Pharm elimination meds notes

1. Antiemetics (for nausea/vomiting)

A. Antihistamines & Anticholinergics

• OTC: Dimenhydrinate (motion sickness)

• Rx: Hydroxyzine (Vistaril, Atarax), Scopolamine (motion sickness)

• Side Effects: Drowsiness, dry mouth, blurred vision, tachycardia, constipation

• Contraindications: Kidney/liver disease, enlarged prostate, heart disease, urinary issues

B. Dopamine Antagonists (Phenothiazines)

• Examples: Promethazine, Droperidol

• Side Effects: Dry mouth, dizziness, extrapyramidal symptoms (EPS), tardive dyskinesia

• Contraindications: Glaucoma, liver disease, prostate/bladder problems

C. Benzodiazepines

• Example: Lorazepam (used adjunctively in chemotherapy)

D. Serotonin Antagonists (5-HT3 blockers)

• Example: Ondansetron

• Indication: Chemotherapy-induced nausea/vomiting

• Side Effects: Headache, dizziness, hypotension, constipation, fatigue

E. Steroids

• Examples: Dexamethasone, Methylprednisolone

• Use: Antiemetic effect in chemo patients

F. Cannabinoids

• Example: Dronabinol

• Side Effects: Euphoria, mood changes, orthostatic changes, drowsiness

G. Miscellaneous

• Example: Metoclopramide

• Side Effects: EPS (esp. in children), sedation/fatigue at high doses

2. Antidiarrheals

A. Traveler’s Diarrhea

• Tx: Fluoroquinolone antibiotics

B. Opiates & Related

• Examples: Loperamide, Diphenoxylate + Atropine, Difenoxin + Atropine

• Side Effects: Constipation, dry mouth, dizziness, urinary retention, CNS depression

• Contraindications: Infectious diarrhea (e.g., Salmonella, E. coli), C. diff

C. Other

• Example: Bismuth subsalicylate

3. Laxatives

A. Osmotic (Saline)

• Examples: Lactulose, Milk of Magnesia, Epsom salt, Sodium phosphates, Magnesium citrate, Glycerin

• Action: Draw water into bowel → soften stool

• Side Effects: Abdominal cramps, flatulence

• Contraindications: Renal insufficiency

B. Stimulant

• Examples: Bisacodyl, Castor oil, Senna

• Action: Increase GI motility, irritate mucosa

• Side Effects: Abdominal cramps, reddish-brown urine, dizziness

• Use: Rapid relief of constipation

C. Bulk-Forming

• Example: Psyllium (Metamucil)

• Action: Increases stool volume → triggers peristalsis

• Side Effects: Flatulence, diarrhea

• Warning: Must take with lots of water

D. Emollients (Stool Softeners)

• Example: Docusate sodium

• Action: Lubricates & softens stool

• Side Effects: Abdominal cramps, diarrhea

4. Antiulcer Agents

A. Tranquilizers

• Effect: Minimal; reduce vagal stimulation/anxiety

B. Anticholinergics

• Example: Glycopyrrolate

• Side Effects: Dry mouth, constipation, palpitations, headache

C. Antacids

• Systemic: Sodium bicarbonate (rarely used)

• Non-systemic:

  • Aluminum hydroxide → constipation

  • Magnesium hydroxide → diarrhea

  • Combo: Maalox, Mylanta

  • Calcium carbonate (Tums) → constipation

• Contraindications: Renal impairment (esp. magnesium-based)

D. H2 Blockers ("-dine")

• Examples: Cimetidine, Famotidine

• Side Effects: Insomnia, constipation, erectile dysfunction

E. Proton Pump Inhibitors (PPIs, "-zole")

• Example: Pantoprazole (Protonix)

F. Pepsin Inhibitor

• Example: Sucralfate (Carafate)

• Action: Forms protective barrier over ulcer

• Instructions: Take on empty stomach; 2 hrs apart from other meds

• Side Effects: Dry mouth, constipation

• Interactions: May increase effects of digoxin, warfarin, benzos, phenytoin

G. Prostaglandin E1 Analogue

• Example: Misoprostol (Cytotec)

• Use: Prevent NSAID-induced ulcers

• Contraindication: Pregnancy (can cause birth defects or miscarriage)

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🌊 Antiemetics Mnemonic – “My Head Spins When D.O.S.E.D.”

D – Dimenhydrinate (motion sickness)
O – Ondansetron (serotonin antagonist – chemo nausea)
S – Scopolamine (anticholinergic patch – motion sickness)
E – Euphoria from Dronabinol (cannabinoid)
D – Droperidol (dopamine antagonist – EPS risk)

🧠 Story:
You’re on a cruise ship called the S.S. Antiemetic. You take Dimenhydrinate to stop spinning. Your friend, undergoing chemo, takes Ondansetron. The captain wears a Scopolamine patch behind his ear. The cook offers brownies laced with Dronabinol, and the DJ gets Droperidol because the loud music makes him twitch (EPS!).

💩 Antidiarrheal Mnemonic – “L.O.A.D. the brakes!”

L – Loperamide (slows GI motility)
O – Opiates (Diphenoxylate + Atropine)
A – Atropine (added to reduce abuse)
D – Don’t use in Diarrhea caused by bugs (E. coli, Salmonella, C. diff)

🧠 Story:
You’re driving a GI truck that's speeding out of control. You L.O.A.D. the brakes — but don’t hit the brakes if the road is slippery with bacteria, or you’ll crash the system (toxic megacolon risk!).

🚽 Laxative Mnemonic – “O.S.B.E. – Open Stool By Effort!”

• O – Osmotic (Lactulose, MOM): pull water in

• S – Stimulants (Senna, Bisacodyl): push stool out fast

• B – Bulk-forming (Psyllium): fiber = mass = movement

• E – Emollients (Docusate): soften the stool

🧠 Story:
Four friends are trying to open a clogged toilet:

• Osmotic friend pours water in (hydrate it).

• Stimulant jumps up and down (shake it loose).

• Bulk friend adds more paper (mass helps movement).

• Emollient squirts oil (softens blockage).

🛡 Antiulcer Mnemonic – “Please Take Meds Before Meals”

P – Proton pump inhibitors (Pantoprazole)
T – Tranquilizers (decrease vagal stimulation)
M – Misoprostol (NSAID-induced ulcers)
B – Bismuth (Pepto-Bismol)
M – Metoclopramide (promotes motility)

🧠 Story:
You're guarding your ulcer castle.

• The Proton Knight (PPI) blocks acid catapults.

• The Tranquil Monk calms your nerves.

• The Midwife Misoprostol warns pregnant women.

• Bismuth spreads a soothing blanket over the fire.

• Metoclopramide speeds up the messenger horses (motility).

🧪 H2 Blockers vs PPIs Mnemonic – “-dine eats dinner, -zole sleeps late”

• H2 blockers = “-dine” drugs (famotidine, cimetidine) → Take with meals (dine!)

• PPIs = “-zole” drugs (pantoprazole) → Take before breakfast (morning slow-zole)

⚠ Danger Mnemonics

🧷 Sucralfate Rules – SUCs up the ulcer

• S – Sticky barrier

• U – Use before meals

• C – Can bind other meds → separate by 2 hours

🚫 Misoprostol = MIScarriage

• Don't give to pregnant women!

• MISO = Miscarriage risk