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

• Confirmation through urea breath test, stool antigen test, or some sort of upper-endoscopy based testing

Histamine 2 Receptor Agonists Prototype

Cimetidine

Cimetidine MOA

blocks secretion of gastric acid

Cimetidine Therapeutic 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/C

• 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

• lidocaine

  • meds with a narrow margin for safety

Cimetidine NI

• checking drug levels and PT/INR

• usually given at bedtime

• monitor for bleeding

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

• Take w/ antacids to help alleviate pn for ~1 wk (but 1-2 hrs apart to not affect absorption)

Cimetidine Healing

• 6-8 wks w/ gastric or duodenal

• 12 wks for esophagitis

Proton Pump Inhibitors Prototype

Omeprazole

THINK “Pretzel”

Omeprazole MOA

• block basal and stimulated acid production

• reduces acid by inhibiting the enzyme that produces gastric acid

• irreversible inhibition

Omeprazole Therapeutic 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

  • Sz, muscle cramps, hyperreflexia

• C. Diff

• GI side effects

Omeprazole CI/C

• pregnancy (indications of congenital birth defects)

• high risk for pneumonia (think COPD, immunosuppressed)

Omeprazole DI

• digoxin

• phenytoin

• clopidogrel

• -azoles

• benzodiazepines

• antivirals

Omeprazole NI

• watching for signs of thrombotic events for pts taking clopidogrel

• should be administered before food

• monitoring for diarrhea or loose stools

• s/s of pneumonia and hypomagnesemia

Omeprazole Healing

• 2 wks for gastric or duodenal ulcers

• 1-2 wks for GERD

• 8 wks for esophagitis

Mucosal Protectants Prototype

Sucralfate

Sucralfate MOA

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

Sucralfate Therapeutic Uses

duodenal ulcers/maintenance, neutralize gastric acid

Sucralfate AE

• Constipation - increase fiber!

• dry mouth

Sucralfate CI/C

pregnancy/ lactation

Sucralfate DI

• phenytoin

• digoxin

• warfarin

• ciprofloxacin

• antacids

Sucralfate NI

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

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

Sucralfate Healing

Usually takes 4-8 wks to help heal, unless confirmed earlier through endoscopy, healing rates similar to h2RAs

Prostaglandin E Analog Prototype

Misoprostol

THINK “Miso Soup”

Misoprostol MOA

• decreases acid secretion

• increases the secretion of bicarb and mucus

• promotes vasodilation

Misoprostol Therapeutic 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/C

pregnancy (Cat X), lactation

Misoprostol DI

some diarrhea w/ antacids

Misoprostol NI

asking women about menstrual cycles/ contraceptives

Antacids Prototype

Aluminum hydroxide

Aluminum Hydroxide MOA

neutralize stomach acid

Aluminum Hydroxide Therapeutic 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/C

• patients with HF 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 NI

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

• assess for s/e and therapeutic action

Digestive Enzymes Prototype

Pancrelipase

Pancrelipase MOA

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

Pancrelipase Therapeutic Uses

replacement treatment in those w/ deficiency exocrine pancreatic enzymes

Pancrelipase AE

• GI irritant

• headache

• cough

Pancrelipase CI/C

• pork allergy

• pregnancy/lactation

• gout/hyperuricemia

Pancrelipase DI

decreases absorption of folic acid/ iron

Pancrelipase NI

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

Substance P/Neurokinin 1 Receptor Antagonist Prototype

Aprepitant

Aprepitant MOA

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

Aprepitant Therapeutic Uses

• post-op n/v (PONV)

• delayed CINV (chemo-induced)

• can prolong action of other meds in combination

Aprepitant AE

• GI effects

• HA/fatigue/dizziness

• possible liver damage (transient elevation in labs)

• abnormal heart rhythm

Aprepitant CI/C

• pimozide

• breastfeeding children

• liver or kidney disease

Aprepitant DI

• warfarin

• oral contraceptives

• many interactions with drugs

• can increase glucocorticoids

Aprepitant NI

• Needs another method of birth control for 28 days after last dose

Serotonin Antagonist Prototype

Ondansetron, Granisetron

THINK “Dancer”

Ondansetron MOA

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

Ondansetron Therapeutic Uses

CINV, radiation therapy, anesthesia, pregnancy, viral gastritis

Ondansetron AE

• HA

• QT Prolongation (Torsades de Pointes)

Ondansetron CI/C

• pregnancy/lactation

• check med list for other meds that prolong the QT or patient hx of QT elongation

• may need ECG prior to administration

Ondansetron DI

• apomorphine

  • can cause drop in BP → LOC

Ondansetron NI

• monitor for side effects, relief of N/V

• Can be given concurrently with corticosteroid for efficacy with CINV

Dopamine antagonist/ Phenothiazines Prototype

Prochlorperazine, Promethazine

Prochlorperazine MOA

blockade of dopamine receptors in CTZ

Prochlorperazine Therapeutic Uses

CINV, PONV, migraines

Prochlorperazine AE

• extrapyramidal side effects (EPs)

• orthostatic hypotension

• sedation

• anticholinergic

• CNS depression

Prochlorperazine CI/C

• geriatrics

• children under 18yrs old

  • extrapyramidal symptoms

• asthma

• urinary retention/obstruction

• narrow angle glaucoma

Prochlorperazine DI

• CNS depressants

• use of HTN meds

• anticholinergics

Prochlorperazine NI

watch for side effects and interactions with other medications

Anticholinergics Prototype

Scopolamine

THINK “SCOPE”

Scopolamine MOA

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

Scopolamine Therapeutic Uses

• motion sickness, pre-op nausea

  • given before symptoms start

Scopolamine AE

• dry mouth

• blurred vision/drowsiness

• less effects when transdermal

Scopolamine CI/C

Geriatric pts

Scopolamine DI

NONE!

Scopolamine NI

• monitor for side effects, especially with geriatric patients

  • risk for falls

Antihistamines Prototype

Dimenhydrinate, Meclizine

Dimenhydrinate MOA

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

Dimenhydrinate Therapeutic Uses

• Motion sickness

  • less effective than Scopolamine

Dimenhydrinate AE

• sedation

• anticholinergic SE

Dimenhydrinate CI/C

Geriatric pts

Dimenhydrinate DI

• anticholinergic meds

• meds w/ s/e of sedation

Dimenhydrinate NI

monitor for side effects, fall risk

Bulk-forming Laxative Prototype

Psyllium

Psyllium MOA

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

Psyllium Therapeutic Uses

constipation

Psyllium AE

• not absorbed

• systemic reactions are rare

Psyllium CI/C

• 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 NI

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 Therapeutic Uses

constipation, softening of fecal matter

Docusate Sodium AE

NONE!

Docusate Sodium CI/C

pregnancy/lactation

Docusate Sodium DI

drug absorption/timing

Docusate Sodium NI

• should be administered with a full glass of water

• monitor for effectiveness, timing of med-admin

• abdominal pain, usually 1-3 days

Stimulant Laxative Prototype

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 Therapeutic Uses

• opioid-induced constipation

• slow intestinal tract; bowel prep for surgery

Bisacodyl, Senna AE

proctitis (local reaction with bisacodyl suppository)

Bisacodyl, Senna CI/C

• some overuse/abuse

• do not chew or crush

• do not give within an hour of milk/antacids

• pregnancy/lactation