pharm 20.2- upper gi medications

cannaboids examples

goals of drugs for PUD and GERD

decrease gastric secretion and neutralize acid to allow ulcers and damaged tissue to heal

H2 receptor antagonist mechanism

blocks H2 receptors in parietal cells, usually started first, decreases production of hydrochloric acid to decrease volume and acidity of contents

H2 receptor antagonist examples

Ranitidine

Cimetidine (prototype)

Famotidine

most are PO or IV

nursing implications of H2 receptor antagonists

do not give PO within 1 hr of antacid, monitor for signs of bleeding in GI tract (vomit or stool)

patient education of H2 receptor antagonist

report persistent symptoms, report black or maroon stool

proton pump inhibitors

usually given if H2 receptor antagonist don't work for upper gi disorders

proton pump inhibitors examples

(-prazole NOT CONAZOLE=antifungal) Omeprazole, lansoprazole, esomeprazole, pantoprazole

mechanism of proton pump inhibitors

block enzyme responsible for Hcl secretion, prevents H ions from going out into the stomach, stops all production of gastric acid secretions more than H2 receptor antagonists

-prazan

new class for erosive esophagitis, P-cabs, halts acid production

uses for proton pump inhibitors

short term for PUD and GERD, can be longer for erosive esophagitis

side effects of proton pump inhibitors

long term can have iron deficiency due to decrease absorption with lower acidity, increased risk for hospital acquired pneumonia, increased risk for c diff infection

nursing implications of proton pump inhibitors

take 30 mins before eating, do not crush or chew, not taken with antacids, can be taken with antibiotics for H pylori

patient education of proton pump inhibitors

report worsening pain or gastric pain, report black or maroon stools

antacids examples

Aluminum hydroxide, calcium carbonate, magnesium hydroxide, sodium bicarbonate

mechanism of antacids

neutralize stomach acid, only reduce symptoms

uses for antacids

dyspepsia

side effects of antacids

diarrhea (mg), constipation (al or ca)

nursing implications of antacids

avoid giving with other meds or meals, caution with renal impairment, only treats the symptoms does not sure ulcers or root of pain/discomfort

patient education of antacids

combination antacids decrease side effects, do not take within 1-2 hrs of other meds, avoid alcohol, no smoking, no coffee or acidic beverages

sucralfate mechanism

gi protectant, binds to ulcerated tissue (sucrose and aluminum hydroxide bind to exposed proteins) protects ulcer from pain or gastric juices

sucralfate uses

ulcers

sucralfate nursing implications

give alone 30-60mins before a meal (up to 4x a day), always given PO

antiemetics types

antihistamine, anticholinergics, benzodiazepines, cannaboids, serotonin receptors antagonists, dopamine blocking agents

antihistamine/anticholinergic examples for n/v

antihistamines- hydroxzine, meclisine, idmenhydrainate anticholinegerics- scopolamine (transdermal patch)

mechanism of antihistamine/anticholinergic for n/v

block histamine receptor to decrease production of gastric acid or block each is gi tract to decrease motility

uses for antihistamine/anticholinergic for n/v

motion sickness, inner ear disorders, vertigo

side effects of antihistamine/anticholinergic for n/v

sedation, anticholinergic effects- dry mouth, tachycardia

benzodiazepines examples for n/v

lorazepam and BAD infusion

BAD infusion

Benadryl (antihistmine), Ativan (benzodiazepines), Dexadron (glucocorticosteroid), can be given slow on an infusion pump for uncontrollable n/v

mechanisms of benzodiazepines for n/v

reduce input to vomiting center by increasing GABA in CNS, slow CNS activity

uses for benzodiazepines for n/v

anticipatory n/v: cancer patient undergoing chemo

side effects of benzodiazepines for n/v

sedation, abuse and dependency

cannaboids examples

marijuana, dronabinol

cannaboids mechanism of action

CNS inhibition of signal reaching vomiting center

uses of cannaboids

n/v related to chemo

side effects of cannaboids

sedation, increased appetite (which can be good for cancer patients who are losing weight)

serotonin receptor agonist example

ondansetron (zofran) can be IV,PO, and melt away tablets or granisetron (7 day patches)

serotonin receptor agonist mechanism

blocks serotonin stimulation of vagus nerve to innate vomiting reflex,

uses of serotonin receptor agonist

severe n/v, first used with patient with medication induced n/v

side effects of serotonin receptor agonist

well tolerates, less sedating than other classes

dopamine blocking agents examples

(antidopaminergics) promethazine (can be suppository, iv can cause phlebitis) , prochlorperazine (stimulates gi motility, can be used for gastrophoresis) , droperidol, metoclopramide

mechanism of dopamine blocking agents

inhibits CNS signal to vomiting center by blocking action of dopamine (overlap between this med and antipsychotic meds)

uses for dopamine blocking agents

n/v, gastric stasis

side effects of dopamine blocking agents

side effects worsen with time or high doses, sedation, ESP and tar dive dyskinesia

ESP

extrapyramidal system- repeated actions like lip smacking, muscle rigidity, muscle twitches, tremors (like Parkinson's)

tardive dyskinesia

progression from ESP, irreversible, permanent movement disorder (common with antipsychotics)

nursing implications of anti emetics

report vomiting blood, assess triggers, assess fall risk with medications causing sedation, do not use OTC antiemetics for long periods, most effective if taken before vomiting begins, stop if ESP occurs (or any muscle changes)

medications that can cause paradoxical reactions

diphenhydramine, lorazepam