ELIMINATION

Here is a structured, source-grounded breakdown of the medications listed in your outline and sources, detailed across all requested clinical parameters:

Anti-Emetic Agents

  • Phenothiazines (promethazine)

    • Therapeutic Indication: Relief of vomiting symptoms; indicated when vomiting is severe enough to cause dehydration and electrolyte imbalance.

    • Contraindications or Precautions: Antiemetics should not be administered before determining the underlying cause of vomiting, unless vomiting is severe enough to threaten fluid/electrolyte balance.

    • Cautions: Masking the underlying cause of vomiting.

    • Nursing Considerations: Obtain an accurate history regarding vomiting frequency (e.g., asking if vomiting occurred 2 times vs. 5–6 times) and assess fluid/electrolyte balance.

    • Side Effects and Adverse Effects: Can mask diagnostic symptoms of underlying GI disorders.

    • Route of Admin: Not specified in the provided sources.

    • Nursing Education: Instruct patients to report exact frequency and characteristics of vomiting episodes.

  • Serotonin Receptor Antagonists (Ondansetron)

    • Therapeutic Indication: Relief of nausea and vomiting symptoms.

    • Contraindications or Precautions: Withhold antiemetics until the underlying etiology of vomiting is established, unless severe dehydration/electrolyte imbalance is present.

    • Cautions: Potential masking of underlying pathology.

    • Nursing Considerations: Assess exact number of vomiting episodes and monitor for signs of dehydration and electrolyte loss.

    • Side Effects and Adverse Effects: Masking underlying GI conditions.

    • Route of Admin: Not specified in the provided sources.

    • Nursing Education: Teach patient to track and report vomiting episodes accurately.

Antidiarrheals

  • Loperamide & Diphenoxylate / Atropine

    • Therapeutic Indication: Symptomatic management of diarrhea (frequent liquid stool).

    • Contraindications or Precautions: Contraindicated for use exceeding 2 days and/or in the presence of a fever.

    • Cautions: Diarrhea causes significant fluid, electrolyte, and bicarbonate loss, which can lead to metabolic acidosis.

    • Nursing Considerations: Assess baseline bowel patterns (number of stools per day and consistency). Note that traveler's diarrhea (commonly caused by E. coli) lasting over 2 days or becoming severe may require fluoroquinolone antibiotics.

    • Side Effects and Adverse Effects: Potential fluid and electrolyte imbalance if underlying infection is masked or antidiarrheals are overused.

    • Route of Admin: Not specified in the provided sources.

    • Nursing Education: For traveler’s diarrhea prevention, educate patients to drink bottled water for all activities (drinking, brushing teeth, washing fruit) and eat well-cooked meats and vegetables. Warn against using OTC antidiarrheals for >2 days or when a fever is present.

Laxatives

Chemical / Stimulant Laxatives

  • bisacodyl & sennosides (senna)

    • Therapeutic Indication: Short-term relief of constipation; increases peristalsis to produce a bowel movement; used to prevent straining after surgery, myocardial infarction (MI), or childbirth, and for pre-procedure bowel prep. Onset of action is 6–8 hours (works overnight).

    • Contraindications or Precautions: Contraindicated in acute abdominal disorders, including appendicitis, GI obstruction, diverticulitis, ulcerative colitis, ileus, GI bleeding or perforation, toxic megacolon, fecal impaction, vomiting, pregnancy, breast-feeding, and children.

    • Cautions: Chronic or excessive use leads to fluid and electrolyte disturbances and hypokalemia.

    • Nursing Considerations: Must assess for acute abdominal pain or appendicitis before administering.

    • Side Effects and Adverse Effects: Abdominal cramps, diarrhea, electrolyte imbalance, hypokalemia, and fluid disturbances with chronic use.

    • Route of Admin: Oral tablets/dragées (e.g., Dulcolax, Senokot).

    • Nursing Education: Advise taking before bedtime for overnight relief; instruct patients not to use stimulant laxatives long-term to avoid electrolyte imbalances.

Bulk-Forming Laxatives

  • psyllium (Metamucil)

    • Therapeutic Indication: Natural fibrous, nonabsorbable agent that absorbs water into the intestine, increasing fecal bulk and peristalsis to promote large, soft stools. Safe for long-term use in patients with diverticulosis, irritable bowel syndrome (IBS), ileostomy, and colostomy.

    • Contraindications or Precautions: Inadequate fluid intake.

    • Cautions: Defecation usually occurs within 8–24 hours but may take up to 3 days for full effect.

    • Nursing Considerations: Does not cause laxative dependence. Ensure adequate fluid administration.

    • Side Effects and Adverse Effects: Intestinal obstruction if taken with insufficient fluid.

    • Route of Admin: Oral powder.

    • Nursing Education: Mix powdered bulk-forming laxatives in a full glass of water or juice, stir, drink immediately, and follow with an additional half to full glass of water.

Osmotic Laxatives

  • polyethylene glycol (Miralax), lactulose, magnesium hydroxide, magnesium citrate

    • Therapeutic Indication: Relieves occasional constipation/irregularity and softens stool by drawing water osmocytes into the bowel.

    • Contraindications or Precautions: Avoid in unevaluated acute abdominal pain or intestinal obstruction.

    • Cautions: Overuse can lead to fluid and electrolyte disturbances.

    • Nursing Considerations: Monitor bowel habit baseline and hydration status.

    • Side Effects and Adverse Effects: Diarrhea, fluid loss, electrolyte imbalances with excessive use.

    • Route of Admin: Oral (powder for solution shown for polyethylene glycol).

    • Nursing Education: Take once daily or as directed for occasional irregularity.

Surfactant Laxatives / Stool Softeners

  • docusate (docusate sodium / Colace, docusate calcium)

    • Therapeutic Indication: Lowers surface tension and promotes water accumulation in the intestine and stool. Used to prevent constipation and decrease straining during defecation (commonly given after MI or surgery, and prior to other laxatives in treating fecal impaction).

    • Contraindications or Precautions: Not specifically restricted; avoid in acute undiagnosed abdominal disorders.

    • Cautions: Stool softening effect and bowel movement may take several days.

    • Nursing Considerations: Administer before other laxatives when treating fecal impaction. (Note: Emollients like mineral oil absorb fat-soluble vitamins A, D, E, K, whereas docusate acts purely as a stool softener).

    • Side Effects and Adverse Effects: Mild abdominal cramping.

    • Route of Admin: Oral capsules.

    • Nursing Education: Take with a full glass of water and advise that results may take several days.

Antacids

Nonsystemic Antacids

  • aluminium hydroxide (Amphojel) & magnesium hydroxide

    • Therapeutic Indication: Neutralizes gastric acid to relieve GERD and heartburn symptoms. Aluminium hydroxide (Amphojel) also acts as an OTC phosphate binder to lower high serum phosphate levels in renal disease.

    • Contraindications or Precautions: Long-term continuous use without evaluation.

    • Cautions: Chronic use causes acid rebound (neutralization triggers parietal cells to produce more acid, leading to returning symptoms and a cycle of antacid dependence).

    • Nursing Considerations:

      • Evaluate for specific cation side effects: Aluminium hydroxide causes constipation.

      • Separate administration of antacids and H2 blockers (like ranitidine/cimetidine) by at least 1 hour.

    • Side Effects and Adverse Effects: Constipation (aluminium hydroxide); acid rebound.

    • Route of Admin: Oral.

    • Nursing Education: Educate older adults taking daily aluminum hydroxide about evaluating for constipation. Advise separating antacid doses from H2 blockers by at least 1 hour.

Systemic Antacids

  • sodium bicarbonate & calcium carbonate

    • Therapeutic Indication: Neutralizes gastric acid for fast relief of ulcer and GERD symptoms.

    • Contraindications or Precautions: Chronic use without medical oversight due to systemic acid-base effects and acid rebound.

    • Cautions: Triggers the acid rebound cycle.

    • Nursing Considerations: Separate from H2 blockers by 1 hour.

    • Side Effects and Adverse Effects: Acid rebound.

    • Route of Admin: Oral.

    • Nursing Education: Do not rely on systemic antacids continuously due to symptom return from acid rebound.

Histamine H2 Antagonists

  • cimetidine, famotidine (and ranitidine)

    • Therapeutic Indication: Inhibits H2 receptors on parietal cells, suppressing gastric acid secretion in peptic ulcer disease and GERD.

    • Contraindications or Precautions: Not specifically detailed in sources.

    • Cautions: Prolonged acid suppression reduces absorption of dietary Vitamin B12.

    • Nursing Considerations: Separate H2 blocker and antacid dosages by at least 1 hour to avoid decreased absorption.

    • Side Effects and Adverse Effects: Vitamin B12 deficiency over prolonged therapy.

    • Route of Admin: Oral.

    • Nursing Education: Teach the patient to eat foods rich in Vitamin B12 (e.g., when taking cimetidine). Remind patients not to take antacids simultaneously.

Proton Pump Inhibitors (PPIs)

  • omeprazole & pantoprazole

    • Therapeutic Indication: Suppresses gastric acid production for treatment and healing of peptic ulcers (esophageal, gastric, duodenal) and GERD. Duodenal ulcers represent the most common ulcer site.

    • Contraindications or Precautions: Caution in patients on long-term steroid therapy, as steroids induce/worsen peptic ulcers and delay recovery.

    • Cautions: Stomach ulcer healing typically requires 4 to 6 weeks.

    • Nursing Considerations: Assess ulcer recovery progress over the full 4–6 week timeline.

    • Side Effects and Adverse Effects: Not explicitly detailed for PPIs in the provided sources.

    • Route of Admin: Oral / IV (general drug class, not explicitly specified in sources).

    • Nursing Education: Inform patients that full ulcer healing takes 4–6 weeks of therapy, and warn against concurrent prolonged steroid use.

Pepsin Inhibitor

  • sucralfate

    • Therapeutic Indication: Treatment of gastric ulcers.

    • Mechanism of Action: Coats the gastric lining (mucosal protectant) to form a barrier over ulcer sites against acid and pepsin.

    • Contraindications or Precautions: Not specified in sources.

    • Cautions: Pepsin is active at pH 2; as pH approaches 5, pepsin activity drops.

    • Nursing Considerations: Administer prior to meals as ordered to establish a protective barrier over the gastric mucosa.

    • Side Effects and Adverse Effects: Not specified in sources.

    • Route of Admin: Oral.

    • Nursing Education: Explain to the patient that sucralfate acts as a protective "coating" over the ulcer site rather than neutralizing acid.

Additional Ophthalmic & Sensory Medications in Sources

  • Glaucoma Eye Drops (timolol, betaxolol, pilocarpine)

    • Therapeutic Indication: Lower intraocular pressure (IOP) in open-angle glaucoma to prevent optic nerve damage and vision loss.

    • Contraindications: Atropine sulfate is strictly contraindicated in glaucoma (causes pupillary dilation and worsens IOP).

    • Nursing Considerations & Administration:

      • For betaxolol eye drops, monitor blood pressure to detect systemic beta-blocker side effects.

      • Press on the inner canthus (nasolacrimal duct occlusion) after drop administration to prevent systemic absorption.

      • Instill drops into the conjunctival sac of the lower lid without touching the dropper to the eye.

      • Instill drops before eye ointments.

      • Wait at least 5 minutes between administering different eye drops.

  • Ocular Decongestants (phenylephrine, naphazoline, tetrahydrozoline)

    • Therapeutic Indication: Stimulate alpha-adrenergic receptors to vasoconstrict conjunctival blood vessels and reduce ocular redness/congestion.

    • Contraindications: Contraindicated in angle-closure glaucoma because they can trigger acute angle closure (a medical emergency).

    • Cautions: Systemic absorption can worsen hypertension or elevated IOP.

💡 Would you like to create a practice quiz or a set of review flashcards based on these medication profiles to test your clinical decision-making?