Meds Affecting Digestion and

Nutrition
(General Key Points)
N203
ATI (Unit 0)
Digestion and Nutrition !
GI tract is the route of administration and the target of action
GI effects are common (abdominal pain, constipation, nausea)
When peptic ulcers are caused by H. pylori, non-antibiotics promote healing but
only antibiotics will cure the disease.
Drug therapy for peptic ulcers is directed at controlling symptoms, facilitating
healing, lowering risk for complications, and preenting relapse
!reention of emesis is more effectie than treating it.
"ista#ine
2
("
2
) $ece%tor
Agonists
N203
ATI (Unit 0)
Digestion and Nutrition !
Expected Action:
Proto: ranitidine ("antec) # Others$ cimetidine (%agamet),
ni&atidine ('(id), famotidine (!epcid)
)electiely block *+ receptors in parietal cells to suppress gastric acid secretion
Therapeutic Uses: ,%- for heartburn, sour stomach, and indigestion
Gastric.peptic ulcers . G/0D . hypersecretory conditions ("ollinger syndrome)
In con1unction with antibiotics to treat ulcers caused by *. pylori.
Adverse Effects: libido . impotence
-2) effects (lethargy, depression, confusion) - fre3uent in elderly 4 renal or
lier dysfunction.
Contraindications/Precautions: 5 (6)
risk of bacterial coloni&ation of stomach and respiratory tract
Interactions$

Warfarin, phenytoin 7 metaboli&ing en&ymes inhibited by cimetidine leels
-oncurrent use of antacids absorption *
+
-receptor antagonists
Education: )top drinking, stop smoking, eat smaller, more fre3uent meals
0anitidine can be taken without regard to food
Proton Pu#% In&i'itor
N203
ATI (Unit 0)
Digestion and Nutrition !
Expected Action:
Proto: omepra&ole (!rilosec) # Others$ pantopra&ole (!rotoni(),
lansopra&ole (!reacid), esomepra&ole (2e(ium)
gastric acid secretion by irreersible inhibition of en&yme that produces it.
0educe basal and stimulated acid production
Therapeutic Uses:
Gastric.peptic ulcers . G/0D . hypersecretory conditions ("ollinger syndrome)
Adverse Effects: Insignificant 4 short-term treatment
Contraindications/Precautions: 5 (-)
risk pneumonia d.t p* promoting bacterial coloni&ation
Interactions:
Delayed absorption of 'mpicillin, digo(in, iron, ketocona&ole if concurrent
Education:
I8 pantoprazole may cause thrombophlebitis, headache, or diarrhea.
(ucralfate
N203
ATI (Unit 0)
Digestion and Nutrition !
Expected Action:
Proto: )ucralfate (-arafate)
'cidic conditions 9 sucralfate to iscous gel that adheres to and protects ulcers.
Therapeutic Uses: 'cute duodenal ulcers
Inestigational use for gastric ulcers and G/0D
Adverse Effects: 2o systemic effects
'oid constipation by : ;<== cc and fiber
Contraindications/Precautions: 5 (6)
Interactions: Antacids interfere with absorption of sucralfate.
absorption of phenytoin, digo(in, warfarin, ciproflo(acin
Education: %ake on empty stomach, >( per day
Antacids
N203
ATI (Unit 0)
Digestion and Nutrition !
Expected Action:
Proto: 'l(,*)
?
gel ('mpho1el), Others$ 'l-,
?
,
@g(,*)
+
(@ilk of @agnesia), 2a*-,
?
2eutrali&e gastric acid and inactiate pepsin
@ucosal protection through stimulation of prostaglandin production
Therapeutic Uses: !eptic ulcer disease and G/0D
Adverse Effects: 'l.-a compounds constipation, @g compounds diarrhea
2aA-containing fluid retention 'l(,*)?hypophosphatemia
@g+A compounds to(icity with renal impairment.
Contraindications/Precautions: 5 (-) GI perforation or obstruction
Interactions:
'luminum-compounds bind to warfarin, tetracycline and their absorption
Education: -hew tablets thoroughly then take with B o& water or milk
Cre3uency of administration makes compliance difficult
Prostaglandin ) Analog
N203
ATI (Unit 0)
Digestion and Nutrition !
Expected Action:
Proto: misoprostol (-ytotec)
acid secretion . secretion of *-,
?
-
and mucus . submucosal
asodilation.
Therapeutic Uses: Dong-term 2)'ID therapy
Induce labor by causing cerical ripening.
Adverse Effects: Diarrhea and abdominal pain Dysmenorrhea and spotting
Contraindications/Precautions: 5 (E) !otential to become pregnant
Antie#etics
(Ty%es)
N203
ATI (Unit 0)
Digestion and Nutrition !
)erotonin antagonists........................................................ondansetron ("ofran)
Dopamine antagonists........................................prochlorpera&ine (-ompa&ine)
Glucocorticoids de(amethasone (Decadron)
-annabinoids dronabinol (@arinol)
'nticholinergics scopolamine (%ransderm )cop)
'ntihistamine dimenhydrinate (Dramamine)
Others
Granisetron (Fytril)
!rometha&ine (!henergan)
@etoclopramide (0eglan)
*ydro(y&ine (8istaril)
'prepitant (/mend)
Antie#etics
(Action* Use* )ffects* Interactions)
N203
ATI (Unit 0)
Digestion and Nutrition !
Agent: Action Use
,ndansetron )/0
0
in -%" G agal nere -hemo, radiation, postop
!rochlorpera&ine D,!
0
in -%" -hemo, opioids, postop
De(amethasone Hnknown -ombo for chemotherapy
Dronabinol Hnknown -hemotherapy (-I28)
)copolamine impulses$ inner ear 8- @otion sickness
Dimenhydrinate *I)
0
@H)
0
inner ear 8- @otion sickness
Agent Adverse Effect
,ndansetron *eadache, diarrhea, di&&iness
!rochlorpera&ine
/!) (%( 4 Benadryl or Ativan), hypotension, sedation, and
anticholinergic effects.
Dronabinol Dissociation, dysphoria, hypotension, tachycardia
'nti-h, 'nti*is )edation, anticholinergic effects
Interactions CTZ = chemoreceptor trigger one
-2) depressants . 'ntihypertensies . 'nticholinergics 'dditie /ffects
'ntagonists 4 urinary retention, asthma, and narrow-angle glaucoma
-ombo therapy allows lower doses of each side effects
8- I
omiting center
+a,ati-es
N203
ATI (Unit 0)
Digestion and Nutrition !
Agent: Action Use
6ulk-forming
JpsylliumK
)often mass, bulk 7 same
as dietary fiber.
diarrhea, control stool, promote
defecation
)urfactant
JdocusateK
*
+
, content
,pioids, pain, straining, risk
impaction, promote defecation
)timulant
JbisacodylK
peristalsis, *
+
, absorption
( colon, intestine)
-olonoscopy prep, short-term %(
d.t opioid use
,smotic
J@g(,*)
?
K
intestine *
+
, mass
stretching peristalsis
-hemotherapy (-I28)
Agent Adverse Effect
'll GI irritation
'll
0ectal burningproctitis ( regular use of bisacodyl suppository)
@g
+A
salts 'ccumulate to(ic leels of magnesium ( in renal dysfunction)
2a
A
salts 'ccumulation$ in heart disease and hypertension
Interactions @ilk G antacids destroy enteric coating
Cecal impaction . bowel obstruction . ulceratie colitis . dierticulitis
!romote fiber foods and : ;.< D daily
Antidiarr&eals
N203
ATI (Unit 0)
Digestion and Nutrition !
Expected Action:
Proto: dipheno(ylate (Domotil)
Others$ loperamide (Imodium), difeno(in (@otofen)
'ctiate opioid receptors in GI to motility and absorption of G 2a
A
Adverse Effects: 't recommended doses, diphenoxylate has no -2) effects
diphenoxylate doses typical opioid responses
Contraindications/Precautions: 5 (L)
risk of megacolon with inflammatory bowel disorders serious complications
including perforated bowel.
Interactions: -2) depressants depressie effect
Education: /ncourage use of electrolyte replacement drinks
'oid plain water (no electrolytes) and caffeine ( motility)
@anage dehydration (weight, 8), IG,) 7 =.><M 2) may be prescribed
Pro.inetic Agents
N203
ATI (Unit 0)
Digestion and Nutrition !
Expected Action:
Proto: metoclopramide (0eglan)
dopamine and serotonin receptors in -%" emesis
'ugments action of acetylcholine to upper GI motility
Therapeutic Uses: !ostop and chemo-induced nausea and omiting
G/0D Diabetic gastroparesis
Adverse Effects:
/!)$ 0estlessness, spasms of face G neck. @inimi&e
/!) with ben&odia&epine like lorazepam (Ativan).
Diarrhea
)edation
Contraindications/Precautions: 5 (L) )ei&ure disorder ( sei&ure risk)
GI perforation or bleeding, bowel obstruction, and hemorrhage
Fids and older adults due to risk of /!)
Interactions: -oncurrent /t,* or -2) depressant$ sei&ure . sedation risks
pioids and anticholiner!ics effects of metoclopramide.
Education: Dose N ;= mg dilute in <= mD D
<
W or 0ingerOsP Infuse oer ;<m