GI Drug Table.pdf

DRUGS FOR GERD AND PUD Drug Name and Class Mechanism of Action Use(s) Adverse Effects Contraindications Nursing Implications ANTACIDS magnesium hydroxide...

DRUGS FOR GERD AND PUD Drug Name and Class Mechanism of Action Use(s) Adverse Effects Contraindications Nursing Implications ANTACIDS magnesium hydroxide - heartburn - diarrhea - chew tablets thoroughly (milk of magnesia) - laxative followed w/ glass of water or milk - shake liquid preparations before dispensing - interacts w/ several drugs, take 1-2 hr apart aluminum hydroxide - constipation - contains high amount of - hypophosphatemia sodium so be cautious - binds with certain drugs calcium carbonate (tums) - releases carbon dioxide - constipation in stomach, causing - acid rebound belching and flatulence - milk-alkali syndrome Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications HISTAMINE2 RECEPTOR ANTAGONISTS prototype: cimetidine - suppress secretion of - promote ulcer healing - for cimetidine: in older - given PO and some IV “tidine” family gastric acid adults, confusion Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications PROTON PUMP INHIBITORS prototype:omeprazole - decreases acid by 90% - severe GERD or active - long term therapy and (Prilosec) in 24 hours ulcers high doses- risk of - most effective drugs for - reduces bleeding and aspiration pneumonia, suppressing gastric acid helps tissue heal poor vitamin D and secretion calcium absorption (osteoporosis) - must be titrated down because stomach will react and compensate for not making acid by hypersecreting Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications CYTOPROTECTIVE AGENTS sucralfate - creates protective - ulcers - take at least 2 hours barrier against acid and apart from other meds pepsin- coats ulcer - give before eating - good for ulcers in mouth (swish and swallow) - no significant AE misoprostol suppress secretion of - prevention of NSAID - diarrhea and abdominal gastric acid, promotes induced ulcers pain secretion of bicarbonate - spotting and and cytoprotective dysmenorrhea in some mucus, and maintains women submucosal blood flow - pregnancy category X  ANTIFLATULENTS Drug Name and Class Mechanism of Action Use(s) Adverse Effects Contraindications Nursing Implications ANTIFLATULENTS prototype: simethicone - antifoaming agent that - relieves bloating in reduces surface tension adults, colic in of gas bubbles children - helps combine small gas bubbles into larger bubble - makes gas easier to expel LAXATIVES Drug Name and Class Mechanism of Action Use(s) Adverse Effects Contraindications Nursing Implications BULK FORMING LAXATIVES prototype:psyllium - same impact as dietary - abdominal cramping - should be administered (Metamucil) fiber and bloating with a full glass of - increases bulk and water or juice methylcellulose stretches intestinal wall stimulating peristalsis polycarbophil - produces soft, formed stool in 1-3 days Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications SURFACTANT LAXATIVES prototype: docusate - facilitates penetration - patients who have had - taken with a full glass sodium (Colace) of water into feces by surgery- anesthesia may of water altering surface tension slow down motility, - produces soft stool pain meds, recently several days after onset given birth of treatment Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications STIMULANT LAXATIVES prototype:bisacodyl - irritates bowels and - treatment of opioid - widely used but - do not crush or take (Correctol, Dulcolax) increase secretion of induced constipation potential for abuse with milk or antacids senna water and ions into - treatment of - do not take at bedtime castor oil intestinal lumen constipation from slow (castor oil) - produces semi fluid intestinal tract - educate patient who is stool in 6-12 hours taking it long term Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications OSMOTIC LAXATIVES magnesium salts - poorly absorbed and - dehydration - will need to use (magnesium hydroxide, draw water into - magnesium toxicity in bathroom quickly citrate, and sulfate) intestinal lumen renal impairment - make sure pt is drinking - fluid retention plenty of water - acute renal failure - IV fluids if needed sodium salts (sodium same as above - same as above phosphate) polyethylene glycol - retains water in - nausea (Miralax, Glycolax, intestinal lumen - abdominal bloating Peglax) - cramping - flatulence polyethylene glycol plus - bowel cleansing electrolytes (Colyte, solution prior to goLytely) procedure - usually ingest 4 L over 2-3 hours - onset 30 mins, evacuates bowel within 4 hours ANTIDIARRHEAL AGENTS Drug Name and Class Mechanism of Action Use(s) Adverse Effects Contraindications Nursing Implications OPIOID ANTIDIARRHEAL AGENTS diphenoxylate with - most effective - schedule V drugs atropine (Lomotil) antidiarrheal agents - s/s of drug abuse: - decreased intestinal drowsiness, sedated, motility constipation - decreases secretion of - morphine like side fluid into small effects intestine - increases absorption of fluid and salt loperamide (Imodium) - OTC, low potential for abuse - will not cross blood brain barrier- no morphine like effects Drug Name and Class Mechanism of Action Use(s) and Route(s) Adverse Effects Contraindications Nursing Implications ADJUVANT ANTIDIARRHEAL AGENTS bismuth subsalicylate - prevention and - may blacken stools and - do not give to children- (Pepto Bismol) treatment of mild tongue Reye’s syndrome diarrhea - has some antibiotic effect bulk forming laxatives - make stool more firm and less watery - serve to bulk up stool  Anti-Emetics Drug Name and Class Mechanism of Action Use(s) Adverse Effects Contraindications Nursing Implications SEROTONIN RECEPTOR ANTAGONISTS prototype: ondansetron - blocks 5- HT3 - N/V related to -first choice drug for N/V (Zofran) receptors anticancer drugs, radiation, anesthesia - Safe in all age ranges Prototype: promethazine : --CNS depressing -blurred vision -BBW : contraindicated -Preferred route is DEEP (Phenergin) properties - urinary retention in children < 2 years IM -Antipsychotic properties - dry mouth old (promethazine) Prototype: - photosensitivity -IV route can cause prochlorperazine - drowsiness - BBW: contraindicated extravasation and tissue (Compazine) - confusion for subcutaneous injury administration (promethazine) Drug Name and Class Mechanism of Action Use(s) Adverse Effects Contraindications Nursing Implications SUBSTANCE P/NEUROKIN 1 ANTAGONIST -Used for HIGHLY -Effective in nausea and Aprepitant (Emend) emetic chemotherapy vomiting associated with - More selective receptor chemotherapy nearly no effect on  serotonin, dopamine, receptors. (Used usually with Zofran and corticosteroids for a better effect) DRUGS FOR MOTION SICKNESS Drug Name and Class Mechanism of Action Use(s) Adverse Effects Contraindications Nursing Implications MOTION SICKNESS scopolamine - sedation, dry mouth, (Transdermal Scop) blurred vision, drowsiness, urinary dimenydrinate, meclizine, retention, constipation, and cyclizine disorientation