GI/GU Medications NUR 328 UAB

Antibiotics for PUD/GERD

Amoxicillin, Bismuth, Clarithromycin, Metronidazole, Tetracycline, Tinidazole

Action of ABX is to eradicate H. Pylori

This will always be a combo of multiple meds for at least 10-14 days

Consider medication resistance, GI upset/side effects, and compliance

Histamine 2 Receptor Agonists

Cimetidine

Cimetidine MOA

blocks secretion of gastric acid

Cimetidine Uses

prevent/treat gastric and duodenal ulcers, GERD, hypersecretory conditions, and heartburn

in conjunction with ABXs for H. pylori and urticaria

Cimetidine AE

Gynecomastia

CNS effects (crosses BBB, more likely in geriatric)

constipation, diarrhea, nausea, decreased libido, impotence

Cimetidine CI/ Precautions

geriatric clients increased CNS effects

clients at high risk for pneumonia (COPD)

reduction in dose for kidney patients

pregnancy

Cimetidine DI

can inhibit enzymatic metabolism of drugs -> increasing levels of meds like warfarin, phenytoin, theophylline, and lidocaine (meds with a narrow margin for safety

Cimetidine Nursing Interventions

checking drug levels and PT/INR

monitor for bleeding,

check med list, S/Es, pneumonia—teaching about compliance and diet

Proton Pump Inhibitors

Omeprazole

Omeprazole MOA

block basal and stimulated acid production

reduces acid by inhibiting the enzyme that produces gastric acid

irreversible inhibition

Omeprazole Uses

short-term therapy (4-8 weeks) of gastric ulcers, erosive esophagitis, and GERD

prevention of stress ulcers

Omeprazole AE

pneumonia, osteoporosis/fractures, rebound hypersecretion, hypomagnesemia

C. Diff, GI side effects

Omeprazole CI/ Precaution

pregnancy (indications of congenital birth defects)

high risk for pneumonia (think COPD, immunosuppressed)

Omeprazole CI/ Precautions

digoxin, phenytoin, clopidogrel, -azoles, benzodiazepines, antivirals

Omeprazole Nursing interventions

watching for signs of thrombotic events for pts taking clopidogrel

monitoring for diarrhea or loose stools

s/s of pneumonia and hypomagnesemia

Mucosal Protectants

Sucralfate

Sucralfate MOA

turns into physical protective barrier for ulcer for up to 6 hours, does not affect acid

Sucralfate Uses

duodenal ulcers/maintenance, neutralize gastric acid

Sucralfate AE

Constipation - increase fiber!

dry mouth

Sucralfate CI/ Precautions

pregnancy/ lactation

Sucralfate DI

phenytoin, digoxin, warfarin, ciprofloxacin, antacids

Sucralfate Nursing Interventions

take this medication 1-2 hours before a meal to maximize effectiveness

keep proper intervals between other meds and this one, usually 2 hours

Prostaglandin E Analog Prototype

Misoprostol

Misoprostol MOA

decreases acid secretion

increases the secretion of bicarb and mucus

promotes vasodilation

Misoprostol Uses

used w/ long-term NSAID use to prevent ulcers

(off-label: to induce labor or medical termination of pregnancy)

Misoprostol AE

diarrhea, dysmenorrhea (painful menstrual cramps)

Misoprostol CI/Precautions

pregnancy (Cat X), lactation

Misoprostol DI

some diarrhea w/ antacids

Misoprostol Nursing Interventions

asking women about menstrual cycles/ contraceptives

Antacids

Aluminum hydroxide

Aluminum Hydroxide MOA

neutralize stomach acid

Aluminum Hydroxide Uses

GERD, prevention of stress ulcers and PUD

Aluminum Hydroxide AE

constipation

fluid retention (if sodium containing) -> electrolyte imbalances

alkalosis, magnesium toxicity

Aluminum Hydroxide CI/ Precautions

use in caution for patients with heart failure or hypertension (Na+)

do not use with abdominal pain or GI perforation/obstructions

careful in renal/hepatic pts

Aluminum Hydroxide DI

delay absorption of meds

the aluminum compounds bind to drugs like warfarin, digoxin and tetracycline

interfering with absorption and reducing their effects

Aluminum Hydroxide Nursing Interventions

do not take these meds within 1-2 hours of other medications -> interfere w/ absorption

assess for s/es and therapeutic action

Digestive Enzymes

Pancrelipase

Pancrelipase MOA

replaces pancreatic enzymes to aid indigestion/absorption of fats, proteins, and carbs

Pancrelipase Uses

replacement treatment in those w/ deficiency exocrine pancreatic enzymes

Pancrelipase AE

GI irritant, headache, cough

Pancrelipase CI/ Precautions

pork allergy, pregnancy/lactation, gout/hyperuricemia

Pancrelipase DI

decreases absorption of folic acid/ iron

Pancrelipase Nursing Interventions

this medication is taken w/ every meal and every snack!

Substance P/Neurokinin 1 Receptor Antagonist

Aprepitant

Aprepitant MOA

acts directly on CNS to block n/v receptors with little to no effect on serotonin, dopamine, or corticosteroid receptors

Aprepitant Uses

post-op n/v (PONV)

delayed CINV (chemo-induced)

can prolong action of other meds in combination

Aprepitant AE

GI effects

headache, fatigue, dizziness

possible liver damage (transient elevation in labs)

abnormal heart rhythm

Aprepitant DI

warfarin, oral contraceptives

many interactions with drugs

can increase glucocorticoids

Serotonin Antagonist

Ondansetron, Granisetron

Ondansetron MOA

block peripheral (vagus) and central (CTZ) receptor sites associated with n/v

Ondansetron Uses

CINV, radiation therapy, anesthesia, pregnancy, viral gastritis

Ondansetron AE

HA

QT Prolongation (Torsades de Pointes)

Ondansetron CI/ Precautions

pregnancy/lactation, check

med list for other medications that prolong the QT or patient hx of QT elongation

may need ECG prior to administration

Ondansetron DI

apomorphine can cause drop in bp that can lead to loss of consciousness

Ondansetron Nursing Interventions

monitor for side effects, relief of N/V

Dopamine antagonist/ Phenothiazines Prototype

Prochlorperazine, Promethazine

Prochlorperazine MOA

blockade of dopamine receptors in CTZ

Prochlorperazine Uses

CINV, PONV, migraines

Prochlorperazine AE

extrapyramidal side effects (EPs), orthostatic hypotension, sedation, anticholinergic, CNS depression

Prochlorperazine CI/ Precautions

geriatrics, children under 18yrs old (extrapyramidal symptoms), asthma

urinary retention/obstruction, narrow angle glaucoma

Prochlorperazine DI

CNS depressants, use of HTN meds, anticholinergics

Prochlorperazine Nursing Interventions

watch for side effects and interactions with other medications

Anticholinergics

Scopolamine

Scopolamine MOA

muscarinic antagonist that interrupts nerve pathway from inner ear to vomiting center

Scopolamine Uses

motion sickness, pre-op nausea

given before symptoms start

Scopolamine CI/ Precautions

dry mouth, blurred vision, drowsiness

less effects when transdermal

Scopolamine DI

NONE!

Scopolamine Nursing Interventions

monitor for side effects, especially with geriatric patients

risk for falls

Antihistamines

Dimenhydrinate, Meclizine

Dimenhydrinate MOA

blocks histaminergic and muscarinic cholinergic receptors in nerve pathway in inner ear to vomiting center

Dimenhydrinate Uses

Motion sickness; less effective than Scopolamine

Dimenhydrinate AE

sedation, anticholinergic

Dimenhydrinate DI

anticholinergic meds

meds w/ s/e of sedation

Dimenhydrinate Nursing Interventions

monitor for side effects, fall risk

Bulk-forming Laxative

Psyllium

Psyllium MOA

increases fluid in intestines-enlarging bulk, stimulation of local stretch receptors and activating peristaltic movement

Psyllium Uses

constipation

Psyllium AE

not absorbed

systemic reactions are rare

Psyllium CI/Precautions

administer with fluids (full glass of water/juice)

can cause obstruction in the intestines or esophagus

pregnancy/lactation

unknown cause of abd. pain

Psyllium DI

drug absorption/ timing

Psyllium Nursing Interventions

should assess for relief in 12-72 hours

Surfactant Laxative Prototype

Docusate Sodium

Docusate Sodium MOA

alters stool consistency by lowering surface tension -> facilitates the penetration of water into the feces

may also act on the intestinal wall

Docusate Sodium Uses

constipation, softening of fecal matter

Docusate Sodium AE

NONE!

Docusate Sodium CI/ Precautions

pregnancy/lactation

Docusate Sodium DI

drug absorption/timing

Docusate Sodium Nursing Interventions

should be administeredwith a full glass of water

monitor for effectiveness, timing of med-admin

abdominal pain, usually 1-3 days

Stimulant Laxative

Bisacodyl, Senna

Bisacodyl, Senna MOA

stimulate intestinal motility and increase the amount of water and electrolytes in the intestinal lumen and reduce absorption

Bisacodyl, Senna Uses

opioid-induced constipation

slow intestinal tract; bowel prep for surgery

Bisacodyl, Senna AE

proctitis (local reaction with bisacodyl suppository)

Bisacodyl, Senna CI/ Precautions

some overuse/abuse

do not chew or crush; do not give within an hour of milk/antacids

pregnancy/lactation

Bisacodyl, Senna DI

drug absorption/ timing

Bisacodyl, Senna Nursing Interventions

monitor for effectiveness, 6-12 hours

Osmotic Laxative Prototype

Magnesium Hydroxide, Lactulose

Magnesium Hydroxide MOA

draw water into the intestines to increase the mass of stool

stretching musculature to result in peristalsis

Magnesium Hydroxide Uses

reduce pain with elimination, prep for procedure, rid of dead parasites after antihelminth therapy or poisons

used in patients with high ammonia levels

Magnesium Hydroxide AE

dehydration

elevated/toxic magnesium levels (impaired kidney fxn)

fluid retention

Magnesium Hydroxide CI/ Precautions

kidney disease, HF, HTN, and edema