆

-Laxative abuse

•Monitor I + O

•Tell patients to take oral form at least 1 hour after drinking milk or taking antacids

•Do NOT give to patients with these conditions:

-Children younger than 1 year

-G.I obstruction, perforation

-Anal or rectal fissures

-Ulcerated hemorrhoids

-Fecal Impaction, illeus

-Proctitis

-Undiagnosed abdominal pain (could be an obstruction; so it is contraindicated)

-Nausea + vomiting

Front 15

Opioids

Back 15

•Treats: Diarrhea + reduction of volume of ileostomy effluent (loperamide)

•Examples:

-Diphenoxylate and atropine (Lomotil)[maximum dose per day is 20 mg]

-Loperamide (Loperamide)[maximum dose per day is 16 mg]

•Decrease intestinal peristalsis, Increase absorption of water from feces

•Side effects

-Sedation

-Dizziness

-Lightheadedness

-Anticholinergic effects (dry mouth, urinary retention) ☆

•Excessive doses with diphenoxylate/atropine causes CNS similar to morphine (antidote:Naloxone)

•After 36 to 48 hours, if diarrhea persist STOP administration

•Do NOT give to patients with these conditions:

-Children younger than 2 years old

-Inflammatory bowel disease (due to excessive diarrheal effects)

-Advanced hepatic disease

-Glaucoma

-Severe fluid + electrolytes imbalance (loss of fluid + electrolytes through diarrhea)

-Pseudomembranous enterocolitis

-Diarrhea due to poisoning

-Ileus (PARALYSIS of INTESTINAL MOTILITY)

-G.I bleeding

Front 16

Irritable bowel syndrome

Back 16

•Alosetron

•Lubiprostone

Front 17

Alesetron

Back 17

•Treats: severe irritable syndrome of diarrhea (IBS-D use women ONLY)

•Blocks serotonin 5-HT3 receptor antagonist( decreases visceral pain, slows peristalsis, increases absorption of water + sodium through intestinal wall and reduces secretion of water + electrolytes from the intestinal wall

•Side effects

-Constipation (can result in Impaction, perforation, obstruction)

-Ischemic colitis

•Instruct patient taking the drug to REPORT immediately if constipation occurs

-Instruct patient to REPORT abdominal pain, bloody diarrhea or rectal bleeding (ischemic colitis) and immediately STOP the drug

•Do NOT give to patients with these conditions

-Chronic, severe or complicated constipation

-Diverticulitis

-Crohn's disease

-Ulcerative or ischemic colitis

-Thrombophlebitis + hyper-coagulable state

-Toxic megacolon

-G.I perforation, obstruction + stricture

Front 18

Lubiprostone

Back 18

•Treat: Irritable bowel syndrome with constipation (IBS-C) in women age 18 years or older + chronic idiopathic constipation (CIC) in men + women

•Serotonin 5-HT4 receptor agonist (decreases visceral pain, INCREASES peristalsis, INCREASES secretion of water and electrolytes from intestinal wall, INCREASES secretion of sodium and water

•Side effects:

-Nausea + vomiting

-Diarrhea

-Flatus

-Headache (report persistent headache)

•Monitor for worsening nausea + vomiting + diarrhea + abdominal pain, notify provider and stop the drug

•Give twice a day orally

•Do NOT give drug if patient is experiencing diarrhea

•Take with food or water

•Do NOT give to patients with these conditions:

-Severe diarrhea

-Diverticulitis

-Crohn’s disease

-Ulcerative colitis

-Volvulus (twisted intestine)

-G.I obstruction

Front 19

Drugs that treat inflammatory bowel disease

Back 19

•5-Aminosalicylates (covering)

•Immunomodulators

•Immunosuppressants (covering)

•Glucocorticoid

Front 20

5-aminosalicylates

Back 20

•Treat: Mild to moderate bowel disease

•Examples:

-Sulfasalazine

-Mesalamine

•Sulfasalazine (Two parts: 5-aminosalicylic acid (mesalamine) & sulfapyridine (non-therapeutic)

•5-aminosalicylic acid (mesalamine) inhibits prostaglandin (DECREASES inflammation in the colon)

•Sulfapyridine (non-therapeutic for I.B.D and causes adverse effects)

•Side effects:

-Nausea + vomiting + diarrhea

-Fever (monitor temp)

-Rash

-Arthralgia (joint pain)

-Hematologic disorders (agranulocytosis, macrocytic or hemolytic anemia)-Monitor CBC periodically

•Give sulfasalazine after meals

•Expect an orange-yellow discoloration of alkaline urine + skin (Sulfasalazine)

•Do NOT give to patients with these conditions

-Sensitivity to salicylates, sulfonamides, or trimethoprim

-Folate deficiency

-Megaloblastic anemia

-Agranulocytosis

-Renal failure

-Porphyria

-G.I or urinary obstruction

Front 21

Immunosuppressant

Back 21

•Treat: inflammatory bowel disease

•Examples:

-Azathioprine

-Cyclosporine

-Methotrexate

•Inhibit production of B & T lymphocytes (decrease immune response)

•Side effects:

-Nausea + vomiting + anorexia

-Hepatitis (Monitor liver function tests ALT, AST, ALP; report abdominal pain, jaundice, fever)

-Bone marrow suppression (neutropenia, thrombocytopenia, leukopenia, agranulocytosis)-Monitor CBC before initiating therapy and periodically thereafter

•Stop therapy for decreased WBC count (less than 5,000 cells; institute neutropenia precautions, REVERSE isolation)

•Therapeutic effects will take up to 6 months after initiating therapy

•Do NOT give to patients with these conditions:

-Acute infections

-Anuria (no urine output)

-Pancreatitis

-Immunization (with live virus vaccine)