Digestion and Metabolism pharm

aluminum hydroxide (Gaviscon) (1)

antiacid (1)

sodium bicarb (alkaseltzer) (2)

antiacid (2)

magnesia hydroxide (milk of magnesia) (3)

antiacid (3)

calcium carbonate (tums/maalox) (4)

antiacid (4)

antiacid function

slows down pepsin, preventing stress induced ulcers

when antiacids should be taken

on empty stomach 2 hours before or after other meds

Gastric mucosa protective agent (1)

Sucraflate(Carafate)(1)

Gastric mucosa protective agent (2)

Pepto Bismol (2)

gastric mucosa protective agent (3)

Cytotec (3)

mechanism of sucraflate

physically sticks to ulcers for up to 6 hours

consideration for sucraflate

do NOT eat afterwards

cannot be crushed or chewed

2 hours between other meds

can cause constipation

consideration with pepto

contains aspirin, can cause aspirin toxicity

cytotec mechanism

prevents NSAID induced ulcers

consideration for cytotec

diarrhea is common side effect

do NOT give to pregnant patients (causes cervical dilation/premature labor)

avoid aspirin

H2 Receptor Blocker (1)

Cimetidine(Tagament HB) (1)

H2 Receptor Blocker (2)

Famotidine(Pepid)(2)

H2 Receptor Blocker (3)

Niztidine(Axid)(3)

mechanism of H2 receptors

makes stomach less acidic, blocking H2 receptors, suppresses secretion of gastric acid

H2 Considerations (Cimetidine)

decreased libido

gynecomastia (development of breasts on males)

pregnancy CNS effects

constipation, diarrhea, nausea

H2 considerations

increased pneumonia risk

need to be ruled out for cardiac issues ALWAYS

caution for GI bleeds

how to take H2 Receptors

limit use of aspirin and NSAIDs

if smoking, take after last cig of night

30 minutes before meals

Famotidine given with meals and at bedtime

no antiacids 1 hour before or after H2

Proton Pump Inhibitor (1)

Protonix (1)

Proton Pump Inhibitor (2)

Omeprotozole (2)

H2 Receptor uses

prevent or treat duodenal ulcers, GERD, Zollinger-Ellison syndrome

mixed with antibiotics to treat H. pylori

also used to manage hives

Proton Pump Inhibitor (3)

Lansoprozole

mechanism of PPIs

Bind to acid-secreting enzyme that functions as proton pump, disabling for up to 24 hours

uses of PPIs

zollinger-ellison syndrome

PPI considerations (1)

can cause pneumonia

osteoporosis risk (leaches calcium out of bones, calcium and vitamin D given)

needs to be tapered off

(1)

PPI considerations (2)

lowers magnesium levels

risk for C-diff

treatment limited to 4-8 weeks

not to be used in children or those with liver disease

(2)

how to take PPIs

once daily 30 minutes before breakfast

swallowed whole

Pantoprozole given IV

avoid aspirin + NSAIDs

Antiemetics

serotonin antagonists

antihistamines

anticholinergics

Serotonin Antagonist

Ondansetron (Zofran)

mechanism of Zofran

blocks receptors in CTZ

Zofran complications

messes with cardiac rhythms (caution with cardiac disorders+electrolyte imbalances)

hypotension and sedation risk

Zofran considerations

gives a high

good for common nausea

compazine for those who cannot take

extra perimetal symptoms (motor skill abnormality/mocks parkinson’s)

Antihistamine(1)

Dimenhydrinate (Dramamine)(1)

Antihistamine (2)

Hydroxyzine (Vistaril) (2)

Antihistamine (3)

Promethazine (Phenergan) (3)

mechanism of antihistamines

blocks inner ear receptors (motion sickness)

antihistamine considerations

sedative (take fall precautions)

take 30-60 minutes before travel

not for children under 2

can cause resp depression in older adults

not for narrow angle glaucoma, urinary retention, bowel obstruction

anticholinergics

scapolamine

mechanism of scapolamine

Interferes with the transmission of nerve impulses traveling from the vestibular apparatus of the inner ear to the vomiting center in the brain

uses of scapolamine

motion sickness

post op nausea

dries up secretions muting death rattle in CMO care

scapolamine considerations

patch behind ear

can stay for up to 3 days

4 hours before travel

NOT for use in elderly, pyloric bladder patients, neck obstruction, or open angle glaucoma

mechanism of metoclopramide (Reglan)

Controls nausea/vomiting by blocking dopamine/serotonin receptors in CTZ

Promotes GI motility by enhancing esophageal clearance, gastric emptying (+ peristalsis)

Increases resting tone of esophageal sphincter so food does not come back up

IV use of Reglan

post op + chemo induced nausea/vomiting

oral use of Reglan

diabetic gastroparesis, GERD management, every day nausea

Reglan complications (1)

Tardive Dyskinesia (long term high doses)

often-irreversible, unusual face movements, lip smacking, wormlike movements of tongue

(1)

Reglan complications (2)

Extrapyramidal Symptoms, motor skill abnormalities, restlessness, anxiety, and spasms of face, neck

stop medication, call the provider, administer anticholinergic (Benadryl) to treat

(2)

Reglan considerations

not to be given to those with seizure disorders, bowel obstructions, hemorrhage

how to take Reglan

30 minutes before meals and at bedtime