Pharmacology Final Exam Study Guide

GI Drugs

• Antacids:
  • Aluminum: causes constipation and hypophosphatemia (monitor phosphorus and sodium levels)
  • Calcium: causes constipation and kidney stones (monitor for hypercalcemia)
  • Magnesium: causes diarrhea, can lead to toxicity in those with renal impairment, and requires 8 oz of water after chewing and swallowing, take 1 hour before eating and 1-2 hours after meds
• H2 receptor antagonists:
  • Cimetidine: causes decreased libido, impotence, and gynecomastia, CNS, and interacts with warfarin
• PPIs:
  • Omeprazole: causes short-term headache and GI, long-term osteoporosis, hypomagnesemia, and rebound acid hypersecretion (wean off), and C diff
• Sucralfate:
  • Causes constipation, increase fiber and fluids, take 4 times daily, 1 hour before meals and at bedtime, and interacts with warfarin
• Misoprostol:
  • Causes diarrhea and abdominal pain, and reproductive concerns such as miscarriage, spotting, and uterine cramps
• Diphenoxylate and loperamide:
  • Diphenoxylate (opioid): causes cardiac arrhythmias or arrest, opioid and anticholinergic effects
  • Loperamide: no potential abuse and few adverse effects

Laxatives

• Psyllium:
  • Functions like dietary fiber, for diverticulosis and IBS, and esophageal obstruction (take with 8 oz of water)
• Docusate sodium:
  • Used for fecal impaction or straining, give with 8 oz of fluid, and AE uncommon
• Bisacodyl:
  • Stimulates nerves in intestines, for opioid-induced constipation and slow intestinal transit
• Magnesium hydroxide:
  • Quick acting, causes dehydration, and magnesium toxicity (don't give in those with renal disease)
• Polyethylene glycol:
  • Empties bowels before procedure (colonoscopy), causes nausea, bloating, and abdominal discomfort
• Lactulose:
  • Draws in ammonia and used in liver disease/kidney failure

Antiemetics

• Ondansetron:
  • Used for chemo, radiotherapy, and anesthesia vomiting, causes headache, diarrhea, and dizziness, and Stevens, serotonin syndrome
• Metoclopramide:
  • Used for gastroesophageal reflux and postoperative N&V, causes sedation, diarrhea, neurologic malignant syndrome, tardive dyskinesia, and extrapyramidal reactions
• Prochlorperazine:
  • Used cautiously in older adults and children, causes extrapyramidal reactions, anticholinergic effects, and hypotension and sedation
• Promethazine:
  • Used cautiously in older adults and children, causes severe respiratory depression, severe local tissue injury, and interactions with alcohol and warfarin

Reproductive

• Estrogen:
  • Causes endometrial and ovarian cancer, thromboembolism, nausea, hypertension, and breast cancer, lowest dose for shortest period, and contraindications include history or risk for thromboembolism, suspected cancer, undiagnosed vaginal bleeding, and liver disease
• Progesterone:
  • Causes thromboembolic events, avoid smoking, and gynecologic effects (breakthrough bleeding)