N/V/D

What is the brand name of loperamide? What is the age limit?

Imodium; 6+, weight based dosing down to 2

What is the max dose for imodium?

Max 2 day use

What is the MOA for imodium?

Synthetic opioid agonist; stimulates peripheral micro-opioid receptors on the intestinal circular muscles to slow intestinal motility and allow absorption of electrolytes and water

What does loperamide treat?

Diarrhea, travelers diarrhea, chronic diarrhea

Can loperamide be used in treatment of c. diff?

no

What are the side effects of loperamide?

Constipation; CV complications + death with overdose

Is loperamide safe in preg/bf?

Preg: safe, bf: probably safe but data lacking

What is the boxed warning on loperamide for?

Torsades de pointes and sudden death with overdose

What are two cautions with loperamide?

Should not be monotherapy for treating bac diarrhea; can be abused

What is the brand name of bismuth subsalicylate? What is the age limit?

Pepto bismol; 12+, Reyes in kids

What’s the MOA for bismuth subsalicylate?

Antisecretory effects mediated by inhibition of PG synthesis that inhibits intestinal secretions; antimicrobial effects (H. pylori treatment)

What does pepto bismol treat?

Traveler’s diarrhea, nausea associated with food/beverages

What are the side effects of pepto bismol?

Black hairy tongue, black stools

What is the pro of bismuth subsalicylate?

Many uses (N/D, fullness, heartburn, prevention of travelers diarrhea)

What is a caution with bismuth subsalicylate?

Bismuth is poorly absorbed, but salicylate is readily absorbed and increases bleeding risk in pts on blood thinners

What are the contraindications for pepto bismol?

Children <15, ASA allergy, preg/bf

What are the anti-emetic OTCs?

Phosphorated carbohydrate solution (Emetrol, conc cola syrup); sodium citrate dihydrate 320mg tab (emetrol)

What is the frequency of doing with antiemetics? What is the age restraint?

Given every 15 mins; max dose: 5 d/hr or 24 tab/24 hours; tabs are 18+

What is the MOA of phosphorated carbohydrate solution?

Hyperosmotic solution; has direct action on GI tract that decreases smooth muscle contractions that can lead to vomiting

What is the MOA for Sodium citrate dihydrate tabs?

Buffering agent that neutralizes HCl and increases pH, inactive ingredients fructose and dextrose

What are anti-emetics for?

Nausea associated with food/bev, gastroenteritis, motion sickness, morning sickness

What are the side effects of the solution anti-emetic?

Stomach upset, diarrhea, hyperglycemia (in diabetics)

What are the side effects of anti-emetic tabs?

Nausea, Bloating, diarrhea

Are anti-emetics safe in preg/bf?

Yes

What are the cons of anti-emetics?

Not very effective, cannot be diluted, very frequent dosing, if it doesn’t work within one hour it won’t work

What are two cautions with antiemetics?

Solution: pts with uncontrolled diabetes; Tab: pts on reduced salt diet

What are the 1st gen AH used for motion sickness? What are there ages?

Meclizine (Bonine, Dramamine Less Drowsy), 12+; Dimenhydrinate (Dramamine), 2+; Diphenhydramine, 6+; Doxylamine

What is the MOA for 1st gen AH for nasuea?

Crosses BBB and competitively blocks H1 receptors in the brain/nausea center

What are the side effects from meclizine?

Anticholingeric effects

Which 1st gen AH lasts the longest for nausea?

Meclizine has longest duration and typically less sedating

Are 1st gen AH safe in preg/bf?

Preg: safe, Bf: CON

How often is the dosing for 1st gen AH?

every 4-6 hours, besides Meclizine which is once a day

What is the patient counseling for 1st gen AH for nausea?

Take 30-60min before motion, avoid alcohol, do not drive or perform tasks with required mental alertness

Who are the caution pts for 1st gen AH?

BPH, dem/alz, older adults, closed angle-glaucoma

What the CON for 1st gen AH?

MAOIs, bf

What products are good ORS?

Pedialyte, gaterlyte, Gatorade G2, Liquid IV Hydration Multiplier

What is the MOA for ORS?

Supplies electrolyte solutes that allow water reabsorption in the intestines through the sodium-glucose cotransporter

What are the patient counselings for ORS?

Do not buy zero formulations as the electrolytes may not be absorbed as well, to avoid diarrhea recommend products with 7-9g sugar in 12 oz

What is the brand name for ginger? What does it treat?

Dramamine Natural; all cases of nausea

What are the side effects for ginger?

in high doses: increased risk of bleeding, mild GI effects like heartburn, diarrhea, mouth irritation

What is the dose for pryidoxine (B6) and doxylamine?

25mg B6 + 12.5mg doxylamine q8h

What is the MOA for B6/doxylamine?

Women with morning sickness are thought to have lower levels of B6 and doxylamine helps with nausea

What are the side effects of pyridoxine/doxylamine?

Large doses of pyridoxine (>100-200mg/d): peripheral neuropathy, weakness, lethargy, nystagmus