Chapter 47 pharmacology

Opiates/opiated-Related Antidiarrhea

Treatment:  for diarrhea

Newest OTC 

Does not affect the CNS

Opiates/Opiate-Related A ntidiarrhea

Treatment: for acute nonspecific chronic diarrhea, combination of a synthetic narcotic / atropine 

Avoid use in narrow-angle glaucoma

• Side Effects
• Dry mouth
• Flush
• Tachycardia

Opiates/Opiate-Related Antidiarrhea

• Treatment
• For acutenonspecif diarrhea to treat withdrawl symptoms in neonates of mothers who are addicted to opiates

Notto be used for diarrhea caused by posion

Avoidtakingalcohol & CNS depressants

Opiates/Opiate-Related Antidiarrhea

• Treatment 
• Decrease GI peristalsis

Side Effects:  Constipation

Cause CNS depression when taken with alcohol sedatives, tranquilizers

Samatostatin Analogue

• treatment: 
• severe diarrhea resulting from metastatic carcinoid tumors

action:  suppresses secretion of serotonin, gastrin, and pancreatic peptides

Antidiarrhea Adsorbents

• Treatment:  for diarrhea, gastric distress

Drug:  administered after each loose stool

AntidiarrheaL

treatment:  to treat diarrhea by slowing intestinal motility

mode of action:  inhibition of gastric motility

• side effects: 
• drowsiness          dizziness
• constipation        dry mouth
• weakness            flush
• rash                   blurred vision
• mydriasis            urine retention

• adverse reactions:
• angioneurotic edema

Life-threatening:  paralytic ileus, toxic megacolon, severe allergic reaction

contraindications:  severe hepatic or renal disease, glaucoma, severe electrolyte imbalance, children <2 yr

• Drug:  increased CNS depressants w/alcohol, narcotics antihistamines, sedative-hypnotics

MAOls may enhance hypertensive crisis

Prescription Antihistamine

Treatment:  postoperative nausea/vomiting, vertigo (dizziness)

Give preoperatively w/narcotics to decrease nausea

Give hydroxyzine deep IM

Side Effects: drowsiness/dry mouth

Prescription Antiemetic

Treatment:  to treat/prevent motion sickness, nausea/vomiting

Action:  Blocks H1 receptor sites, inhibits chemoreceptor trigger zone

• Side Effects:
• drowsiness          confusion
• anorexia             dry mouth/eyes
• constipation        blurred vision
• hypertension       hypotension
• photosensitivity   transient leukopenia
• urinary retention

Adverse Reactions:  extrapyramidal syndrome (tardive, dyskinesia, akathsia)

• Life-threatening:  angranulocytosis, respiratory depression

Contraindications:  hypersensitivity, narrow-angle glaucoma, severe liver disease, intestinal obstruction, blood dyscrasias, bone marrow depression

• Caution:  Cardiovascular disease, liver dysfunction, asthma respiratory dysfunction, hypertension, older adults & debilated cilents

Drugs:  increase CNS depression & anticholinergic effects when take w/alcohol & other CNS depressants

•       

Dopamine Antagonists Phenothiazines

• Treatment:  Primary use is for severe
• nausea, vomiting

Secondary use:  reduce anxiety & tension & for psychosis

• Side Effects:
• drowsiness
• dizziness
• EPS
• dry mouth

Butyrophenones

Treatment:  prevention of nausea/vomiting during surgical & diagnostic procedures

• Side Effects:
• hypotension (monitor Blood Pressure)
• tachycardia
• EPS

antiphsycotic

Action:  blocks the dopamine2 receptors in the CTZ

Benzodiazepines

• Treatment:  Prevention of nausea/vomiting resulting from cancer chemotherapy

Usually administered w/antiemetic such as metoclopramide


Other Drugs:  vilaum, diazepam

emesis control, sedation, anxiety reduction, amnesia.  When use w/glucocorticoid serotonin 5 HT3 receptor antagonist

Serotonin (5-HT3) Receptor Antagonists

Treatment: prevent nausea/vomiting before chemotherapy or pre & postoperatively

Act on serotonin 5-HT3 receptor in stomach and CTZ

Serotonin (5-HT3) Receptor Antagonists

Treatment:  prevention of nausea/vomiting caused by cancer chemotherapy

Acts on the CTZ and vomiting center

Side Effects: headache

Serotonin (5-HT3) Receptor Antagonist

Treatment:  for nausea/vomiting related to cancer chemotherapy especially treatment with cisplatin

Cannabinoids

Treatment:  for nausea/vomiting caused by cancer chemotherapy

taken before and for 24 hours after chemotherapy

Can be on appetite stimulant for clients AIDS

• Side Effects:
• drowsiness             dizziness
• dry mouth              impaired thinking
• euphoria                headache
• nightmares            confusion
• incoordination        memory loss
• tachycardia            hypertension/hypotension

Prescription Antiemetics

Treatment: for nausea/vomiting related to cancer chemotherapy/postoperatively

increase gastric & intestinal emptying

Avoid alcohol & CNS depressant

Side Effects:  EPS may occur

Action:  suppress emesis by blocking the dopamine receptors in the CTZ

• Contraindications: 
• GI obstruction
• hemorrhage
• perforation

high doses can cause sedation/diarrhea

Prescription Antiemetics

Treatment:  for postoperative nausea/vomiting motion sickness, vertigo

Avoid with CNS depressants and if sensitive to benzocaine or similar local anesthetics

• Side Effects: 
• dry mouth           increase heart rate
• urine retention     constipation
• blurred vision

• Adverse Reactions:
• hypotension          diarrhea
• EPS (abnormal involuntary movements, postural disturbances, alteration in muscle tone

Laxative Stimulant

Treatment:  Short-term treatment for constipation, bowel preparation for diagnostic tests

Action:  Increases peristalsis by direct effect on smooth muscle of intestine

• Side Effects: 
• anorexia          nausea
• vomiting          cramps
• diarrhea

• Adverse Reactions:
• dependence     hypokalemia

Life-threatening:  Tetany

• Contraindications:
• hypersensitivity     fecal impaction
• appendicitis          abdominal pain
• nausea                 vomiting
• rectal fissures
• intestinal/biliary obstruction

• Drug:  decrease effect with antacids, histamine2 blockers, milk

Laxative Bulk Forming

Treatment:  to control chronic constipation

Action:  acts as bulk-forming laxative by drawing water into intestine

• Side Effects:
• anorexia            nausea
• vomiting            cramps
• diarrhea

Adverse Reactions:  esophageal or intestinal obstruction if not take with adequate water

• Life-threatening: Bronchospasm, anaphylaxis

Contraindications:  hypersensitivity, fecal impaction, intestinal obstruction, abdominal pain

Drug:  decrease absorption of oral anticoagulants, aspirin, digoxin, nitrofurantoin

Laxatives: Bulk Forming

Treatment:  for prevention of constipation.  Also used to treat acute nonspecific diarrhea associated with irritable bowel syndrome.

For diarrhea, absorb water and produces formed stool.  For constipation:  chew tablet and follow with a full glass of water