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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