a HOW DO THEY WORK? ” ” ° ACTION Reduces the secretion of gastric acid by inhibiting the ation of histamine at H, receptor cels of the stomach. . . * WHAT ARE THEY USED FORT “INDICATIONS” © —Hartbum, acd indigestion, and sour stomach (requently sold as over-the-counter remedies) GERD Gastric or cuodenal ulcer Gastric hypersecretory Conditions (excessive gastric secretion of HCI) eee Abvese REACTIONS Dizon, somnolence, ® Confusion, hallucinations, larthea, and reversible Impotence HISTAMINE H2 AGONIST: acto repucess CONTRALND CATIONS Hypersensitivity . CAUTION ON Renal orhepatic impairment in severely, older, or dbiltated pationts. * (Cimetidine is used cautousl in patients suith abetes. Histamine H, antagonists are pregnancy category 8 (cimetidine, famotidine, and ranttine) and C (izatine) ‘drugs and should be used with caution . during pregnancy an lactation. INTERACTIONS * ‘Antacids and metoclopramide: Decreased absorption of the H, antagonists ‘Carmustine: Decreased white blood call count Opioid analgesics: Increased risk of respiratory depression (Oral anticoagulants ‘increased risk of bleeding Digoxin: May decrease serum digoxin levels ZS NURSING MANAGEMENT * Because ofthe possibilty of an antacid Interfering with the activity of other oral ‘rugs, no oral drug should be administered within 1 to 2 hours of an antacid. ‘When one ofthese drugs is given IV, monitor the rate of infusion al frequent intervals. Too rapid an infusion may induce ‘cardiac arthythmias. keep a record of the patient's bowel movements, because these drugs may ‘cause constipation or diarrhea. ‘observe the patient for signs of dehydration, which include poor skin turgor, dry mucous membranes, decrease in or absence of urinary output, ‘concentrated urine, restessness, Initabilty, increased respirator rate, and confusion instruct the patient to chew the tablets ‘thoroughly before swallowing and then rink a full glass of water or milk. Magnesium-containing products may produce a laxative effect and may cause ‘Garrhea; aluminum- or calcium-containing antacids may cause constipation. “Taking too much antacid may cause the ‘stomach to secrete excess stomach aci. ‘Consult the primary health care provider or pharmacist about appropriate dose. Do not use the maximum dose for more than 2 ‘weeks, except under the supervision of a primary health care aan gv, HINT ! ‘Look for similarities such as uses ‘and sutfixes ‘Meds that end in * Dine are H2 antagonists Cimetiaine Tagamet ‘800-1600 mg/day orally; 300 mg 4 GhriMorlv Famotidine Pepcid Gastric/duodenal ulcers, GERD, | 20-40 mg oral IV if unable to ‘gastric hyporsecretory conditions, | take orally Gl bleeding, heartburn Ranitidine Zantac Gastic/duodenal ulcers, GERD, | 150-600 mg oraly in one dose or ‘gastric hypersecretory conditions, Gi bleeding, heartburn divided doses orally; 50 mg q 6-8 hr IM, IV (do not exceed 400 mg/day)Ey ads ACID REDUCERS HOW DO THEY WORK? “ACTION” ‘These drugs suppress gastric acid secretion by innbiton of the hhydrogen-potassium adenosine triphosphatase (ATPase) enzyme syatem of the gastric parietal cells The ATPase enzyme system is also Called the acid (proton) pump system. ‘The proton pump inhibitors suppress gastric acid secretion by blocking the fina step in the production of gastric acid by the gastric mucosa. Think of itas putting a cap on a voleano so t doesn't erupt! WHAT ARE THEY USED FOR? “INDICATIONS” © Gastric and duodenal ulcers (specifically associated with H. pylori infections) GERD and erosive esophagitis % Pathologic hypersecretory conditions & Prevention of bleeding in high-risk patients using antiplatelet drugs. An important use of these drugs is combination therapy forthe treatment of H. pyr infection n patients with duodenal uicers. One treatment ;egimen used to treat infection with H. pylon is a triple-drug therapy, such as one ofthe proton pump inhibitors (eg, omeprazole oF Jansoprazole) and two antiinfectives (e.., aroxilin and clarithromycin). Ford 2006) PROTON CONTRAINDICATIONS Hypersensitivity lansoprazole, rabeprazole, and pantoprazole (pregnancy category B) are contraindicated ‘during pregnancy and lactation. CAUTION & Older adults Patients with hepatic impairment. % Prolonged treatment may decrease the ‘body's ability to absorb vitamin 8, resulting in anemia, & Omeprazole (pregnancy category ©) ° INTERACTIONS % —Sucralfate: Decreased absorption of the proton pump inhibitor Ketoconazole and ampicilin: Decreased absorption ofthe antlintective % Oral anticoagulants: Increased risk of bleeding & Digoxin: increased absorption of digoxin ® Benzodiazepines, phenytoin: Risk or toxi level of antiseizure drugs © Clarithromycin (with omeprazole, PUMP INATBITORS ce NURSING MANAGEMENT @ Because of the possibilty of an antacid interfering with the activity of ether oral ‘drugs, no oral drug should be administered Within to 2 hours of an antacia, @ When one of these drugs is given IV, ‘monitor the rate of infusion at frequent Intervals. Too rapid an infusion may induce ccardiae arhythmias. @ keep a record of the patient's bowel ‘movements, because these drugs may ‘cause constipation or diarrhea. & observe the patient for signs of dehydration, which include poor skin turgor, dry mucous membranes, decrease In or absence of urinary output, Concentrated urine, restlessness, initabilty, Increased respiratory rate, nd contusion, % instruct the patent to chew the tablets thoroughly before swallowing and then drink a ful glass of water or mil Magnesium-containing products may produce a fazative effect and may cause siarthea; aluminum or ealelum-containing antacids may cause constipation. % Taking too much antacid may cause the stomach to secrete excess stomach acid. Consult the primary health care provider or pharmacist about appropriate dose. Do not se the maximum dose for more than 2 weeks, except under the supervision of a primary health care provider. & CRITICAL THINKING * ‘specitically): Risk for an increase in plasma levels of both drugs % Bisphosphonates: roreased risk of ¢ Menopausal Women [An increase in fractures of the hip, wrist, and spine have news been een in thous aighigh does of pron pune ) ints an una trainee of oteopers uth ADVERSE REACTIONS ioaton stn + eadacha nausea, area, erdabaorina! pal . a3 one ee rr ae omeprazoie Nes Eros esophecis GERD, H.pyot_| 20-40 mglay oly saatan ne anced ate = omeprazole Prilosec: ‘Same as esomeprazole, 20-60 mg/day orally hypersecretory conditions, heartburn, eat eeelteeecel ee pantoprazole Protonix 40 mg/day orally or IV Ce Hypersereton 80 mg Vg 12 he hypersecretory condtions crane Prevacid ECE 1530 malay oly ‘hypersecretory conditions, cystic Flasher a ennBe ACID NEUTRALIZERS 1 HOW DO THEY WORK? CONTRAINDICATIONS NURSING MANAGEMENT Sarat ¢ seeeabaniel peti Beemer pom ofan ct ACTION $ Somme reine Peasnteabe oa 5 2ekveonslngaiaais we ceneshdctain Se nboaltupchess Teyretaae eee paler encoders pak sa Seehof ten snort od ices ee ean Toca aoe gorse By conmigo Sedunresicted dets When one of ese drugs i en fat Reoaag the pc e ‘+ Calcumcontaning antacids are convandcated in mmonter the rate of nfsion at Feauent re patients with renal calculi or hypercalcemia. intervals. Too rapid an infusion may the sphincter tone ofthe lower ‘esophagus, Examples of antacids induce cardiac arrhythmias. 4 keep a record ofthe patient's bowel . movements, because these drugs may cause constipation or diarthea. © Observe the patient for signs of I | dehydration, which include poor skin CAUTION fzasuoahwmyenea, + Atminumcontining arate uc ost ——Seeanta re ane, HAT ABE THEY USED FORT * stminmeannr mts oto a ecleetar INDICATIONS + Magni snd atninenconiing” late palerio ch tw ales + sereusesinaesiner Tega nna clon Soca Sarena — Gitvoccopagestrtcasoase —* —Callumcontaining antacids: respiatory Mages conag pres may ¥ bat doe insufficiency, renal impairment, or cardiac produce a laxative effect and may cause: Sen rin + Aluminum carbonate : Treats Seen: calcium-containing antacids may cause Sa 6 detect a cited a reanancr carpi cmon oa re siege ur and shen ieedwih —¢ ‘Tengo mach tactics one oie tach caution during pregnancy. Consult the primary health care provider orpramacstabor aot soe Co octane a 5 AVERSE EATON faints crea parton srr woes, Somer stone pi INTERACTIONS peters wincs—tvon igri noi phan aaa ent eimcenrgeennenscesee — THINK OUI OF THE BOL respirations) eee Dae ‘Sodium bicarbonate ¢ Stents antacid «Tune: Drewes efecanensct SASS" MUSE o hyperacicity, metabolic alkalosis, © — Corticosteroids: Decreased prot ee ae eon hypercalcemia, vomiting, confusion, headache, antiinflammatory properties ‘ meccacaesreangeneamen ¢ Sekyiaar Patton mcradnere & Maran cite & Sodium bicarbonate: systemic alkalosis and ‘replay inthe ure alkalosis rebound hyperacity ‘Sodium bicarb i also given to + somecne who isin acidosis to bind to the hydrogen fons and balance PH ‘Aluminum carbonate | Basaljl ‘Symptomatic relief of peptic ulcer and stomach | 2 tablets or capsules (10 mL. of regular oral hyperacidity, hyperphosphatemia ‘suspension) as often as q2 hr, up to 12 times daly ‘Calcium carbonate Tums, Mylanta, ‘Symptomatic ref of peptic ulcer and stomach | 0.5-1.5 g orally (May cause acid hyperacidity, calcium daficiencies (ostaoporosis) rebound) magnesia (magnesium | Mik of Magnesia, | Symptomatic relief of peptic ulcer and stomach | Antacid: 622-1244 mg (5-18 mL in hydroxide) Philips MOM hyperaciaity, constipation suspension) orally QID Laxative: 15-60 mL orallyi HOW DO THEY WORK? “ACILON” Bismuth subsalicylate works by protecting the stomach lining, ‘Antihistamines appear to dul the inner ear's abilty to sense motion They “block” messages to the part ofthe brain that controls hhausea and vomiting, The Sshydroxytryptamine type 3 (6-HT3) receptor antagonists target serotonin receptors both at the CTZ and peripherally at the nerve endings in the stomach eooee ° WHAT ARE THEY USED FOR? “INDICATIONS” ‘An antiemetic is used to treat nausea and vorniting typically by preventive administration (prophylaxis): © Before surgery to prevent vvoriting during surgory @ Immediately after surgery when ‘the patient is recovering from anesthesia & Before, during, and ator ‘administration of antineoplastic ‘rugs that induce a high degree ‘of nausea and vomiting & During raciation therapy when the GI tract i in the treatment field During pregnancy for hhyperemesis ADVERSE REACTIONS ® Varying degrees of drowsiness ANTTEMETIC CONTRATNDICATIONS ‘Known hypersensitivity ‘Severe CNS depression Pregnancy ‘uncomplicated voriting in young chien S-HTS receptors: Should not be used by patients with heart block or prolonged QT intorvals Prochlorperazine is contraindicated in patients with bone marrow depression, biood dyscrasia, Parkinson's disease, or severe liver or cardiovascular disease. CAUTION & —_Antiemetic drugs may hamper the diagnosis (of disorders such as brain tumor or injury, ‘appendicitis, intestinal obstruction, and drug toxicity (e.g. digitalis toxicity). % Cholinergic blocking antiemetics are used ‘cautiously in patients with glaucoma or ‘obstructive disease of the Gl or genitourinary ‘system, in those with renal or hepatic Increased risk of hypertensive crisis : A) be Ta de a per Bismuth Pepto bismol,bismatrol H. pylon infection witn duodenal | 2 tablets or 30 mL orally every 30 min Ulcer, nausea, vomiting diarthea, | to 1 hr, up to 8 doses in 24 hr ‘abdominal cramps Difenoxin with atropine Motofen Relieves symptoms of acute Initial dose: 2 tablets orally, then 1 diarrhea ‘tablet after each loose stool (not to exceed 8 tablets/day) Diphenoxylate with atropine Lomotil, lonox. Relieves symptoms of acute 8 mg orally GID diarthea Loperamide Imodium, kaopectate, maalox | Relieves symptoms of acute Initial dose 4:mg orally then 2 mg after diarrhea each loose stool (not to exceed 16 mg/day) Tincture of opium Paregoric Severe diarrhea 0.6 mL orally Q1Da) HOW DO THEY WORK? “ACTION” Work by reducing flatus in the GI tract via expulsion such as; belching or passing gas. Simethicone also has a defoaming agent that disperses and prevents the formation of gas pockets. WHAT ARE THEY USED FOR? “INDICATIONS” Post op gas distention & air swallowing Dyspepsia Peptic vicer Irritable bowel syndrome Diverticulosis Charcoal may be used to prevent pruritus associated with kidney dialysis treatment & as an antidote in poisoning eeeee & ADVERSE REACTIONS No adverse reactions have been reported, Generic ° % * ANTIFLATULENTS CONTRAINDICATIONS Known hypersensitivity + CAUTION Pregnancy category C INTERACTIONS Decreases the effectiveness of other drugs & NURSING MANAGEMENT ‘Assess patient for abdominal pain, distention, and bowel sounds prior to and periodically throughout course of therapy. Frequency of belching and passage of flatus should also be assessed, PO: Administered after meals and at bedtime for best results. Shake liquid preparations well prior to administration. Chewable tablets should be chewed thoroughly before swallowing, for faster ‘and more complete results. Drops can be mixed with 30 mL of cool water, infant formula, oF other liquid as directed. Shake well before using. Explain to patient the importance of diet land exercise in the prevention of gas. Also explain that this medication does not prevent the formation of gas. ‘Advise patient to notify health care professional if symptoms are persistent. S$ Charcoal Charcocaps, Flatulex Intestinal gas, Diarrhea, | 520 mg orally after meals poisoning antidote Simethicone Post op gas distention, 40-125 mg QID after Gas-x , mylicon, maalox, mylanta ulcer dyspepsia, IBS, peptic meals and at bedtimea) HOW DO THEY WORK? ‘There are many forms of laxatives "ACTION" eeeee but the main goal is to relieve constipation. WHAT ARE THEY USED FOR? ° ee “INDICATIONS” Stimulant, emollient, and saline laxatives— evacuate the colon {or rectal and bowel examinations Stool softeners or mineral cil—prevention of strain during defecation (after anorectal surgery or a myocardial infarction) Psyllium and polycarbophil—irrtable bowel ‘syndrome and diverticular disease Hyperosmotic (lactulose) agents—reduction of blood ‘ammonia levels in hepatic encephalopathy ADVERSE REACTIONS Constipation diarrhea and a loss of water and electrolytes abdominal pain or discomfort, nausea, vomiting, perianal initation, fainting, bloating, flatulence, cramps, and weakness. Prolonged use of a laxative can result in serious electrolyte imbalances, as well as the “laxative habit,” that is, ‘dependence on a laxative to have a ‘bowel movernent. ‘Some of these products contain tartrazine (a yellow food dye), which may cause allergic-type reactions (including bronchial asthma) in susceptible individuals. Obstruction of the esophagus, stomach, small intestine, and colon has occurred when bulk-forming laxatives are administered without adequate fluid intake or in patients with intestinal stenosis. LAXATIVES % ConteatorcaTtOns GD yyrste wanacemenn Known hypersensitivity Persistent abdominal pain Nausea or vomiting of unknown cause * Signs of acute appendicitis * = — ~ a * * CAUTION ‘Magnesium: Used cautiously in any ° degree of renal impairment ° INTERACTIONS Mineral oll may impair the Gl absorption of fat-soluble vitamins (A, D, E, and K), 4 Laxatives may reduce absorption of other ‘drugs present in the GI tract by ‘combining with them chemically or thastening their passage through the intestinal tract. © When surfactants are administered with ‘mineral ol, they may increase mineral oil ‘absorption. Mik, antacids, histamine H2 antagonists, ‘and proton pump inhibitors should not be ‘administered 1 to 2 hours before bisacody! tablets because the enteric coating may dissolve early (before reaching the intestinal tract), resulting in ‘gastric lining irritation or dyspepsia and decreasing the laxative effect of the drug. Simple Nursing ‘www. SimpleNursing.com Avoid long-term use of these products unless use Of the product has been recommended by the primary health care provider. Long-term use may result in the “laxative habit," which is dependence ‘on a laxative to have a normal bowel mavement. Constipation may also occur with overuse of these drugs. Laxatives are not to be used for weight loss. Read and follow the directions on the label Do not use these products in the presence of abdominal pain, nausea, or vomiting Notify the primary health care provider if constipation is not relieved or if rectal bleeding or ‘other symptoms occur. To avoid constipation, drink plenty of fluids, get ‘exercise, and eat foods high in bulk or roughage.Cascara sagrada or senna—Pink-red, red-violet, red-brown, yellow-brown, or black discoloration of urine may occur. (Ford 440) TyPes Bulk-producing laxatives are not digested by the body and therefore add bulk and water to the contents of the intestines. The added bulk in the intestines stimulates peristalsis, moves the products of digestion through the intestina, and encourages evacuation of the stool. Sometimes these laxatives are used with severe diarthea to ‘add bulk to the watery bowel contents and slow transit through the bowel. Psylium Metamucil” Emollient laxatives lubricate the intestinal walls and soften the stool, thereby enhancing passage of fecal material. Mineral oil Stool softeners promote water retention in the {fecal mass and soften the stool. One difference between emollient laxatives and stool softeners is that the emollient laxatives do not promote the retention of water in the stool. Docusate Hyperosmolar drugs dehydrate local tissue which causes irritation and increased peristalsis, with consequent evacuation of the fecal mass. Glycerine or lactulose Irritant or stimulant laxatives incroase peristalsis, by direct action on the intestine. Cascara sagrada Saline laxatives attract or pull water into the intestine, thereby increasing pressure in the intestine, followed by an increase in peristalsis. Magnesium preparations