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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


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)