-
aluminum hydroxide
- constipation
- often combined with magnesium hydroxide to counteract diarrhea
- can bind to certain drugs as well as pepsin (can help heal ulcers)
-
Magnesium hydroxide
- diarrhea
- frequently used as a laxative
- watch for mag toxicity with renal impairment
-
calcium carbonate
- constipation
- can cause acid rebound or milk alkali syndrome
- incr CO2 in the stomach and causes belching
- watch for kidney stones
-
sodium bicarbonate
- no effect on bowel function
- used to treat alkalosis and incr urine pH to hasten drug elimination
-
H2 blockers
cimetidine, ranitidine, famotidine
- block H2 receptors in the stomach and slow down gastric acid
- *ulcer healing, GERD, aspiration pneumonitis prevention (surgery)
- **cimetidine has a huge effect on drug metabolism = P450 inhibitor that can lead to toxicity of other medications; can also block androgen receptors
- watch for GI effects, arrythmias, CNS effects
-
PPI's
omeprazole, lansoprazole, esomeprazole, pantoprazole
- irreversibly block Na/K pump in stomach to block 97% of acid production
- *GERD, PUD
- limit length of tx due to concerns for osteoporosis and cancer, B12
- If taken for H.pylori must be started with abx
-
Mucosal protectants
sucralfate
- gel creates protective barrier over ulcer
- *short term tx of ulcers
- watch for constipation and nausea
- Give two hours before or after other meds
-
bismuth subsalicylate
- inhibits pepsin, incr mucus production, antimicrobial H. pylori
- *H.pylori ulcers, diarrhea
- watch for tinnitus, don't give to kids with chicken pox or flu
-
misoprostol
- synthetic prostaglandin
- *used for prophylaxis of NSAID ulcers, induction of labor and delivery
- abortifacient if given early in pregnancy
-
Prokinetics
metocloperamide, cisapride
- increase GI motility
- *GERD, post-op N/V
- watch for sedation and diarrhea with high doses, tardive diskinesia with long term tx
- Don't give to pts with obstruction or perfed bowel
- **cisapride can only be given by special permission
-
antidiarrheals
diphenoxylate (lomotil), loperamide (imodium) - opiates
kaopectate, pepto, attapulgite - adsorbents
- reduce GI motility, enhance water reabsoprtion
- *short term tx of diarrhea
- low abuse potential with opiates but can cause resp depression and sedation
- dont' use for infectious diarrhea, tx cause
-
Bulk-forming laxatives
psyllium, methylcellulose
- non-absorbable substances that for a gel to soften stools
- *used for constipation and also sometimes diarrhea
- take with lots of fluid to prevent obstruction, can help lower choelsterol
-
sufactant laxatives
ducosate
- lower surface tension to help water enter feces and incr intestinal fluid
- *use prophyllactically after rectal surgery
- take with lots of water
-
lubricants
minteral oil
- coat fecal mass to help lubricate
- *to prevent straining
- can alter fat vitamin absorption, cause lipid pneumonia, dehydration, incontinence
-
Stimulant laxatives
bisocodyl, senna, phenophthaline
- irritate bowel to stimulate peristalsis
- *widely abused by the public to treat "constipation"
- senna turns urine colors
- don't use more than once/wk
-
Osmotic laxatives
mag citrate, milk of mag, miralax, golytely
- draw water into the bowel to soften feces, swelling of stool promotes peristalsis
- *elimnatino of poisons/parasites, bowel prep for procedures
- watch for electrolyte imbalance and dehydration
-
relistor
prevents opiate induced constipation by blocking mu receptors in GI tract
-
lubirostone
- open's Cl channels in teh gut to draw water in
- *used for IBS-C and chronic idiopathic constipation
-
dopamine antagonists
compazine, phenergan
- inhibit dopamine receptors in the CTZ
- *N/V, hiccups, psych
- watch for anticholingergic fx, orthostatic Hypo, parkinsonian movements
-
serotonin antagonists
ondansetron
- block serotonin receptors of vagal nerve
- *chemo and post-op nausea/vomiting
- better if given prophylactically
-
obesity drugs
meridia, orlistat
-
Antihistamines
Benadryl, phenergan, vistaril, periactin (1),
Claritin, Zyrtec, Allegra (2)
Astalin, Astepro, Patanase (intranasal 2nd)
- block H1 receptors throughout body, no effect on release of histamine! (also has antimuscarinic properties)
- *allergic rhinitis, motion sickness, urticaria, insomnia, prevention of allergic reactions
- overdose causes CNS excitation (resembles atropine poisoning)
- 2nd generation drugs = less sedation and muscarinic blockade
- can worsen asthma (1st generation)
-
Nasal glucocorticoids
budesonide, fluticasone, monetasone
- inhibit inflammatory mediators to reduce secretions, inflammation
- * rhinitis, sinusitis, nasal polyps
- Can cause drying of mucosa = nose bleeds,
- sore throat and thrush = limited if administered properly
-
nasal decongestants
oxymethazoline, phenylephrine, pseudophedrine
- stimulate a1 receptors on nasal blood vessels
- **highly addicting**
- can lead to rebound congestion, tachy, restlessness, insomnia
- Withdraw one nare at a time and give nasal steroids until off drug
-
cromolyn sodium
- mast cell stabilizer - inhibit histamine and leukotriene release
- *prophylaxis of allergic rhinitis, asthma control
- no local or systemic absorption - can be used safely in pregnancy
-
oral decongestants
pseudophedrine, phenylephrine, ephedrine, epinephrine
- a1 agonists - shrink respiratory membranes
- *systemic relief of sinusitis, colds, flu
- caution with uncontrolled HTN
- watch for CNs stim, urinary retention, cardiac rhythms, HTN
- Don't give with MAOI's, BB, methyldopa, alkalinizing drugs
-
Antitussives
benzonatate, dextromethorphan - non-narcotic
codeine, hydrocodone
- supress cough reflex in medulla
- *suppress dry non-productive cough
- watch for dizziness, N/V, CNS effects
- opiate ones much more effective but potential for abuse
-
Expectorants
guiafenisen, ipecac syrup
- incr respiratory fluids, reduces viscosity of secretions
- *persistent cough, mucus plugs, colds
- watch for GI probs, careful in women due to enhanced preg risk (reduces mucus plug in cervix)
- Short term use, encourage fluid intake
-
Mucolytics
mucomyst (acetylcisteine)
- reduces thickness of secretions
- *chronic bronchitis, COPD, CF
- watch for bronchospasm, severe rhinorrhea
-
inhaled corticosteroids
beclamethasone, budesonide, fluticasone
- decreases inflammatory mediators and cells
- *used for maintenance therapy of asthma (prevention)
- watch for throat irritation, thrush, adrenal suppression with long term high doses
- **use a spacer when possible, rinse mouth after dosing to prevent thrush
-
oral glucocorticoids
prednisone, prednisolone
used in short bursts for exacerbation
- use for less than 10 days where possible, taper off.
- Can cause bone loss, hyperglycemia, growth suppression, wt gain when used long term.
-
IgE antibody
omalizumab (xolair)
- suppresses immune repsonse
- injectable, used only when glucocorticoids fail.
- VERY expensive
-
Leukotriene receptor antagonists
montelukast, zileutron
- inhibit leukotrienes hence reduced inflammation
- *prevention and control of asthma
- watch for GI effects, HA
- check liver enzymes and watch with other medication (coumadin, theophylline)
-
B2 Adrenergic agonists (short acting)
albuterol, levabuterol, pirbuterol, terbutaline
- stimulate B2 receptors in lung to cause bronchodilation
- *rescue drugs for asthma (all asthma pts should have one)
- can cause muscle tremor, hyperactivity, HA
-
B2 Adrenergic agonists (long acting)
salmeterol, formoterol, aformoterol (copd)
Advair/symbicort (combo of glucocort and LABA)
- block B2 receptors in the lung
- *oral or inhaled for prophylaxis/control of asthma
- watch for tremor, cardiac effects with high doses
- **can be counteracted in pts on BB
-
muscarinic antagonists (inhaled)
ipratroprium bromide, tiotropium
- block Ach in bronchial smooth muscle = bronchodilation
- *used for bronchospasm of COPD, chronic bronchitis
- low SE because poorly absorbed
-
Methylxanthines
theophylline, caffiene
- bronchodilator, CNS stimulant
- *used mostly when other drugs have failed
- watch for cardiac SE
- **very narrow therapeutic range and many drug interactions
-
Sulfonylureas (basal/PP glucose)
tolbutamide, glyburide, glipiside, glimepiride
- Increase insulin secretion
- *1st line oral drug
- 2nd generation much better SE profile
- **watch for hypoglycemia, careful with renal impairment
- bad for prego's
-
Meglitinides
repaglinide, nateglinide
- increase insulin release
- *used for PP glucose control, take only with meals
- **watch for hypoglycemia, don't take if you don't eat
- cause wt gain
-
Biguanides
metformin
- increase insulin sensitivity
- *control basal/PP glucose,
- watch for nausea, diarrhea, lactic acidosis (rare)
- safe for pregnancy
- can stimulate wt loss!, lower cholesterol
-
TZD's/glitazones
rosiglitazone, pioglitazone (Avandia, Actos)
- decrease insulin resistance
- *reduce basal/PP glucose
- Lots of drug interactions from P450 and protein binding
- Watch for fluid retention, edema
- check LFT's periodically, can incr lipid levels
-
a gluconidase inhibitors
acarbose, miglitol
- delay absoprtion of carbs
- *for PP glucose reduction
- causes GI distrubances and flatulence
- **if given with insulin you have must tx hypo with straight glucose
- avoid with metformin for GI effects, careful giving to pts with GI probs
-
GLP-1 agnoists
exenatide
- mimics incretin hormones = stim release of insulin, supress appetite, slow emptying
- *for use with metformin or sulfonylurea for PP glucose
- watch for pancreatitis, don't give with renal disease
- can promote wt loss
-
DPP-4 inhibitor (gliptins)
sitagliptin, saxagliptin
- prevent the enzyme that breaks down incretins
- *used to control basal glucose
- major effects are respiratory, no effect on wt
- watch for drug interaction with digoxin
- **saxagliptin has many more SE
-
amylin agonist
pramlintide
- delays gastric emptying, suppresses glucagon
- *used for PP glucose control
- major risk of hypoglycemia when combined with insulin
- nausea is a common side effect.
- Don't give with altered GI motility
|
|
