Digestive System Pharm

antacids

basic components to neutralize stomach acid

Stimulate secretion of: Mucus: protective barrier against HCl, Bicarbonate: helps buffer acidic properties of HCl, Prostaglandins: prevent activation of the proton pump

acute relief symptoms, used alone or in combination

antacid contraindicaitons

Fluid imbalances → Heart failure, Severe HTN (antacids contain high sodium content), Severe Renal disease, GI obstruction

antacid admin

Often contain calcium & magnesium → MANY drug interactions, often should not give with other drugs, Give at least 1-2 hrs before or after different drugs, May dissolve Enteric Coatings → can lead to GI upset• Ensure at least 8 oz. of water with administration, Chronic, frequent antacid use can mask serious illness → can lead to a delay in care (such as GI bleed, malignancy

calcium salts, aluminum hydroxide

maalox

maalox class

antacid

maalox contents

aluminum hydroxide, magnesium hydroxide, simethicone

maalox action

Neutralizes gastric acid, promotes gastric mucosal defense mechanisms, Anti-gas (reduced surface tension of gas bubbles with GI system

maalox indications

Peptic ulcer disease, GERD, gas pain, heartburn relief

maalox contraindications

Caution in renal impairment, Hypermagnesemia or aluminum toxicity (can not clear Mg or Al)

maalox adverse side effects

Constipation, decreased GI motility, hemorrhoids, stomach cramping

Prolonged use can cause hypophosphatemia

maalox education

Take 1 hour before or after meals, Avoid taking w/ other medications

maalox monitoring

Monitor for relief of GERD/ulcer symptoms (heartburn), Assess medical history before use: renal disease, Monitor for abdominal pain, distention, tenderness

famotidine

pepcid

famotidine class

Histamine-2 receptor antagonist (H₂ blocker)

famotidine actions and use

Selectively blocks H₂ receptors in the stomach lining → ↓ gastric acid secretion and concentration of hydrogen ions, Allows time for the body to heal without continued irritation from acid

famotidine indications

Peptic Ulcers (gastric and duodenal), GERD (gastroesophageal reflux disease), Esophagitis, Heartburn, indigestion, sour stomach (OTC use), Prevention of stress-induced ulcers in critically ill patients

famotidine contraindications

Caution in severe renal impairment, the drug is renally excreted → dose adjustment needed, Caution in elderly, ↑ risk of CNS effects

famotidine adverse effects

Headache, dizziness, Constipation, diarrhea, agitation, confusion, delirium, Thrombocytopenia (rare)

famotidine education

Can take with or without food. Avoid smoking, alcohol, caffeine, and NSAIDs (which worsen gastric irritation), Report black/tarry stools, coffee-ground emesis, or persistent abdominal pain (may indicate GI bleed), Discuss with provider if needed > 2 weeks

famotidine monitoring

Monitor for relief of GERD/ulcer symptoms (heartburn, abdominal pain), assess for confusion, dizziness, or headache (esp. in elderly or renally impaired patients), monitor CBC with prolonged therapy (rare bone marrow suppression), evaluate for adverse GI effects (diarrhea, constipation)

omeprazole

prilosec

omeprazole class

proton pump inhibitor

omeprazole actions and uses

Irreversibly inhibits the H⁺/K⁺ ATPase (proton pump) in gastric parietal cells, Suppresses the final step of gastric acid secretion → profound and prolonged reduction in stomach acid

omeprazole indications

GERD, Peptic ulcer disease (gastric & duodenal ulcers), Erosive esophagitis, Zollinger–Ellison syndrome and other hypersecretory conditions, Used with antibiotics (clarithromycin, amoxicillin, metronidazole) for H. pylori eradication**, OTC use: frequent heartburn

omeprazole contraindications

hepatic impairment

omeprazole adverse effects

N/V/D, constipation, ABD pain, flatulence, Headache, dizziness, Upper Respiratory infection, cough, ↑ risk of Clostridioides difficile–associated diarrhea, Long-term use linked to osteoporosis-related fractures, Vitamin B12 deficiency, hypomagnesemia with prolonged therapy, Acute interstitial nephritis (rare but serious), Rare severe hypersensitivity reactions (anaphylaxis, angioedema, Stevens–Johnson syndrome)

omeprazole education

Take medication 30–60 minutes before eating, Swallow capsules/tablets whole → do not crush or chew (enteric-coated for acid protection), May take several days for full symptom relief → not for immediate relief, Do not self-treat chronic heartburn beyond 14 days OTC without evaluation by PCP, Report persistent diarrhea, abdominal pain, or black/tarry stools (possible C. diff or GI bleed), Stress importance of completing antibiotic regimen if prescribed for H. pylori, Long-term users should ensure adequate calcium and vitamin D intake

omeprazole monitoring

Monitor for improvement in GERD/ulcer symptoms, assess for abdominal pain, diarrhea, or persistent GI symptoms (possible C. diff), Monitor magnesium, vitamin B12, and bone density if long-term therapy is required, Evaluate liver function if prolonged use or high-dose therapy

metoclopramide

reglan

metoclopramide therapeutic class

antiemetic

metoclopramide pharm class

prokinetic, dopamine antagonist

metoclopramide actions and uses

block dopamine receptors in the chemoreceptor trigger zone(CTZ), cause CTZ to be desensitized to impulses from GI tract, stimulate peristalsis in GI tract

metoclopramide indications

GERD when failed traditional therapy (refractory),Chemotherapy induced nausea/vomiting, Postoperative nausea, Gastroparesis

metoclopramide contraindications

Some neurological disorders (i.e. Parkinson’s disease), GI obstruction → risk for perforation

metoclopramide adverse effects

restlessness, fatigue, drowsiness, depression, Tardive Dyskinesia (with chronic use - irreversible)

metoclopramide education

Take 30 min before a meal, Report depression, restlessness, uncontrollable movements

metoclopramide monitoring

neuro changes, improvement of nausea/vomiting

ondansetron

zofran

ondansetron therapeuutic class

antiemetic

ondansetron pharm class

selective 5-HT3 receptor antagonist

ondansetron actions and uses

Blocks the action of serotonin by binding to the serotonin receptors, Stops the transmission at receptors in chemoreceptor trigger zone (CTZ), vomiting center and GI tract

ondansetron indications

GERD when failed traditional therapy, Chemotherapy induced nausea/vomiting, Postoperative nausea

ondansetron contraindications

Some neurological disorders (i.e. Parkinson’s disease), Interacts with Serotonergic agents (depression drugs)

ondansetron adverse effects

Cardiac: arrhythmias (QT prolongation), GI: constipation → can lead to obstruction, CNS: Headache and Serotonin syndrome

ondansetron education

Take 30 min before meal, Report depression, restlessness, uncontrollable movements, Caution when used w/ other serotonin drugs, Maintain regular bowel schedule

ondansetron monitoring

neuro changes, improvement of nausea/vomiting

bismuth subsalicylate

peto-bismol

bismuth subsalicylate class

anti-diarrheal and absorbant

bismuth subsalicylate actions

Antisecretory – decreases fluid secreted in mucosal lining, Coats walls of intestines, Can inactivate enterotoxins before they bind to the intestinal lining, Has antimicrobial properties – disrupts bacterial membranes and enzymes

bismuth subsalicylate indications

Diarrhea relief, upset stomach (belching/gas/indigestion/nausea), heartburn, ‘travelers’ diarrhea

bismuth subsalicylate contraindications

Not used in active ulcers or GI bleeding → salicylates worsen bleeding, Allergy to salicylates (includes aspirin), Pregnant women and children (due to aspirin → Reye’s syndrome)

bismuth subsalicylate adverse effects

Minimal! Nausea, constipation, turns stool black, CNS: Large doses can be neurotoxic

bismuth subsalicylate educations

Discuss possibility of black tongue/stool as a benign/expected reaction, Not to be used with pregnancy or young children

bismuth subsalicylate monitoring

Monitor for relief of diarrheal symptoms and possible constipation, Monitor for black stools/teeth staining

loperamide

imodium

loperamide therapeutic class

anti-diarrheal

loperamide pharm class

anti-motility(opioid receptor agonsit)

loperamide actions

Stimulating opioid receptors in the intestinal wall → decreases peristalsis, Prolongs transit time → slows down fluid and electrolyte loss, Increases anal sphincter tone

loperamide contraindications

Infectious Diarrhea (C. diff, salmonella, shigella, or E. Coli) → can cause toxic megacolon, ABD pain without diarrhea → can cause bowel obstruction, Children < 2 years old → Risk of respiratory depression or cardiac event, Can cause toxic megacolon, CNS & Respiratory Depression if combined with CNS depressants

loperamide indications

diarrhea, IBS, traveler’s diarrhea

Loperamide adverse effects

dizziness, constipation, abdominal cramps, nausea

ardiac Dysrhythmia (Torsade's de pointes) and sudden death with high doses

loperamide education

Seek medical attention if diarrhea does not resolve in 2 days, blood in stool or fevers. Take 30 minutes before a meal, stay hydrated!, Taking more than recommended can increase cardiac risk, Caution when combined with other depressants

loperamide monitoring

Monitor I/Os, GI system (bowel sounds, ABD distention, ABD pain), ECG if concern for overdose, Neuro assessment (Dizziness, drowsiness, confusion)

constipation management

med rec, maintain hydration and fiber intake, increase physical activity, warm foods and warm liquids

psyllium

metamucil

psyllium therapeutic class

fiber supplement

psyllium pharm class

bulk-forming laxative

psyllium actions

Soluble fiber absorbs water in the intestine to form viscous liquid, promoting peristalsis, Makes stool softer and easier to pass

psyllium indications

mild chronic constipation

psyllium contraindications

Fecal impaction or GI obstruction → Can worsen blockage by absorbing water

psyllium adverse effects

Bloating, gas, stomach cramps, esophageal or intestinal obstruction

psyllium considerations

Use with caution in elderly patients → may have insufficient fluid intake → can lead to fecal impaction, Some formulations contain sugar, sodium or phenylalanine, Can affect patients with diabetes, hypertension or needing low-sodium diets

psyllium educaiton

Take with at least 8 oz of fluid (can form a hard mass in the bowel and worsen constipation). Take 2 hours before or after other medications → Can decrease absorption, takes 1-3 days to begin to work

psyllium monitoring

Assess for Difficulty swallowing (can become stuck in the esophagus), signs of bowel obstruction or fecal impaction, Monitor for gas, bloating, stomach cramps

docusate

colace

docusate

stool softener

docusate ations

Reduces surface tension between water and fat in the stool → softens

stool by increasing fat and water in stool, Produces soft and easier to pass stool, More effective in preventing than treating constipation!

docusate indicatated for

Prevention of constipation, Can be used via enema to treat fecal impaction

docusate education

Must maintain adequate hydration, Seek medical attention if develop severe pain, tenderness, vomiting, Seek medical attention if no BM in ~2-3 days with no bowel movement

docusate monitoring

Improvement in bowel movements: frequency, consistency and ease of stool passage, Monitor for abdominal pain, distention, cramping, Signs of obstruction (no bowel movement, severe pain, tenderness, vomiting)

senna class

stimulant laxative

senna actions

Stimulates smooth muscle contractions → Increases peristalsis

senna indications

Treatment of occasional constipation, Opioid induced Constipation (OIC)

senna contraindications

Do not give in patients with fecal impaction or GI obstruction, Patients with severe abdominal pain, nausea, vomiting – something else may be going on!

senna and docusate

prevent constipation, while one increases peristalsis

senna considerations

Consult provider if prolonged use needed (> 1-2 weeks) – may indicate something else going on!

senna education

Discuss with provider if needing for more than 1-2 weeks, Consume adequate fluids throughout day, Seek medical attention if severe abdominal pain, bloody diarrhea, no bowel movements

senna monitoring

Presence of abdominal pain, ABD pain, cramping, N/V prior to taking, Easy bowl movement – typically within 6-12 hours, Signs of obstruction (no bowel movement, severe pain, tenderness, vomiting), Hydration status and electrolytes, Monitoring for dehydration, sodium/potassium levels if needed

polyethylene glycol

miralax, PEG

polyethylene glycol class

osmotic laxative

polyethylene glycol actions

Causes water retention in stool → increases stool frequency

polyethylene glycol indicaitons

Constipation, Bowel Prep for Colonscopy (in large quantities)

polyethylene glycol contraindications

Concern for fecal impaction or GI obstruction, Caution in patients with renal disease → can cause fluid/electrolyte imbalance

polyethylene glycol adverse effects

mild abdominal pain, bloating, gas, ABD cramps, diarrhea

polyethylene glycol education

Discuss with provider if needing for more than 1-2 weeks, Consume adequate fluids throughout day, Mix with enough liquid (4-8oz), Expect BM within 1-2 days

polyethylene glycol monitoring

Monitor for abdominal pain, distention, cramping, Signs of obstruction (no bowel movement, severe pain, tenderness, vomiting), Monitor kidney function and electrolyte imbalance

Lactulose pharm class

osmotic laxative, ammonium detoxicant

lactulose actions

Draws fluid into colon → promotes peristalsis, Ammonia Detox effects: inhibits ammonia from diffusing into blood, also promotes serum ammonia to diffuse into gut (for excretion) → lowers blood ammonia levels

lactulose indications

constipation hepatic encephalopathy

lactulose warnings

Electrolyte imbalances, Galactose intolerance → solution contains galactose and lactose, Solution contains sugar → may cause hyperglycemia in diabetics