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32 Cards in this Set

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Non-pharmacologic measures to prevent vomiting

Tea, flat carbonated beverages, eating gelatin, drinking pedialyte, dry crackers and toast, IV fluids

Antiemetics: Phenothiazines

Mechanism of Action: Block dopamine receptors in the chemotrigger zone of the brain


Sedation helps control nausea


Side Effects: Rare, neutropenia (low WBCs)


Adverse Effects: Neuroleptic malignant syndrome - muscle rigidity, fever of 105-106


Tardive dyskinesia - involuntary repetitive movement


Examples: Compazine, Phenergan

Antiemetics: Anticholinergics

Mechanism of Action: Inhibit intestinal cramping and vestibular input


Side Effects: Dry mouth


Adverse Effects: Respiratory depression


Examples: Scopolamine


Note: Don't use with Glaucoma patients!

Antiemetics: Antihistamines

Mechanism of Action: Block action of histamine at H1 receptor sites


Side Effects: Sedation


Adverse Effects: Rare


Examples: Meclizine (Dramamine) available OTC

Antiemetics: 5HT3 Receptor Antagonists

Mechanism of Action: Block Serotonin (5HT3) receptors in intestine and chemo-trigger zone


Side Effects: Heart arrythmias, fatigue, diarrhea


Adverse Effects: Heart arrythmias


Examples: Ondansetron (Zofran), Granisetron


Note: All end in -setron, they are highly effective for chemo induced n/v

Antiemetics: Dopamine Receptor Antagonists

Mechanism of Action: Block Dopamine receptors in the chemo-trigger zone and intestine, facilitate movement of contents through the intestine (promote peristalsis)


Side Effects: Rare


Adverse Effects: Rare, anxiety and delirium


Examples: Metroclopramide (Reglan)


Note: Do not use with GI obstruction, hemorrhage, or perforation

Antiemetics: Benzodiazepines

Mechanism of Action: Reduce anxiety r/t anticipation of n/v


Example: Lorazepam (Ativan)

Antiemetics: Glucocorticoids

Mechanism of Action: For n/v unknown


Examples: Decadron, Solu-Medrol


Note: Used with chemotherapy, given IV

Antiemetics: Cannabinoids - THC

Mechanism of Action: Used for n/v to stimulate appetite


Example: Marinol

Poisoning Drugs

Ipecac Syrup - emetic


Mechanism of Action: Stimulates chemo-trigger zone and gastric mucosa


Note: Induces vomiting within 15-30 minutes, not available OTC due to abuse with anorexia/bulimia


Activated Charcoal - absorbent


Mechanism of Action: Binds to poison and prevents absorption in gut


Note: Use more often than Ipecac

Define Constipation and causes

Defined as fewer than 3 bowel movements per week, with hard stools that are difficult to pass. Usually accompanied by feelings of bloating and incomplete emptying.


Causes: Inadequate fluid, low-fiber diet, lack of physical activity, ignoring to defecate, stress and travel. Opioid analgesics can also cause constipation.

Nonpharmacologic methods of treating constipation

High fiber diet


Increase fluid intake


Regular exercise


Routine bowel habits


Prune juice

Laxatives:Bulk-forming Laxatives

Mechanism of Action: Absorb fluid and swell in intestine by activating Na/Cl channels. Stimulate peristalsis.


Side Effects: Rare, not systemically absorbed, safest


Adverse Effects: Rare


Examples: Citrucel, Metamucil


Note: Used for daily/profilactic/preventative measures. Take up 8-72 hours for response. Need to be taken with 8oz of fluid.

Laxatives: Stool Softeners

Mechanism of Action: Permits mixing of fats and fluids with fecal mass. Does NOT stimulate peristalsis


Side Effects: Rare, not systemically absorbed


Adverse Effects: Rare


Examples: Surfak, Colace (ducosate sodium)


Note: Consider initiation of stool softeners with opioid administration. Takes several days to work.

Laxatives: Saline

Mechanism of Action: Draw water into intestines through osmosis


Side Effects: Salts may be absorbed systemically, dehydration with prolonged use


Adverse Effects: Rare unless renal impairment and prolonged use


Examples: Milk of Magnesia, GoLytely


Note: Used for constipation and prep for bowel procedures

Laxatives: Stimulants

Mechanism of Action: Produce chemical irritation and increased peristalsis


Side Effects: Ex-Lax causes GI discomfort, reddish-brown urine. May cause dependence.


Adverse Effects: With overuse - electrolyte imbalance and arrythmias


Examples: Ex-Lax, Dulcolax


Note: Works within 6-12 hours, available OTC, patients may become dependent on stimulants

Diarrhea

Increase in amount of water in bowel movements with increased volume and frequency


Children are most at risk for dehydration


Many causes - Drugs, diseases, pathogens

Non-pharmacologic methods of treating diarrhea

Clear liquid diet


Electrolyte preparations- Pedialyte - Gastrolyte


Avoid milk products and fatty foods


IV fluids and electrolytes

Anti-diarrheals: Opiates and opiate-related agents

Mechanism of Action: Decrease intestinal motility


Side Effects: CNS depression


Adverse Effects: Respiratory depression


Examples: Lomotil, Imodium


Note: Lomotil contains atropine (anticholinergic), don't give to someone who has had Glaucoma

Anti-diarrheals: Absorbents

Mechanism of Action: Coat GI tract and bind bacteria/toxins. Ultimately slows GI movements.


Side Effects: Rare, not systemically absorbed


Adverse Effects: Rare


Examples: Kaopectate


Note: Consider necessity for antibiotics

Anti-diarrheals: Anti-secretory

Mechanism of Action: Pepto-Bismol - Decreases secretion of bacterial fluids, slows bacterial activity.


Somatostatin analog - Inhibits GI secretions, relaxes smooth muscle of the GI tract.


Side Effects: Many, drug dependency


Adverse Effects: Many, drug dependency


Examples: Pepto-bismol, Octreotide


Note: Not good for children - may cause Reye's syndrome (neurologic impairements)

Gastric Problems

HCl secreted by parietal cells


pH range 2-5


Stomach has gastric mucosal barrier (GMB) that protects the stomach mucosa from HCl; esophagus does not have GMB


Lower esophogeal (LES) and pyloric sphincters prevent reflux of gastric acid into esophagus and duodenum

Peptic Ulcer Disease (PUD)

Types of ulcers:


Esophogeal: Incompetent LES



Gastric: Breakdown of GMB



Duodenal: Insufficient gastric buffering, defective pyloric sphincter, gastric hypermotility


Stress: Result of critical medical issue

Gastroesophageal Reflux Disease (GERD)

Inflammation of the esophagus from gastric refluxIncompetent LES

Non-pharmacological ways of treating GERD

Avoid Alcohol and Tobacco


Weight Loss


Avoid irritating foods (spicy, citrus)


Avoid NSAIDs (ibuprofen, aleve)


Raise HOB while sleeping


Avoid eating before bed


Wear loose fitting clothing

H. pylori

Gram-negative bacillus implicated in PUD


Diagnosed through EGD or breath test


Triple-therapy regimen: Peptol-bismol, metronidazole, tetracycline or ampicillin

Drugs for GERD and Ulcers: Antiulcer Drugs:Histamine H2 blockers

Mechanism of Action: Inhibits histamine at H2 sites of parietal cells in stomach, reducing secretion of HCl


Side Effects: GI discomfort, confusion, drowsiness


Examples: Zantac, Pepcid


Note: Used for PUD and GERD, give before meals, some available OTC

Drugs for GERD and Ulcers: Antiulcer Drugs: Proton-Pump Inhibitors (PPIs)

Mechanism of Action: Inhibits acid production by blocking final step in parietal cells


Side Effects: GI discomfort


Adverse Effects: Pulmonary fibrosis


Examples: Prevacid, Prilosec, Protonix


Note: Used for PUD and GERD, strong interactions with anticoagulants (Warfarin) and phenytoin, more effective than H2 blockers, give before meals, long term use could cause stomach infections

Drugs for GERD and Ulcers: Antiulcer Drugs: Antacids

Mechanism of Action: Alkaline agents that neutralize HCl (use salts from Ca++, Mg+, or aluminum). Decrease irritation and inflammation.


Side Effects: Rare, Magnesium - diarrhea, Aluminum - constipation


Adverse Effects: Nephrotoxic with abuse


Example: Systemic - Calcium carbonate, Alka-Seltzer Non-Systemic - Maalox, Mylanta


Note: Used for PUD and GERD, Systemic - Rapid onset/short duration of action Non-Systemic - Long-term therapy, magnesium/aluminum combination. May bind to other drugs. Increase gastric pH, which may decrease absorption of other drugs, increase urinary pH, inhibiting or promoting excretion of other drugs. Administer oral drugs 1-2 hours before or after antacid.

Cytoprotective Drugs: Pepsin Inhibitor

Mechanism of Action: Coats ulcer, protects exposed mucosa


Example: Carafate (sucralfate)

Cytoprotective Drugs: Pepto-Bismol

Mechanism of Action: Coats stomach and intestine; inhibits H. pylori activity

Cytoprotective Drugs: Prostoglandin Analogue

Mechanism of Action: Suppresses HCl secretion and increases GI mucous; decreases pepsin activity


Given with long-term NSAIDs


Example: Cytotec (Misoprostol)