Pharm II (GI drugs)

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Expected Action of Cimetidine (Tagamet)

  • Histamine H2 Antagonist

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Nursing

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1

Expected Action of Cimetidine (Tagamet)

  • Histamine H2 Antagonist

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

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2

Side Effects of Cimetidine (Tagamet)

Rare to have side effects

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

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3

Safety Alert for Cimetidine (Tagamet)

  • Increases serum levels of Warfarin and Phenytoin

  • Interacts with Theophylline

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4

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

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5

Expected Action of Omeprazole (Prilosec)

  • Proton Pump Inhibitor (PPI)

  • suppresses gastric acid production

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6

Side Effects of Omeprazole (Prilosec)

  • decreased calcium absorption; hypomagnesemia

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7

Safety Alert for Omeprazole (Prilosec)

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

  • Interacts with Warfarin, Phenytoin, diazepam

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8

Special Instructions for Omeprazole (Prilosec)

  • Lowest dose for shortest possible duration

  • Calcium and Vitamin D supplements

  • weight bearing activities

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9

Expected Action of Sucralfate (carafate)

  • Mucosal Protectant

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

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10

Side Effect of Sucralfate (carafate)

constipation

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11

Safety Alert for Sucralfate (carafate)

  • affects absorption time of other drugs

    • administer 2 hours before or after other oral drugs

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12

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

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13

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

  • Antacids

  • neutralizes gastric acid

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14

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

constipation

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15

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

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16

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

  • Increase fluid and fiber

  • chew tablets thoroughly

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17

Expected Action of Misoprostol (cytotec)

  • Prostaglandin E Analog

  • decreases gastric acid secretion

  • increases bicarbonate

  • increases protective mucous

  • increases vasodilation of submucosal blood flow

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18

Side Effects of Misoprostol (cytotec)

  • diarrhea and abdominal pain

  • menstrual cramping

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19

Safety Alert for Misoprostol (cytotec)

  • stimulate uterine contractions and can cause miscarriage and premature labor

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20

Instructions for Misoprostol (cytotec)

  • increase fluids

  • avoid alcohol or foods that irritate GI tract

  • pregnancy test (HCG)

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21

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

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22

Side Effects of Ondanestron (Zofran)

CNS: headache, dizziness, constipation, diarrhea

ADVERSE:

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

  • Stevens Johnson Syndrome

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23

Safety Alert for Ondanestron (Zofran)

risk for falls

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24

Instructions for Ondanestron (Zofran)

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

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25

Interactions with Ondanestron (Zofran)

  • SSRIs

  • SNRIs

  • MAOIs

  • etc

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26

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

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27

Side Effects of Dimenhydrinate

  • sedation

  • drowsiness

  • anticholinergic effects

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28

Safety Alert for Dimenhydrinate

  • urinary retention

  • bladder infection

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29

Instructions for Dimenhydrinate

  • avoid activities that require alertness

  • increase fluids and fiber

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30

Interactions with Dimenhydrinate

other CNS depressants (alcohol)

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31

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

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32

Side Effects of Metoclopramide (Reglan)

  • sedation, restlessness, diarrhea

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

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33

Safety Alert for Metoclopramide (Reglan)

contraindicated for bowel obstructions

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34

Instructions for Metoclopramide (Reglan)

  • monitor for extrapyramidal symptoms

  • avoid activities that require mental alertness

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35

Interactions with Metoclopramide (Reglan)

other CNS depressants (alcohol)

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36

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

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37

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

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38

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

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39

Side Effects of docusate sodium (Colace)

  • diarrhea

  • mild cramping

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40

Expected Action of bisacodyl (Dulcolax)

  • stimulant laxative

stimulate intestinal motility

  • encourage dietary changes and exercise

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41

Side Effects for bisacodyl (Dulcolax)

  • diarrhea

  • abdominal cramping

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42

Safety Alert for bisacodyl (Dulcolax)

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

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43

Expected Action of Diphenoxylate with atropine (Lomotil); loperamide

  • drugs for diarrhea

decrease peristalsis

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Side Effects of Diphenoxylate with atropine (Lomotil); loperamide

  • drowsiness

  • constipation

  • cardiac arrhythmias

  • anticholinergic effects

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Safety Alert for Diphenoxylate with atropine (Lomotil); loperamide

  • risk for fluid and electrolyte imbalances

  • fall risk

  • CNS depression

    • avoid activities that require alertness

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46

Instructions for Diphenoxylate with atropine (Lomotil); loperamide

  • increase fluids

  • avoid caffeine (diuretic effect and increases intestinal motility)

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47

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

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48

Adverse Reaction to Alosetron (Lotronex)

constipation

  • impaction, perforation, obstruction

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49

Safety Alert for Alosetron (Lotronex)

monitor bowel patterns closely

  • treatment agreement (Risk Management Program)

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50

Expected Action of Lubiprostone (Amitiza)

  • drugs for irritable bowel syndrome

decreases visceral pain, increases peristalsis

  • IBS with constipation

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51

Adverse Reactions to Lubiprostone (Amitiza)

  • N/V/D

  • flatulence

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52

Instructions for Lubiprostone (Amitiza)

  • take with food or water

  • maintain hydration

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53

Expected Action of Sulfasalazine (Azulfidine)

  • drugs for Inflammatory Bowel Disease (CD and UC)

decrease inflammation in the intestine

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54

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

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55

Safety Alert for Sulfasalzine (Azulfidine)

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

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56

Expected Action of Azathroprine (Imuran)

  • drugs for Irritable Bowel Diseases (CD and UC)

decreases immune response

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57

Adverse Reactions to Azathroprine (Imuran)

  • N/V

  • anorexia

  • hepatoxicity

  • fever

  • bone marrow suppression

  • SAFETY ALERT: risk for infection

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58

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

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