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Gastrointestinal RX

Antacids, Antidiarrheals, Laxatives, Anti-emetics and Antinausea Agents

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;
Created by: 100000174040213



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