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Gastrointestinal RX
Antacids, Antidiarrheals, Laxatives, Anti-emetics and Antinausea Agents
| Question | Answer |
|---|---|
| Catergories of antacids? (5) | 1. Cholinergic Blocking agents; 2. Aluminum, Calcium, and Magnesium based antacids; 3. H2 antagonists; 4. proton pump inhibitors 5. Cyrtoprotective Agents |
| Mechanism of Action for cholinergice blocking agents? | antispasmotic |
| MOA for aluminum, Calcium & Magnesium based antacids? | Neutralize gastric acid |
| MOA fo H2 antagonists? | block H2 receptors of the acid-producing parietal cells |
| MOA for Proton Pump Inhibitors? | blocks all gastric acid secretion |
| MOA for cytoprotective agents? | Little absorption from the gut, chemically inert |
| Classification and therapeutic uses of Atropine, Bentyl, and Robinul? | Choliniergic blocking agent (anticholinergic) works as an antacid and antispasmotic |
| Therapeutic uses of ALuminum, Magnesium, & Calcium based antacids? (3) | 1. Relief of symptoms r/t hyperacidity r/t PUD, gastritis, esophagitis, hiatal hernia; 2. reduction of stomach acidity; 3. reduction of stomach pain; |
| Adevers effects of Magnesium antacids (Maalox, Mylanta)? | diarrhea; excessive use can cause systemic alkalosis; |
| Adverse effet of Aluminum/Calcium (Amphogel) antacids? | constipation; excessive use can cause systemic alkalosis; |
| What is the preferred antacid in pts. with impaired renal function? | Amphogel |
| Classification and MOA of Cimetidine (tagamet), Pepcid, Axid, & Zantac? | H2 antagonist blocks H2 receptors of the acid-producing parietal cells; reduces amount of acid; |
| Adverse rxn of Cimetidine (tagamet), Pepcid, Axid, & Zantac? | low incidence; < 3% ecperience headaches, depression, lethargy; |
| Drug interactions of Cimetidine (tagamet), Pepcid, Axid, & Zantac? | inhibits the absorption of theohyllin, warfarin; |
| Cimetidine (tagamet), Pepcid, Axid, & Zantac are contraidicated in what types of pts? | Pts. with impaired renal or hepatic function; |
| Classification and MOA for Omeprazole (Prilosec)? | proton pump inhibitor; blocks all gastric acid secretion; |
| Therapeutic uses of Omperazole (Prilosec)? | due to some carcinogenic concerns, only approved for the Tx of gastric/esophageal reflux disease (GERD), Zollinger-Ellison Disease; |
| Drug interactions of Omeprazole (Prilosec)? | may increase serum levels of Diazapam, Phentoin; may ineract with warfarin; |
| Classification and MOA for Sacralfate (Carafate)? | Cytoprotective agent that has little absorption from the gut, chemically inert; |
| Therapeutic use of Sacralfate (Carafate)? | Tx of stress ulcers & chronic PUD; Esophageal Ulcers; |
| Adverse rxn of Sacralfate (Carafate)? | constipation, Nausea; |
| Pt teaching for Anactids? (3) | 1. do not take any other medication within 1-2 hours after taking the antacid; 2. contact MD immediately, if experience constipation, diarrhea, increased abdominal pain; 3. antacids may prematurely dissolve enteric coatings and thereby increase GI upset; |
| what are the four classess of antidiarrheals? | 1. absorbents; 2. anticholinergics; 3. intestinal flora modifiers; 4. Opiates; |
| MOA for absorbents? | coat the wall of the intestines; bind with the causative bacteria or toxin and eliminate it in the stools; |
| MOA for Anticholinergics? | decrease peristalsis |
| MOA for intestinal flora modifiers? | obtained from bacteria; restore the body's normal flora; |
| MOA for Opiates? | decrease bowel motility; |
| Classification of Kaopectate (PeptoBismol)? | absorbant antidiarrheal agents |
| Adverse rxn of Kaopectate (PeptoBismol)? | increased bleeding time, constipation, dark stools, confusion, tinnitus, hearing loss, twitching, metalic taste in mouth |
| Classification fo Belladonna Alkaloid (Donnatal)? | anticholinergic; antidiarrheal |
| Adverse rxn of Belladonna Alkaloid (Donnatal)? | urinary retention/hesitancy, impotence, drowsiness, headache, hypotension, tachycardia, blurred vision, photophobia; |
| Classification of Lactobaccilus Acidophillus? | intestinal flora modifier given as a food additive; |
| Adverse rxn of Lactobaccilus Acidophillus? | drowsiness, sedation, respiratory depression, bradycardia, hypotension, urinary retention; |
| Classification and therapeutic use of Diphenoxylate (Lomotil) & Loperamide (Immodium)? | opiate used as anti-diarrheal. |
| Adverse rxn of Diphenoxylate (Lomotil) & Loperamide (Immodium)? | drowsiness, sedation; |
| Causes of constipation? (4) | 1. Metabolic & endocrine disorders; 2. neurologic disorders; 3. adverse side effects; 4. life style; |
| Types of Laxatives? (4) | 1. bulk forming; 2. emollient (stool softeners); 3. hyperosmotic; 4. saline; |
| MOA for bulk forming laxatives? | absorb water into the bowel, which increases bulk and stimulates the bowel's natural evacuation reflex activity; |
| MOA for Emollient (stool softener) laxatives? | lower the surface tension of GI fluids allowing more water and fat to be absorbed into the stools; |
| MOA for hyperosmotic laxatives? | increase fecal water content which results in distention, increased preistalsis and evacuation; |
| MOA for Saline laxatives? | inhibit water and electrolyte absorption in the intestine, resulting in watery stools (ex enemas of sodium phosphate initiate defecation within 2-5 minutes) |
| Classification of Methyllcellulose (Citrucel) & Psyllium (Metamucil)? | bulk forming laxatives |
| Adverse rxn of Methyllcellulose (Citrucel) & Psyllium (Metamucil)? | impaction above strictures, fluid overload; |
| Classification of Mineral Oil & Docusate Salts (Surfax, Diocto-K) ? | emollimnet laxatives also used in prevention of constipation; |
| Adverse rxn of Mineral Oil & Docusate Salts (Surfax, Diocto-K) ? | skin rashes, decreased absorption of vitamins, lipid pnuemonia; |
| Classification of GoLytely, Lactulose (Chronulac)? | hyperosmotic laxative |
| Therapeutic use of GoLytely? | used for contrast and endoscopic prep |
| Therapeutic use of Lactulose? | lowers blood ammonia levels in pts with severe hepatic involovement |
| Adverse rxn of GoLytely & Lactulose (Chronulac)? | abdominal bloating, rectal irritation; |
| Classification of Magnesium Salts (Milk Of Magnesia, Fleets Enema)? | saline laxative |
| Adverse rxn of Magnesium Salts (Milk Of Magnesia, Fleets Enema)? | magnesium toxicity in pts with renal insufficiency; |
| Classification of Phenolphthalein & Senna (Ex Lax & Senokot)? | stimulant laxatives |
| Adverse rxn of Phenolphthalein & Senna (Ex Lax & Senokot)? | nutrient malabsorption, skin rashes, gastric irritations, laxative dependence; |
| Pt teaching for Laxatives? (5) | 1. swallow all laxative tablets with at least 6oz of water; 2. do not crush or chew enteric coated tablets; 3. long term use of laxatives may result in laxative dependence; |
| pt teaching for laxatives? (5) cont. | cont. 4. notify MD immediately if you develope abdominal pain, muscle weakness, cramps, dizziness; 5. Do not take laxative if you are experiencing nausea, vomiting or abdominal pain; |
| What are the nonsurgical Tx's of contipation? (3) | Dietary (fiber supplementation), Behavioral (increasing physical activity), Pharmeceutical |
| How does pharmaceutical use of laxatives promote bowel movements? (3) | 1. Effecting stool consistency; 2. increasing fecal movement through the colon; 3. removing stool from the rectum; |
| Categories of Antiemetics? (6) | 1. anticholinergics; 2. antihistamines; 3. neuroleptic Agents; 4. prokinetic agents; 5. serotonin blockers; 6. tetrahydrocannabinoid (THC); |
| Indications for anti-emetics? (anticholinergics) | motion sickness, secretion reduction for surgery |
| Indications for anti-emetics? (antihistamines) | motion sickness, allergy & rhinitis symptoms |
| Indications for anti-emetics? (Neuroleptic Agents) | also used in the treatment of psychotic disorders, anxiety, agitation; |
| Indications for anti-emetics? (prokinetic agents) | promote movement of substances through the GI tract; increase GI motility in delayed gastric emptying; |
| Indications for anti-emetics? (serotonin blockers) | N&V associated with cancer chemotherapy; |
| Indications for anti-emetics? (tertrahydrocannabinoid THC) | major psychoactive component of marijuana; N&V assciated with cancer chemotherapy; |
| Classification and therapeutic use of Meclizine (Antivert)? | antihistamine anti-emetic used for motion sickness, allergic rhinitis, N&V; |
| Adverse rxn of Meclizine (Antivert)? | drowsiness, dizziness, dry mouth, blurred vision, difficulty urinating; |
| Major drug interactions of Meclizine (Antivert)? | additive effects with CNS depressants |
| Classification and therapeutic use of Scopolomine (Trans Derm Scop)? | Anticholinergic anti-emetic used for mostion sickness, reduction of secretions preoperatively, N&V; |
| Adverse rxn of Scopolomine (Trans Derm Scop)? | drowsiness, dizziness, dry mouth, blurred vision, difficulty urinating; |
| Major Drug interaction fo Scopolomine ( Trans Derm Scop)? | additive effects wih antihistamines & antidepressants; |
| Classification and therapeutic uses of Prochlorperazine (Compazine)? | neuroletic anti-emetic used for pyschotic disorders, intractable hiccoughs, N&V; |
| Adverse rxn of Prochlorperazine (Compazine)? | orthostatic hypotension, dry mouth extrapytamidal symptoms |
| Major drug interactions of Prochlorperazine (Compazine)? | blocks levodopa; additive effects with quinidine; |
| Classification and MOA of Metoclopramide (Reglan)? | Porkinetic agent that acts on dopamine receptors and promotes movement of substances through the GI tract; |
| Therapeutic use of Metoclopramide (Reglan)? | delayed gastric emptying, N&V |
| Adverse rxn of Metoclopramide (Reglan)? | sedation, fatigue, hypotension, dry mouth; |
| Major drug interactions of Metoclopramide (Reglan)? | additive effects with ETOH; |
| Classification and MOA of Dronabinol (Marinol)? | tetrahydrocannabinoid (THC) that has an inhibitory effect on reticular formation, thalamus & cerebral cortex; |
| Therapeutic use of Dronabinol (Marinol)? | N&V associated with cancer chemotherapy, appetite stimulant; |
| Adverse rxn of Dronabinol (Marinol)? | drowsiness, dizziness, confusion, dry mouth, visual disturbances; |
| Calssification and therapeutic use of Gansitron (Kytril) & Ondanestron (Zofran)? | serotonin blocker used to N&V associated with cancer chemotherapy and postoperatively; |
| Adverse rxn of Gansitron (Kytril) & Ondanestron (Zofran)? | Headache, Diarrhea, bronchospasm; |
| Pt teaching for Anti-emetic Drugs? (4) | 1. take exactly as directed; 2. may cause drowsiness, use caution; 3. do not take with alcohol or other CNS depressants; 4. pts on Dronabinol (Marinol) should change positions slowly; |
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