Pharm II (GI drugs)

Expected Action of Cimetidine (Tagamet)

• Histamine H2 Antagonist

blocks H2 receptors in the stomach; decreases stomach acid; increases pH in stomach

Side Effects of Cimetidine (Tagamet)

Rare to have side effects

• if they do: impotence, gynecomastia, confusion and arrhythmias

Safety Alert for Cimetidine (Tagamet)

• Increases serum levels of Warfarin and Phenytoin

• Interacts with Theophylline

Special Instructions for Cimetidine (Tagamet)

• take oral doses with or without food

• Administer IV doses slowly to avoid bradycardia

• avoid antacids within 1 hour

• avoid products that increase GI irritation

Expected Action of Omeprazole (Prilosec)

• Proton Pump Inhibitor (PPI)

• suppresses gastric acid production

Side Effects of Omeprazole (Prilosec)

• decreased calcium absorption; hypomagnesemia

Safety Alert for Omeprazole (Prilosec)

• Risk of osteoporosis with long term use (>8 weeks)

• Interacts with Warfarin, Phenytoin, diazepam

Special Instructions for Omeprazole (Prilosec)

• Lowest dose for shortest possible duration

• Calcium and Vitamin D supplements

• weight bearing activities

Expected Action of Sucralfate (carafate)

• Mucosal Protectant

• coats ulcers and creates a barrier between the stomach and gastric secretions

Side Effect of Sucralfate (carafate)

constipation

Safety Alert for Sucralfate (carafate)

• affects absorption time of other drugs

  • administer 2 hours before or after other oral drugs

Special Instructions for Sucralfate (carafate)

• administer on an empty stomach (4x per day); 1 hour before meals and bedtime)

• monitor bowel function

• stool softener

• increase fluid and fiber

Expected Action of Aluminum hydroxide, Calcium carbonate, and Milk of Magnesia

• Antacids

• neutralizes gastric acid

Side Effect of Aluminum hydroxide, Calcium carbonate, Milk of Magnesia

constipation

Safety Alert for Aluminum hydroxide, Calcium carbonate, and Milk of Magnesia

• Affects absorption of other drugs

  • do not give within 1 to 2 hours of other meds

Special Instructions for Aluminum hydroxide, Calcium carbonate, and Milk of Magnesia

• Increase fluid and fiber

• chew tablets thoroughly

Expected Action of Misoprostol (cytotec)

• Prostaglandin E Analog

• decreases gastric acid secretion

• increases bicarbonate

• increases protective mucous

• increases vasodilation of submucosal blood flow

Side Effects of Misoprostol (cytotec)

• diarrhea and abdominal pain

• menstrual cramping

Safety Alert for Misoprostol (cytotec)

• stimulate uterine contractions and can cause miscarriage and premature labor

Instructions for Misoprostol (cytotec)

• increase fluids

• avoid alcohol or foods that irritate GI tract

• pregnancy test (HCG)

Expected Action of Ondanestron (Zofran)

• Serotonin antagonists

• blocks receptors in the CTZ (in the brain near the cerebellum)

• used for N/V secondary to chemotherapy or post-op

Side Effects of Ondanestron (Zofran)

CNS: headache, dizziness, constipation, diarrhea

ADVERSE:

• serotonin syndrome (HTN, tachycardia, rigidity, tremors)

• Stevens Johnson Syndrome

Safety Alert for Ondanestron (Zofran)

risk for falls

Instructions for Ondanestron (Zofran)

Timing: prior to anticipated need (30 minutes-1hour) and then regularly after

Interactions with Ondanestron (Zofran)

• SSRIs

• SNRIs

• MAOIs

• etc

Expected Action of Dimenhydrinate

• antihistamine/anticholinergic

• blocks the release of histamine (H1) receptors in the inner ear, and those that affect the CTZ

• antiemetic and antivertigo

• used for motion sickness

Side Effects of Dimenhydrinate

• sedation

• drowsiness

• anticholinergic effects

Safety Alert for Dimenhydrinate

• urinary retention

• bladder infection

Instructions for Dimenhydrinate

• avoid activities that require alertness

• increase fluids and fiber

Interactions with Dimenhydrinate

other CNS depressants (alcohol)

Expected Action of Metoclopramide (Reglan)

• Dopamine Antagonist/Prokinetic

• dopamine receptor blocker

• increase threshold of CTZ

• increases tone of lower esophagus

• used for N/V associated with chemo, opioids; reflux and gastroparesis

Side Effects of Metoclopramide (Reglan)

• sedation, restlessness, diarrhea

• extrapyramidal symptoms (akathisia, tardive dyskinesia, Parkinson;s-like symptoms, dystonia)

Safety Alert for Metoclopramide (Reglan)

contraindicated for bowel obstructions

Instructions for Metoclopramide (Reglan)

• monitor for extrapyramidal symptoms

• avoid activities that require mental alertness

Interactions with Metoclopramide (Reglan)

other CNS depressants (alcohol)

Safety Alert for psyllium (Metamucil)

• bulk-forming agents for constipation

• assure adequate intake with fiber supplement (8 ounces

  • can cause esophageal or intestinal obstruction without adequate fluid intake

Instructions for psyllium (Metamucil)

• take 1-3 times a day

• expect results in 1-3 days

• mix with 8 ounces of water or juice and drink immediately

Expected Action of docusate sodium (Colace)

• surfactant laxative

change the surface tension of the stool

• administration: give with 8 ounces of fluid

  • expect results in several days

Side Effects of docusate sodium (Colace)

• diarrhea

• mild cramping

Expected Action of bisacodyl (Dulcolax)

• stimulant laxative

stimulate intestinal motility

• encourage dietary changes and exercise

Side Effects for bisacodyl (Dulcolax)

• diarrhea

• abdominal cramping

Safety Alert for bisacodyl (Dulcolax)

• risk for abuse, especially in clients who have eating disorders

Expected Action of Diphenoxylate with atropine (Lomotil); loperamide

• drugs for diarrhea

decrease peristalsis

Side Effects of Diphenoxylate with atropine (Lomotil); loperamide

• drowsiness

• constipation

• cardiac arrhythmias

• anticholinergic effects

Safety Alert for Diphenoxylate with atropine (Lomotil); loperamide

• risk for fluid and electrolyte imbalances

• fall risk

• CNS depression

  • avoid activities that require alertness

Instructions for Diphenoxylate with atropine (Lomotil); loperamide

• increase fluids

• avoid caffeine (diuretic effect and increases intestinal motility)

Expected Action for Alosetron (Lotronex)

• drugs for irritable bowel syndrome

• only with women with IBS and diarrhea for greater than 6 months

• decreases visceral pain, slows peristalsis, increases absorption of water

Adverse Reaction to Alosetron (Lotronex)

constipation

• impaction, perforation, obstruction

Safety Alert for Alosetron (Lotronex)

monitor bowel patterns closely

• treatment agreement (Risk Management Program)

Expected Action of Lubiprostone (Amitiza)

• drugs for irritable bowel syndrome

decreases visceral pain, increases peristalsis

• IBS with constipation

Adverse Reactions to Lubiprostone (Amitiza)

• N/V/D

• flatulence

Instructions for Lubiprostone (Amitiza)

• take with food or water

• maintain hydration

Expected Action of Sulfasalazine (Azulfidine)

• drugs for Inflammatory Bowel Disease (CD and UC)

decrease inflammation in the intestine

Adverse Reactions to Sulfasalazine (Azulfidine)

• yellow/orange discoloration of urine (EXPECTED)

• photosensitivity (EXPECTED)

• nausea (goes away over time)

• fever

• rash

• hematologic disorders (agranulocytosis [low white count], anemia, thrombocytopenia)

  • Intervention: monitor closely for symptoms of hematologic disorders

Safety Alert for Sulfasalzine (Azulfidine)

should not be given to patients with sulfa drug allergies or those allergic to aspirin

Expected Action of Azathroprine (Imuran)

• drugs for Irritable Bowel Diseases (CD and UC)

decreases immune response

Adverse Reactions to Azathroprine (Imuran)

• N/V

• anorexia

• hepatoxicity

• fever

• bone marrow suppression

• SAFETY ALERT: risk for infection

Interventions for Azathroprine (Imuran)

• Neutropenic precautions (handwashing, avoid unnecessary invasive procedures, restrict visitors, avoid raw fruits and vegetables, no flowers in room)

• Monitor CBC

• monitor Liver function

• antibiotics