-
Tranquilizers
- Librax (Chlordiaepoxide + Clidinium)
- Combination of anxiolytic and Anticholinergic
- Robinul (Glycopyrrolate)
- Reduces vagal stimulation, decreases anxiety
-
Anticholinergics
Pro-Banthine (Propantheline)
Inhibits release of HCL by blocking acetylcholine and histamine
Take with meals to decrease acid secretion
-
Mechanism of Action for Antacids:
- -Neutralize stomach acid by
- Promoting gastric mucosal defense mechanisms and secretion of:
- -Mucous (protective barrier against HCL)
- -Bicarbonate (helps buffer acidic properties of HCL)
- -Prostaglandins (prevent activation of proton pump)
-
Raising the gastric pH from 1.3 to 1.6 neutralizes
_____________% of gastric acid
50%
-
Raising the gastric pH 1 point (1.3 to 2.3) neutralizes
__________% of gastric acid
90%
-
Which Antacid has Constipating effects?
- Aluminum Salts
- (Often used with with Magnesium to counteract constipation)
-
What Antacid is often recommended for patients with renal disease since it is more easily excreted?
Aluminum Salts
-
Aluminum Salts (Examples)
- Basajel (Aluminum carbonate)
- AlternaGEL (Hydroxide salt)
- COMBO of AL and Mg =
- Gaviscon, Maalox, Mylanta, Di-Gel
-
What Antacid commonly causes diarrhea?
Magnesium Salts
-
What Antacids are dangerous to use with patients with Renal Failure?
Failing Kidney cannot excrete extra magnesium resulting in accumulation
Calcium Salts can also cause accumulation of Calcium causing kidney stones
-
Magnesium Salts (Examples)
- Milk of Magnesia (Hydroxide Salt)
- Gaviscon (Carbonate salt) - Combo product
- Maalox, Mylanta (aluminum and magnesium combo)
-
Calcium Salts (Example)
- -Carbonate is most common
- -Long duration of acid action (may cause increased gastric acid secretion) *hyperacidity rebound*
- -Advertised as an extra source of dietary calcium
TUMS (calcium carbonate)
-
Sodium Bicarbonate
- Buffers the acidic properties of HCL
- Quick onset, but short duration
- May cause Metabolic alkalosis Sodium content may cause problems in patients with HF, HTN, or Renal insufficiency
-
Antiulcer Drugs: Action and SE's
Action: Neautralize gastric acid by reducing pepsin activity
Systemic side effects: Sodium excess, water retention, metabolic alkalosis, acid rebound
- Non systemic side effects: Al: Constipation
- Mg: diarrhea (Taken in combo = none)
-
Histamine 2 blockers Action:
Reduces gastric acid by blocking H2 receptors of parietal cells in stomach
promotes healing of ulcer by eliminating cause
SE: HA. dizziness, diarrhea, constimpation, reversible IMPOTENCE, gynecomastia (MAN BOOBS)
-
Histamine 2 Blockers (Examples)
- Tagamet (Cimetidine)
- Zantec (Ranitidine)
- Pepcid (famotidine)
- Axid (Nizatidine)
-
Proton Pump inhibitors Action
Reduce gastric acid by inhibiting hydrogen/potassium ATPase
SE: HA, insomnia, dizziness, dry mouth, flatulence, abdominal pain
-
Proton Pump inhibitors Examples
- Nexium (Esomeprazole)
- Protonix (Pantoprazole)
- Prilosec (Omeprazole)
- Prevacid (Lansoprazole)
-
Pepsin inhibitors Action and example
Combines with protein to form thick paste covering ulcer, protects from acid and pepsin
- SE: Constipation
- Example: Carafate (Sucralfate) "saran wrap"
GIVEN 30 MIN BEFORE MEALS AND BEDTIME
-
Non prescription Antiemetics
ANTIHISTIMINES
- Dramamine (Dimenhydrinate)
- Benadryl (Diphenhydramine)
- Pepto-Bismol (Bismuth subsalicylate)
- *acts directly on gastric mucosa to suppress vomiting*
SE: Similar to anticholinergics: Drowsiness, dry mouth, constipation
-
Prescriptive antihistimines
Acts on VC, decreases stimulation of CTZ
- Vistaril (Hydroxyzine)
- Phenergan (Promethazine) *Dopamine antagonist*
- *Phenothiazine*
-
Anticholinergic Antiemetics
Trasdermal-Scop (Scopolomine)
Acts on VC, decreases stimulation of CTZ
-
Promethazine (Phenergan)
Action: Inhibit CTZ, blocks H1 receptor sites
SE: Drowsiness, dry mouth, blurred vision, tachycardia, constipation, urinary retention, photosensitivity, EPS (tardive dyskinesia *involuntary movement of the lower face*, acute dystonia *movements that cause twisting or abnormal postures*, akathisia *restless leg syndrome*)
-
Antiemetics Cont....
Dopamine Antagonists
Nutyrophenones
Action (Blocks Dopamine (D2) receptors in CTZ)
- Haloperidol (Haldol)
- Droperidol (Inapsine)
- Metoclopramide (Reglan)
SE: Sedation, diarrhea, EPS
-
Antiemetics Cont....
Benzodiazepines - uses
Antivan (Lorazepam)
- Use - Cancer chemotherapy
- Used in combination with a glucosteroid and serotonin 5-HT3 receptor antagonist
-
Antiemetics Cont.....
Serotonin receptor antagonist
Action and uses + SE
Zofran (Ondansetron)
Action - Blocks serotonin receptors in CTZ and afferent vagal nerve terminals in UGI
- use - Cancer chemotherapy
- SE: HA, diarrhea, dizziness, fatigue
-
Antiemetics cont......
Glucocorticoids
use and examples
use: Cancer chemotherapy
- Decadron (Dexamethasone)
- Solu-Medrol (Methylprednisolone)
-
Misc Antiemetics
- Vontrol (diphenidol)
- Tigan (Trimethobenzamide)
- Suppresses impulses to CTZ
- SE:drowsines, dry mouth, tachycardia, urine retention, constipation, diarrhea, blurred vision, hypotension, EPS
-
Nursing interventions for Antiemetics
- Provide mouth care
- monitor VS, bowel sounds
- Monitor for dehydration
- Warn not to take alcohol with Antiemetics
- Warn pregnant females to avoid Antiemetics
- Avoid driving motor vehicles
-
Opiates and Opiate related Antidiarrheals
Examples and SE
- Paraegoric (camporated opium tincture)
- Lomotil (Diphenoxylate with Atropine)
- Immodium (Loperamide)
Opiates decrease GI motility, can cause respiratory depression in the children and elderly, may cause physical dependence
Atropine contraindicated in glaucoma
-
Somatostatin analog
use and example
Use: sever diarrhea from Cancer
Sandostatin (Octreotide)
-
Adsorbents
Examples and Action
Action: Coats GI tract, absorbs bacteria or toxins
-
Combination agents (Antidiarrheal)
Parepectolin (paragoric, Kaolinpectin)
-
Nursing interventions for Anidiarrheals
- Monitor BP, R
- Report more than 10-15 mmHg decrease in BP
- Monitor frequency of bowel movements and bowel sounds
- Assess for dehydration
- Monitor electrolytes
- Avoid fried foods, milk and sedatives
- If Diarrhea persists after 48hrs, notify MD
-
Causes of Constipation
- Bowel Obstruction, fecal impaction
- Chronic laxative use, ignoring urge to defecate
- Neurologic disorders
- SE of drugs
- Lack of exercise, fiber and water
-
Causes of Diarrhea
- Spicy or spoiled foods
- Bacteria (E-coli), virus or toxins
- Drug reactions
- Fecal impaction, laxative abuse
- Malabsorption disorders, bowel tumor, inflammatory bowel disease
- Stress + Anxiety
-
Laxatives vs Cathartics vs Purgatives
Laxatives - promote soft stool
Cathartics - soft to watery stool with cramping
Purgatives - watery stool with cramping
-
Osmotic (saline) Laxatives
Action, SE and examples
Action - Hyperosmolar salts pull water into colon, increase water in feces to increase bulk, which stimulates peristalsis
- GoLYTELY - Polyethylene glycol
- Chronulac - Lactulose
SE: Fluid and electrolyte imbalances, hypotention, weakness
-
Stimulant (Irritant) Laxative
Action and example
Action: Increase peristalsis by irritating sensory nerve endings in intestinal mucosa
- Ex-Lax, Correctol (Phenolphthalein)
- Dulcolax (Biscacodyl)
SE: Abdominal cramps, weakness, reddish brown urine, diarrhea
-
Bulk Forming Laxatives
Action and Examples
- Metamucil (Psyllium hydrophilic mucilloid)
- Fiber-Con (Calcium polycarbophil)
Action: Absorb water into intestines, increase bulk and perstalsis
Takes 8-12 hours
-
Admin and Side effects of Bulk forming laxatives
Mix in glass of water or juice,stir, drink immediately, follow with 1 glass of water
- SE: Abdominal cramps
- Excess Laxative = N/V, gas, diarrhea
-
Emollients (Stool Softners)
Action and example
- Action: Lowers surface tension
- Promotes water accumulation in intestine
- Emulsifies and lubricates feces for easier passage
Colace (Docusate)
-
Uses for Emollients (Stool Softners)
- Prevents constipation
- Reduces straining post surgery or myocardial infarction
SE: ABD cramping, N/V, Diarrhea
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