GI Drugs

Antiemetics

-Two major groups
1. nonprescription
__________ , bismuth, __________ solution (__________)
2. prescription
Antihistamaines, __________ antagonists, __________, __________, cannabinoids.

Antiemetics

• -Two major groups
• 1. nonprescription
• Antihistamaines , bismuth, phosphated carbohydrate solution (Emetrol)
• 2. prescription
• Antihistamaines, dopamine antagonists, benzidiazepines, glucocorticoids, cannabinoids.

Brain Control

-Two major centers:
1. _____________ (CTZ) -near _______
2. _______ center- in _______

-CZ gets impulses from _______, _______ & from _______ center in ear, etc.
- _______ stimulate CTZ which stimulates _______ center.

Brain Control

• -Two major centers:
• 1. Chemoreceptor trigger zone (CTZ) -near medulla
• 2. Vomiting center- in medulla

• -CZ gets impulses from drugs, toxins, & from vestibular center in ear, etc.
• -Dopamine stimulate CTZ which stimulates vomiting center.

Non-Pharm Measures

Used first when N&V occur
-_____ tea
-_____soda
-_____
-_____
-_____
-_____ & _____ toast.

• Non-Pharm Measures
• Used first when N&V occur
• -Weak tea
• -Flat soda
• -Jello
• -Gatorade
• -Pedialyte
• -Crackle & dry toast.

Non-Prescription Antiemetics

-Can be brought _______
-Prevent motion sickness but minimal effect on_______, _______,_______ &_______.
-Drugs include: _______, _______, _______, _______
-These drugs inhibit _______ stimulation.
-These drugs cause effects similar to _______

Non-Prescription Antiemetics

-________ & ________ act on stomach
-Act by changing gastric ________ & ________ smooth muscle contraction
-These drugs are not to used in the ________ of pregnancy because they may ________ fetus.

Prescription Antiemetics

1. Anti_______
2. Anti_______
3. _______ Antagonists
-_______ (Compazine)
-_______ (Haldo)
-_______ (Reglan)
-_______ (Ativan)
4. _______ antagonists
5. ____corticoids
6. Cannabinoids (_______)

Antihistamines and Anticholinergics

-Atarax (________)
-Scopolamine (________)
-These cause ________, ________ mouth & ________ vision
-Do not use in ________ Patients

Dopamine Antagonists

-Block ________ receptors in ________
-Common side effects of dopamine antagonists include ________ & ________
-Used for N&V from ________, ________, ________ & ________ sickness.

Phenothiazines- Thorazine & Compazine

-These drugs inhibits the _______
-In cancer patients given the night before the _______, the _______ of & for 24hrs _______.
-Can cause _______, _______ & _______ effects ( _______, _______)

Serotonin Antagonists

-_________
-Block _________ receptors in _________ & afferent _________ nerve terminals in upper _________ tract
-Most _________ of all antiemetics for _________ induced N&V
-Does not cause _________ but does cause _________, _________, _________

Glucocorticoids

-_________ & __-medrol
-Given ____, short term for _________N&V

Cannabinoids

-May be prescribed for _____ patients for those who do not respond to other _____
-Not to be used in patients with _____ disorders
-Also used to stimulate appetite in _____ patients
-Causes _____ changes including _____ & _____ lapse, ____cardia, HTN, _____tension

Diarrhea

- _____, _____ stools
-Causes are numerous including:
_____, _____, virus, toxins, _____ reaction, _____ abuse, _____ syndrome, _____, _____ tumor &inflammatory bowel tumor & inflammatory bowel disease
-Can cause _____, _____ imbalance & _____

Non Pharmacology Measures

1. Identify ______
2. ______ liquids
3. Oral solutions (______ , ______ , ______ )

Traveler's Diarrhea

-aka ______ or ______ diarrhea
-usually caused by ______
-lasts ______ days
-if severe treated with ______ & OTC______
-teach travelers to drink ______, was ______, cook ______ & eat only well cooked ______.

Anti Diarrheals

-Classes:
-1. _______ & opiate related drugs
-2. _______ analogue.
-3. _______
-4. _______

Opiates

-Prototype: ______
- ______ motility- may cause ______
-can cause CNS ______ particularly when combined with ______, ______, ______
-can cause drug ______
-not to be used with ______ impairment
-children and elderly can develop ______ depression

Somatostatin Analog

-________
-used to inhibit ________, ________, gastrin, ________ secretions & ________ fluid.
-________ smooth muscle contractility
-frequently used for ________ diarrhea in patients with ________ cancer.

Adsorbents

-act by coating the _____ tract wall
-and absorbing _____ or _____ that can cause diarrhea
-combined in _____ and are OTC drugs
-_____, can also be used as an antacids.

Constipation

- _____ of hard fecal material in the _____ intestine
-Frequent complaint of _____
-insufficient _____ intake and _____ diet are contributory factors.

Causes of Constipation

-1. fecal _________
-2. bowel _________
-3. chronic _________ use
-4. _________ disorder
-5. ignoring urge to _________
-6. lack of _________
-7. drugs ( _________, _________, some _________)

Non Pharmacologic Treatments

-Increasing _____ in diet
-_____
-_____
-routine _____ habits
-normal - _____ day or a week

Laxatives & Cathartics

-Laxatives = _______ stool
-cathartics= _______ to _______ stool with _______
-(lax vs cathartic= _______)
-purgatives are _______ cathartics = _______ stool with abdominal _______.

Laxatives

-Types:
-1. ________ (saline)
-2. ________ (contact or irritant)
-3. ________ forming
-4. ________ (stool softeners)

Osmotic (Saline) Laxatives

-__________- salts or saline products, lactulose and glycerin
-Osmotics contain three types of _________ salts:
-1. _________ salts (Feet Phosphsoda)
-2. _________ salts (Milk of Magnesia
-can cause gas, _________, ______ pain, weakness, complete _______ block, hypotension and _______ depression.
-3. _________ salts

Osmotic Laxatives

-generally used to _____ bowel
- _____ glycol ( _____ - miralax) can be used
-PEG + electrolytes = _____
-GoLYTELY requires consumption of __-__ liters over _____ hours
-The solution is non _____ , non_____ that contain _____ & _____
-can be used in presence of _____ or _____ disorders.

Osmotic Diuretics

-Lactulose is non-_____ saline laxative that draw h20 into_____ to form _____ stool
-used in_____ disease to lower serum _____
-excess _____ can cause gas, diarrhea, belly pain, N&V
-not to be used in _____
-_____ acts the same way.

Stimulant (Contact) Laxatives

-_______ peristalsis by irritating sensory nerve _______
-_______, _______, _______, _______
-Most frequently _______ and _______
-Gets results in __ to __ hours
-Can cause nausea, belly_______, _______.

Bulk Forming Laxatives

-natural fibrous substances that form _______, ______stool through absorption of water into intestine-> ______ fecal bulk & peristalsis
-defecation takes about ___ to __ hours but can take up to _ days
-______ fluid intake -> intestinal ______
-______, ______, ______.

Chloride Channel Activators

-New category of ______
-used for ______ constipation in adults
-______ - FDA approved 2006
-Opens chloride channels in bowel causing ______ intestinal fluid secretion & motility
-Relieves ______, belly pain, ______
-Not to be used if history of ______, obstruction, ______, severe ______.

Emollients (Stool Softeners)

-Lubricants (_______ oil) and stool softeners (surface acting or wetting drugs) (_______) used to prevent constipation
-Used to prevent _______ at stool
-Lubricants _______ water retention
-_______ surface tension on stool.
-These are used _______ other agents.

General Indications

-1. to _______ bowel for OR & diagnostic _______
-2. to _______ elimination of noxious substances
-3. to keep stool _______ when it is essential to avoid _______ and/or obstruction.
-4. to expel _______ & toxic anti-_______ (except is _______ is needed)
-5. to relieve _______
-6. to overcome decreased motility caused by _______

Special Considerations in Laxative Use

-Constipation in _______ can be due to a variety of reasons.
-Better to try increasing intake of _______, fruit juice, _______, and _______
-Elderly can't take laxatives too often as these can --> _______
-In pregnancy constipation is _______ because _______ of uterus can cause decreased motility. _______ laxatives can lead to labor.

When to Give with Caution or Not at all

-1. _________ disorder like appendicitis or ulcerative colitis
-2. Undiagnosed abdominal pain when giving laxatives could lead to _________
-3. After surgeries like _________ of rectal vaginal fistulas
-4. Bowel _________

Ulcer Disease

-Mucosal ________ is when pepsin is ________ and an acid-pepsin complex in gastric secretions --> mucosal ________
-Peptic ulcer is an ulcer anywhere in the ________ tract
-H. pylori is a gram ________ linked to peptic________ disease (PUD)

GERD

-aka reflux _________
-treatment is similar to _________

Non Pharmacologic Treatment of PUD & GERD

-Avoid _________ & ________
-nicotine relaxes ________ sphinter --> reflux
-weight loss-> ________ symptoms
-avoid hot, ________, ________ food
-NSAIDS & ASA should be taken with ________ or________ dose.
-Steroids can cause ________
-raise head of bed, do not eat before ________, wear ________ clothing.

Antiulcer Drugs

-Seven Groups:
-1. __________-decrease vagal activity
-2. __________-decrease acetylcholine
-3.__________-neutralize acid
-4. __________ blockers
-5. __________inhibitors-inhibit gastric acid
-6. __________ inhibitor
-7.__________ E1 analogue-inhibit gastric acid.

Antiulcer Drugs

-Tranquilizers-________
-________ vagal stimulation and ________ anxiety

Antiulcer Drugs

-Anticholinergics (__________ & __________ & __________)
-Development of ______ blockers made these drug obsolete
-they act by inhibiting acetylcholine block __________, and ______
-They __________ gastric emptying time
-Pro-banthine ________ gastric secretion and used to treat ________ ulcers.

Antacids

-neutralize ______ & decrease ______ activity
-two types:
-1. systemic effect-sodium bicarn can cause ______ & metabolic ______
-calcium carbonate can cause ______
-milk ______ syndrome
-not to be taken with ______ products.

Milk Alkali syndrome

-Chronic milk -alkali syndrome can result in metastatic _________ due to high serum ________ levels and relatively high ________ levels ( calcium times phosphate.) Irreversible ________ failure may result.
-However, even severe renal failure may be completely reversible if milk-alkali syndrome is diagnosed ________

Probiotics

-The term "probiotics" refers to dietary ________ or foods that contain beneficial, or "good", ________ that are similar to those normally found in your body.
-These microorganisms may provide some of the same health such as assisting with digestion and helping protect against ________ bacteria.

Antacids

-2. Non-systemic
-composed of _______ and _______
-small degree of systemic _______
-can cause diarrhea or constipation with_______ term use
-take antacids __ to ___ hours after meals
-mg are contraindicated in impaired _______ function
-abuse can --> _______

H2 Blockers

-______:
-Block H2 receptors on parietal cells in ______ -> ______ gastric acid secretion
-can cause headaches, ______, ___&___, hepatotoxicity, ______dysrhythmias
-Do not take with ______

Proton Pump inhibitors

-_______,_______
-Block the final step of acid _______
-only works for _______ hours
-take _______ meals
-caution in _______ impairment
-prolonged use may increase risk of _______.
-may cause headache, dizziness, _______.

Pepsin Inhibitors

-_________-sulfated sucrose and aluminum
-Forms a viscous substance that covers ulcer to protect it from _______ & _______
-can decrease absorption of other _______
-can cause dizziness, nausea, _______, rash, _____ mouth, _____ pain & sleepiness.

Prostaglandin Analogue Antiulcer Drug

-_________ (Cytotec) _________ gastric acid secretion and _________ protective mucous.
-as effective as _________
-Frequently used with _________
-can cause ____ pain, diarrhea, gas, constipation, _________ spotting.
-Category "___" in pregnacy

Probiotics

-In addition to supplements, probiotics can be found in such foods as ______, fermented and unfermented ______ , miso, and some______ and ___ drinks.
-______ yogurt, is an example of a probiotic food

Probiotics

-There is a growing public and scientific _______ in probiotics. Researchers are studying whether probiotics taken as foods or supplements can help treat or prevent illness.
-There is encouraging evidence that probiotics may _______.

Probiotics

-Treat __________, especially following treatment with certain __________
-Prevent and treat vaginal _____ infections and ______ tract infections.
-Treat _______ bowel syndrome (IBS)
-Reduce bladder ________ recurrence
-_________ the duration of intestinal infections
-Prevent and treat inflammation following _______ surgery (pouchitis)
-Prevent _______ in children

Digestive Enzymes

-Digestive Enzymes are made by ______
-Digestive enzymes are secreted by the salivary glands, ______, ______, and the ______ intestine.
-Technically, digestive enzymes are also considered to be ______ enzymes whose metabolic role is to ______ food.

Food Enzymes

-Already present within the _____
-Food enzymes exist naturally in _____ food.
-If the food is cooked the high temperature involved in the cooking process will destroy the _____.

Digestive Enzymes

-______ enzymes and ______ enzymes basically serve the same function, which is to digest food so it can be absorbed through the walls of the small intestine into the ______ stream.
-They only actual difference between food enzymes is whether they come from inside the ______ or from ______.

Digestive enzymes

-______ food supplements
-That claim to assist in digestion of food to ______ nutritional benefits.