5M: Digestive system drugs

antiemetics

antiemetics

inhibits stimulation of CTZ and vestibular pathways

masks underlying cause of vomiting

pregnancy

antiemetics: c/i

• dimenhydrinate

• cyclizine Hcl

• meclizine Hcl

• diphenhydramine Hcl

• bismuth subsalicylate

• phosphorated carbohydrate solution

— non-prescription antiemetics

bismuth subsalicylate

antiemetic drug that acts directly on gastric mucosa

liquid or chewable

phosphorated carbohydrate solution

antiemetic drug that changes the gastric pH

contains high sugar (c/i: DM)

• ginger

• red raspberry leaf tea

non-pharmacologic measures for antiemetic in pregnancy

pyridoxine & doxylamine

antiemetic drug in pregnancy only if necessary

promethazine & metoclopramide

antiemetic drug in pregnancy for severe vomiting

• antihistamines

• anticholinergics

• dopamine antagonists

• serotonin receptor antagonists

• glucocorticoids

• cannabinoids

• miscellaneous

— prescription antiemetics

hydroxyzine

antihistamine antiemetic drug for post-op nausea and vomiting

administered deep IM

scopolamine

anticholinergics antiemetic drug for post-op & motion sickness

patches

dopamine antagonists

antiemetic drugs that blocks dopamine receptors in CTZ

PBB

EPS or extrapyramidal syndrome

dopamine antagonists: s/e

• phenothiazines

• butyrophenone

• benzodiazepines

— dopamine antagonist classification

• chlorpromazine

• prochlorperazine edisylate

• promethazine

— drug examples under phenothiazines

promethazine

phenothiazines antiemetic drug which becomes HAM if administered IV

effect increases with antihistamines

interferes with pregnancy tests

causes EPS

droperidol

antiemetic drug (butyrophenones) for post-op; for NV associated with toxins, cancer chemotherapy, and radiation therapy

EPS if prolonged

hypotension

droperidol: s/e

benzodiazepines

indirect antiemetic drug: for NV associated with cancer chemotherapy

serotonin receptor antagonists

antiemetic drugs that block serotonin receptors in CTZ and afferent vagal nerve terminals in GI tract

serotonin receptor antagonists

most effective antiemetic drug

does not cause EPS

• ondansetron

• granisetron

• dolasetron

• palonosetron

— drug examples for serotonin receptor antagonists

glucocorticoids

antiemetic drugs used for NV associated with chemotherapy

minimized s/e

• dexamethasone

• betamethasone

— drug examples of glucocorticoid drugs

cannabinoids

active ingredient is cannabis

only prescribed for pt who does not respond to other antiemetics

psychiatric pt

cannabinoids: c/i

dronabinol

drug examples of cannabinoids

trimethobenzamide

miscellaneous antiemetic drug that suppresses impulse to CTZ

doesn’t strictly act as antihistamine, anticholinergic, or phenothiazine

metoclopramide

miscellaneous antiemetic drugs that blocks dopamine receptors in CTZ

can cause EPS in children

emetics

drugs that induce vomiting

only given to alert and conscious individual

victims who ingested corrosive substances

emetics: c/i

syrup of ipecac

drug example of emetics

• opiates and opiate-related agents

• adsorbent

— types of antidiarrheals

opiates and opiate-related agents

antidiarrheals that decreases intestinal motility, thus decreasing persitalsis

diphenoxylate with atropine

opiate antidiarrheal drug used for traveler’s diarrhea

less potential to dependence

difenoxin with atropine

opiate antidiarrheal drug for non-specific and chronic diarrhea

can cause drug dependence

decrease abdominal cramping, intestinal motility, and hypersecretion

use of atropine in antidiarrheals

loperamide

opiate antidiarrheal drug that is like diphenoxylate but less CNS depression

adsorbent

antidiarrheals that coats the wall of the GI tract and adsorbs the bacteria/toxins

kaolin and pectin

adsorbent antidiarrheal drugs used for mild to moderate diarrhea

bismuth subsalicylate

adsorbent antidiarrheal drug used for traveler’s diarrhea

colestipol and cholestyramine

adsorbent antidiarrheal drug for diarrhea with excess bile acids in colon

laxatives

drugs that promote soft stool with no cramping

cathartics

drugs that promote watery stool with some cramping

purgatives

cathartic drugs that promotes watery stool with abdominal cramping

• contact (stimulant or irritants)

• chloride channel activators

• emollients (stool softener)

• bulk-forming

• osmotic (saline)

— drug classifications under laxatives (CCEBO)

contact (stimulant or irritants)

laxative drugs that irritates nerve endings in the intestinal mucosa leading to increased peristalsis

• bisacodyl

• castor oil

— drug examples of contact laxatives

bisacodyl

most frequently used and abused contact laxative drugs

castor oil

drugs considered as purgatives and is used for bowel preparations

bedtime

pregnancy

castor oil: c/i

chloride channel activators

laxative drugs that increases intestinal fluid secretion and motility by activating chloride channels

used to treat idiopathic constipation

lubiprostone

drug example of chloride channel activators laxatives

• history of mechanical obstruction

• chron’s disease

• diverticulitis

• severe diarrhea

chloride channel activators: c/i

emollients (stool softeners)

laxative drugs used to lubricate and soften stools by lowering surface tension and promotes water accumulation

decreases straining during defecation

• docusate sodium

• docusate calcium

• docusate sodium with Senna

— drug examples of emollients laxatives

• children

• older adults

• pt with debilitating disease

• pregnancy

• bowel obstructions

emollients: c/i

bulk-forming

laxative drugs which is composed of natural fibrous substance and is non-absorbable

• polycarbophil

• psyllium

• polyethylene glycol

• methylcellulose

— drug examples under bulk-forming laxatives

polycarbophil

bulk-forming laxative drugs that has high calcium content

psyllium

bulk-forming laxative drugs that becomes viscous when mixed with water

osmotic (saline)

hyperosmolar laxative drugs which includes salt or saline products, lactulose, and glycerin

heart failure

osmotic (saline): c/i

• sodium phosphate

• sodium diphosphate

• magnesium hydroxide

• magnesium citrate

• polyethylene glycol (PEG) with electrolytes

• lactulose

— drug examples under osmotic laxatives

• tranquilizers

• anticholinergics

• antacids

• histamine-2 blockers

• proton pump inhibitors (PPI)

• pepsin inhibitors

• prostaglandin analogue

— drug classifications under antiulcer

tranquilizers

antiulcer drugs that reduces vagal nerve stimulation and decrease anxiety

has minimal effect

• chlordiazepoxide

• clidinium bromide

— drug examples of tranquilizers antiulcer

agranulocytosis

tranquilizers: c/i

anticholinergics

antiulcer drugs that inhibit acetylcholine and blocks histamine and Hcl

relieves pain by decreasing GI motility and secretion

used for duodenal cancer

DOC for peptic ulcer

• propantheline bromide

• glycopyrrolate

— drug examples of anticholinergics antiulcer

antacids

antiulcer drugs that neutralizes Hcl and reduce pepsin activity

• sodium bicarbonate

• calcium carbonate

— drug examples of systemic antacids

sodium bicarbonate

seldomly used antacids

causes hypernatremia, water retention, metabolic alkalosis, and acid rebound

calcium carbonate

most effective antacids

causes hypercalcemia and burnett syndrome

• aluminum hydroxide

• magnesium hydroxide

— drug examples of non-systemic antacids

aluminum hydroxide

non-systemic antacid that causes constipation and is used to lower high serum phosphate

magnesium hydroxide

non-systemic antacid that can cause diarrhea

impaired renal function

magnesium hydroxide: c/i

histamine-2 blockers

antiulcer drugs that reduces gastric acid secretions and concentration

used to treat gastric and duodenal ulcers

before meals

at bedtime

when to administer histamine-2 blocker antiulcers

• cimetidine

• famotidine & nizatidine

— drug examples of histamine-2 blockers antiulcers

cimetidine

histamine-2 blockers antiulcer drug that requires good kidney functioning

has short duration

famotidine

histamine-2 blockers antiulcer drug for zollinger-ellison syndrome

promotes healing by eliminating cause and for longer duration

nizatidine

histamine-2 blockers antiulcer drug for nocturnal gastric acid secretion

promotes healing by eliminating cause and for longer duration

proton pump inhibitors (PPI)

antiulcer drugs that blocks the final stage of acid production

• omeprazole

• lansoprazole

• rabeprazole

• pantoprazole

• esomeprazole

• dexlansoprazole

— drug examples for proton pump inhibitors antiulcer

omeprazole

first PPI marketed

antiulcer drugs that takes days to take effect

lansoprazole

antiulcer PPI drugs that takes 1 week to take effect

rabeprazole

antiulcer PPI drugs that is more effective in treating duodenal than gastric ulcers

most effective for treating GERD and hypersecretory disease

pantoprazole

antiulcer PPI drugs prescribed to treat short term erosive GERD

IV preparation for zollinger-ellison syndrome

esomeprazole

antiulcer PPI drugs that has a highest success rate in healing erosive GERD

dexlasoprazole

antiulcer PPI drugs used to treat erosive esophagitis and symptomatic non-erosive GERD

pepsin inhibitors

antiulcer drugs that covers the ulcer and protects it from pepsin

sucralfate

drug example of pepsin inhibitor antiulcer

prostaglandin analogue

antiulcer drugs that suppresses gastric acid secretion and increase cytoprotective mucus

misoprostol

prostaglandin analogue antiulcer drugs used for gastric distress from prolonged use of NSAIDs

pregnancy

misoprostol: c/i