Pharmacology: Nausea/Vomiting, GI

Antiacids, Mucosal Protectant, Proton Pump Inhibitors, Histamine H2 antagonist, Prostaglandins, Serotonin Antagonists, Dopamine agonists/Prokinetic Agents, Antihistamine/Anticholinergics, Neurokinin-1 Receptor Antagonist

Drug class for Aprepitant

NK1 Antagonists

Method of action for Aprepitant

Blocks NK1 receptors that transmit signals that cause nausea and vomiting

Side effects for Aprepitant

Bradycardia, deep vein thrombosis, and renal insufficiency

Contraindications for Aprepitant

Use of primozide, hypersensitivity, and pregnancy

Therapeutic Use of Dimenhydrinate

Antiemesis, vertigo, motion sickness.

Adverse Drug Reactions of Dimenhydrinate

Sedation, anticholinergic effects (dry mouth, urinary retention, constipation).

Interventions when administering Dimenhydrinate

Monitor clients when ambulating, for anticholinergic effects, bowel elimination patterns, and vital signs

Client Instructions for Dimenhydrinate

Do not take prior to driving, sit or lie down if feeling drowsy, and increase fluid and fiber intake

Contraindications for Dimenhydrinate

hypersensitivity, glaucoma, and infants

Method of action for Dimenhydrinate

Blocks the release of histamine at H1 receptors in the inner ear connected to the CTZ

Drug class for Dimenhydrinate

Antihistamine

Ondansetron

A serotonin 5-HT3 antagonist

Serotonin Syndrome

A potentially life-threatening condition caused by excessive serotonergic activity in the nervous system, often due to drug interactions.

Torsade de Pointes

A specific type of abnormal heart rhythm that can lead to sudden cardiac death.

Stevens-Johnson Syndrome

A severe skin reaction that can be triggered by medication, leading to skin blistering and detachment.

Contraindications for Ondansetron

Phenylketonuria, congenital long QT syndrome, and concurrent use with apomorphine.

Precautions for Ondansetron Use

Consider liver dysfunction, recent abdominal surgery, pregnancy/lactation, and use in children under 3.

Client Instructions for Ondansetron

Report headaches and dizziness, avoid activities that cause dizziness, change positions slowly, stay hydrated, and report diarrhea.

Adverse Drug Reactions of Ondansetron

Include headache, dizziness, diarrhea, constipation, serotonin syndrome, torsade de pointes, and Stevens-Johnson syndrome.

Drug Interactions of Ondansetron

Including SSRIs, SNRIs, tricyclic antidepressants, MAOIs, and others that affect serotonergic systems increase the risk of serotonin syndrome.

Therapeutic Use of Metoclopramide

Nausea and vomiting: Increase GI motility

Adverse Drug Reactions of Metoclopramide

Sedation, restlessness, diarrhea, extrapyramidal manifestations, neuroleptic malignant syndrome.

Intervention for Metoclopramide Therapy

Monitor client ambulation, diarrhea, monitor for extrapyramidal manifestations.

Client Instructions for Metoclopramide

Avoid driving; sit if drowsy; report diarrhea and involuntary movements.

Contraindications for Metoclopramide

Gastrointestinal obstruction, uncontrolled seizures, pheochromocytoma, breast cancer.

Precautions for Metoclopramide

Use cautiously in heart failure, hypertension, asthma, Parkinson's disease, and older adults.

Misoprostol

Prostaglandin E

Therapeutic use of Misoprostol

Prevention of gastric ulcers from long-term NSAID use.

Adverse drug reactions of Misoprostol

Diarrhea, abdominal pain, uterine cramping, spotting, miscarriage.

Interventions of Misoprostol

Monitor for severe diarrhea and abdominal pain; monitor for excessive menstrual pain or mid-cycle bleeding.

Contraindications for Misoprostol

Pregnancy due to teratogenic effects and hypersensitivity to the medication.

Client instructions for Misoprostol

Report worsening diarrhea or abdominal pain, drink plenty of clear fluids, take with food, avoid alcohol and irritating foods.

Precautions with Misoprostol

Use with caution in children younger than 18 years.

Interactions with Misoprostol

Antacids that contain magnesium worsen diarrhea.

Classification of Aluminum hydroxide

Antiacid

Indications for Aluminum hydroxide

Peptic ulcer disease (PUD) and gastrointestinal reflux disease (GERD)

Method of action for Aluminum Hydroxide

Aluminum hydroxide works by neutralizing stomach acid

Adverse reaction for Aluminum hydroxide

Constipation

Client Teaching for Aluminum Hydroxide

Increase fiber and fluid intake

Contraindications for Aluminum hydroxide

Unknown abdominal pain

Therapeutic Use of Sucralfate

Acute duodenal ulcers.

Adverse Drug Reactions of Sucralfate

Constipation.

Administration Instructions for Sucralfate

Administer orally on an empty stomach

Client Instructions for Sucralfate

Increase fluid and fiber intake, increase activity and exercise, and report any gastrointestinal bleeding.

Contraindications of Sucralfate

Hypersensitivity

Precautions for Using Sucralfate

Chronic renal failure, diabetes, and difficulty swallowing.

Interactions with Sucralfate

Absorption of certain medications decreases; antacids reduce its therapeutic effects.

What should not be given within 30 minutes of administration of Sucralfate?

Antacids.

What are the signs of gastrointestinal bleeding to report when taking Sucralfate?

Coffee-ground emesis or any other manifestation of obvious or occult gastrointestinal bleeding.

Therapeutic use of Proton Pump Inhibitors (PPI)

Gastric and duodenal ulcers, GERD

Adverse drug reactions of omeprazole

Bone loss (long-term use), headache, abdominal pain, nausea, vomiting, diarrhea, and hypomagnesemia.

Interventions for omeprazole therapy

Limit therapy to the lowest dose and shortest duration, monitor bone density, severe vomiting, diarrhea, and magnesium levels.

Client instructions for patients on omeprazole

weight-bearing exercise, consume adequate calcium and vitamin D, report vomiting/diarrhea, drink plenty of clear fluids

Contraindications for omeprazole

Hypersensitivity to the medication and concurrent use of rilpivirine.

Precautions for omeprazole use

Liver dysfunction and precautions for pregnancy and lactation.

Method of Action for Omeprazole

Inhibits enzyme system reducing secretion of stomach acid

Cimetidine

A histamine H2 antagonist

Therapeutic Uses of Cimetidine

Gastric and duodenal ulcers, heartburn

Adverse Drug Reactions of Cimetidine

Impotence, reduced libido, and gynecomastia

Client Instructions for Cimetidine

avoid smoking and irritating foods, and report signs of gastrointestinal bleeding.

Contraindications for Cimetidine

Known sensitivity and impaired liver function

Precautions for Cimetidine

hepatic or renal dysfunction

Drug Interactions with Cimetidine

Antacids can reduce absorption; cimetidine increases levels of warfarin, phenytoin, lidocaine, and theophylline.

Method of action for Cimetidine

Block histamine receptors in the stomach responsible for secretion of stomach acid