N365 Final Exam

classification of famotidine (Pepcid)

antihistamine (H2- blocking agent)

actions of famotidine (Pepcid)

it blocks H2 receptors as a competitive antagonist and doesn’t allow stimulation to happen on the parietal cells, it decreases gastric acid secretion

ADRs of pepcid

• uncommon

• pneumonia

• constipation

why might famotidine cause pneumonia

it decreases the acid production, so pH is raised, which might allow for the survival of organisms in that environment, leading to respiratory aspiration

what is pepcid used for

GERD

classification of omeprazole (Prilosec)

proton-pump inhibitor (PPI), gastric acid secretion

actions of omeprazole (Prilosec)

it inhibits H+K+ATPase, the enzymes that produces gastric acid; suppresses the last phase of gastric acid production

ADRs of omeprazole

• with short term use (4-8 weeks) = headache, N/V/D

• long-term use = higher incidence of CKD, dementia, magnesium deficiency, pneumonia and weakened bones

why does omeprazole cause weakened bones

there’s interference with calcium absorption occurring since some acidity in the stomach was lost

what is the most effective drug for suppressing gastric acid secretion, especially if you have an active ulcer

omeprazole (Prilosec)

what are some lifestyle modifications we can suggest to patients with GERD

• no tobacco use

• increases gastric acid production

• no lying down for at least 2 hours after eating

• raise HOB

• weight loss

what medication do you give to a patient who has been responding inadequately or has GERD too frequently?

proton pump inhibitor

classification of sucralfate (Carafate)

anti-ulcer

actions of sucralfate (Carafate)

acts locally within the GI tract to “patch” an ulcerated area in the stomach mucosa in order to protect it against further attack by acid, pepsin, or bile salts

ADRs of sucralfate

• constipation — most common
  VERY well tolerated

• dizziness

• vertigo

how should sucralfate be taken

it needs to be given on an empty stomach, it will not get to where it needs if given with food

what should you not ttake within ½ hour of taking sucralfate

antacid and fat soluble vitamins

classification of magnesium & aluminum hydroxide gels (Maalox)

antacid, nonsystemic

actions of Mg & Al hydroxide gels (Maalox)

neutralizes gastric acid by chemical reaction, leading to a higher pH

ADRs of Maalox

Al products = constipation
Mg products = diarrhea
This medication tries to balance the 2 effects

when should Maalox be given

after meals when the acid has already been produced

why should we avoid giving Maalox closely to other drugs

it can reduce absorption of various drugs and bind with a lot of other medications

classification of simethicone (Mylicon)

antiflatulent

actions of simethicone (Mylicon)

alters surface tension of gas bubbles, causing them to coalesce and free the gas, which is then eliminated by belching or passing flatus

ADRs of simethicone (Mylicon)

none; very well tolerated drug

how is simethicone given to infants

via drops

how is simethicone usually found

in combination with antacids

classification of dimenhydrinate (Dramamine)

antiemetic, anticholinergic, antihistamine

what is dimenhydrinate used for

it is used to prevent motion sickness, so you can’t use it once you’re already feeling motion sick

actions of dimenhydrinate

decreases GI motility and GI spasms (which leads to vomiting)

ADRs of dimenhydrinate

anticholinergic effects:

• sedation

• dry mouth

• blurred vision

• urinary retention

what are some considerations you must think about before giving dimenhydrinate to patients?

• do not use if patient has glaucoma since it can increase intraocular pressure

• may mask symptoms of ototoxicity

classification of promethazine (Phenergan)

antiemetic

what is promethazine used for

used to treat vomiting or decrease vomiting

actions of promethazine

acts directly on CTZ and vomiting center by suppressing their response

why should promethazine NEVER be given as IV?

there is a high risk of necrosis of the surrounding tissues and blood vessels

ADRs of promethazine

• sedation

• hypotension

• dystonias

• peripheral anticholinergic effects (dry mouth, blurred vision, constipation)

what are some considerations you should think about before taking promethazine

• not effective for motion sickness

• synergistic for analgesia with narcotic and non narcotics - pain relief is better

classification of metoclopramide (Reglan)

antiemetic

what is metoclopramide used for

can be used as a promotility agent when there is no N/V, helps things move forward in GI tract and can be used for people who have diabetic gastroparesis

actions for metoclopramide

• blocks dopaminergic receptors in the CTZ

• stimulates acetylcholine effect which enhances motility of smooth muscle

ADRs of metoclopramide

• drowsiness

• restlessness

• extrapyramidal symptoms esp w/ high IV doses = nystagmus, tongue thrusting

• gynecomastia

what drug would you recommend to a chemo patient to get rid or prevent their N/V?

metoclopramide

contraindications of metoclopramide

• obstruction

• hemorrhage

• perforation of GI tract

how long do you have to wait before you can eat when administering metoclopramide

30 minutes

classification of ondansetron (Zofran)

antiemetic

action of ondansetron

selective serotonin antagonist that works in the CTZ to prevent nausea and vomiting

what is ondansetron used for

prevention of N/V, also used post-op

ADRs of ondansetron

• constipation

• rashes

• transient blurred vision

why was ondansetron developed

to assist those receiving chemo

ondansetron causes abnormal muscle movement. true or false

false; it does not

how long before or after chemo should ondansetron be given

30 minutes before chemo

ondansetron prevents delayed CINV. t or f

false, it does NOT prevent delayed CINV

classification of magnesium hydroxide mix (Milk of Magnesia)

cathartic, saline (laxative)

why should milk of magnesia not be given by itself

it causes diarrhea, that’s why it’s a mixture

action of milk of magnesia

reacts with HCl in the stomach —> MgCl = saline/salt effect pulls water into the intestinal lumen; if theres enough it increases peristalsis. this produces bowel movement

how long does it take for milk of magnesia to work

can work in half an hour to 3 hours

ADRs of milk of magnesia

• occasionally diarrhea (if taken too often)

• hypermagnesemia if you have renal failure

why should we be careful of giving milk of magnesia to patients with renal failure

about 20% of magnesium may be absorbed, which is a problem in patients w/ CRF due to magnesium toxicity

what is used for bowel cleansing before a colonoscopy procedure

polyethylene glycol and electrolytes

what is used for chronic constipation

miralax

why should we give milk of magnesia with large amounts of water

to avoid fluid imbalance

classification of bisacodyl (Dulcolax)

cathartic, stimulant (laxative)

action of bisacodyl

stimulates peristalsis by irritating mucosa

ADRs of bisacodyl (Dulcolax)

• intestinal cramps

• diarrhea

• suppositories may produce mild burning sensation in rectum

what is something you should educate your patient on before taking bisacodyl?

to not crush, cut or chew tablets

classification of psyllium (Metamucil)

laxative, bulk-forming

actions of psyllium

it absorbs water which enlarges bulk of fecal mass and mechanically stimulates bowel

ADRs of psyllium

rare

how should psyllium be prepared

it should be stirred in 8 oz. glass of liquid and drunk immediately while in suspension

why are the doses much higher in psyllium

it decreases cholesterol

classification of sodium docusate (Colace)

Emollient agent (stool softener)

actions of sodium docusate

acts like a detergent and penetrates fecal material with water and fatty substances to soften it; it has NO effect on intestine and peristalsis, just fecal mass

ADRs of sodium docusate

negligible, occasional diarrhea

why might sodium docusate be used

for its prophylactic effect (constipation)

classification of loperamide (Imodium)

antidiarrheal

what is the action of loperamide

it suppresses bowel motility / slows down or stops diarrhea

what is traveller’s diarrhea

when you’re exposed to foreign microbes from another country

what is loperamide used for

• traveller’s diarrhea

• any sudden onset of diarrhea

ADRs of loperamide

• black box: torsades de point — VERY chaotic VENTRICULAR rhythm

• constipation

• abdominal cramps

what is the daily max of dosage for loperamide

8mg, 24g if being supervised

why does the drug lomotil (antidiarrheal) have atropine

it is an opioid used ONLY to tread diarrhea, atropine is put in there to discourage abuse as it can cause unpleasant side effects

classification of corticotropin (ACTH)

hormone, anterior pituitary

actions of corticotropin

it stimulates cortex of adrenal gland to produce cortisol

what is corticotropin used for

used to detect adrenal insufficiency, now used for more diagnostic purposes

Adrs of corticotropin

same as cortisone:

• edema in LE

• HTN

• mood swings, memory, behavior

• confusion

• delirium

how do we know if the adrenal gland is functioning

if cortisol levels rise after giving a shot of cosyntropin (corticotropin) then adrenal gland is working, if it fails to rise = dx is made

classification of vasopressin

hormone, post-pituitary

actions of vasopressin

• used to treat diabetes insipidus

• causes contraction of the smooth muscle of vascular bed

• promotes renal conservation of water

ADRs of vasopressin

• excessive vasoconstriction

• decreased cardiac output

• water retention and intoxication

what is vasopressin used for

• to treat diabetes insipidus

• gaseous distention

what medication do you use to treat nocturnal enuresis

desmopressin

classification of oxytocin (Pitocin)

posterior pituitary hormone

action of oxytocin

• stimulate uterine smooth muscle

• constricts vascular muscle

• limited ADH effect

ADRs of oxytocin

• water intoxication can occur with large doses

• hyponatremia

• injudicious use can cause uterine rupture, hypertensive crisis and cerebral hemorrhage

what can oxytocin used for

• induction of labor

• post partum bleeding

classification of cholecalciferol

vitamin D

action of cholecalciferol

• stimulates intestinal Ca absorption

• decreases Ca excretion

• bone Ca mobilization

what is renal osteodystrophy

when you have renal disease, you can’t activate vit D, so it causes a change in the bones

ADRs of cholecalciferol

• hypercalcemia

• weakness

• lethargy

• ataxia