Pharm Chapter 20- GI drugs – Flashcards
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Many patients self-medicate with antacids. Which patients should be counseled to not take calcium carbonate antacids without discussing it with their provider or a pharmacist first?
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Patients with kidney stones
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Patients taking antacids should be educated regarding these drugs, including letting them know that:
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may cause constipation or diarrhea, high in sodium, separate antacids from other meds by 1 hour
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Kelly has diarrhea and is wondering if she can take loperamide (Imodium) for the diarrhea. Loperamide:
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slows gastric motility and reduces fluid and electrolyte loss form diarrhea
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Bismuth subsalicylate (Pepto Bismol) is a common OTC remedy for gastrointestinal complaints. Bismuth subsalicylate:
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May lead to toxicity if taken with aspirin & Is contraindicated in children with flu-like illness & Has antimicrobial effects against bacterial and viral enteropathogens
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Hannah will be traveling to Mexico with her church group over spring break to build houses. She is concerned she may develop traveler's diarrhea. Advice includes following normal food and water precautions as well as taking:
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Bismuth subsalicylate with each meal and at bedtime
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Jim presents with complaints of "heartburn" that is minimally relieved with Tums (calcium carbonate) and is diagnosed with gastroesophageal reflux disease (GERD). An appropriate first-step therapy would be:
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Ranitidine (Zantac) twice a day
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Patients who are on chronic long-term proton pump inhibitor therapy require monitoring for:
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Iron deficiency anemia, vitamin B12 and calcium deficiency
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Sadie is a 72-year-old patient who takes omeprazole for her chronic GERD. Chronic long-term omeprazole use places her at increased risk for:
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Megaloblastic anemia
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Patrick is a 10-year-old patient who presents with uncomfortable constipation. Along with diet changes, a laxative is ordered to provide more rapid relief of constipation. An appropriate choice of medication for a 10-year-old child would be:
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Bisacodyl (Dulcolax) suppository
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Methylnaltrexone is used to treat constipation in:
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Opioid-associated constipation
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An elderly person has been prescribed lactulose for treatment of chronic constipation. Monitoring with long-term treatment would include:
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Electrolytes, including potassium and chloride
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Treatment of IBS
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Anticholinergic agents (Dicyclomine and hyoscyamine) & antidepressants (tricyclic antidepressants, SSRI)
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Side effects of anticholinergic
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dry mouth, urinary retention, visual disturbances, rebound constipation
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Most common treatment of constipation in IBS
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bulk forming laxatives (psylliom, methylcellulose and calcium polycarbophil), osmotic laxative (Magnesium citrate, milk of mag)
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Most common treatment of diarrhea
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loperamide
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Diet for inflammotroy bowel disease
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low fiber diet
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First line for inflammatory bowel disease
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aminosalicyclates (mesalamine, sulfasalazine) corticosteroids (budesonide, prednixone, hydrocortisone)
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Dose range for sulfasalazine
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4-6gm daily
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Dose range for mesalamine
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PO or Rectal 4.8g/day
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Treatment of IBD needs to needs to be used cautiously in
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pregnancy
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Magnesium based CI should discuss use with a provider if
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renal failure is present
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Antacids decrease absorption of
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digoxin, phenytoin, INH, Ketoconazole
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Antacids increase absorptions of
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pseudoephedrine, levodopa
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loperamide dosing
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4mg 4 times a day
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Bismuth turns tounge and stools
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black/grey
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Misoprostol is excreted
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in urine
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H2 blockers have
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many drug interactions and increase alcohol levels
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PPI last for about
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72 hours after dose
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Treat fecal impaction and pts with neurogenic bowel with
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hyperosmolar- acute for lower bowel
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Bulk producing laxative drug
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psyllium, methycellulose, pollycarbophil
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Osmotic laxative drug
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mag hydroxide, mag citrate, sodium phosphate, polyethylene glycol
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avoid in pregnancy for laxitive
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caster oil and lubricants
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Drug induced constipation classes
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benzodiazepines, phenothiazines, seratonin, opiods
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First line for prevention of constipation
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Docusate sodium (colase)... emollient laxitive
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Emollient laxative dosing
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50-360 mg in divided doses
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Stimulant laxatives that can be used as prevention OR maintenace
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casanthranol or senna
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Onset of casanthranol or senna
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delayed onset- 12-24 hours
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Stimulant laxative drugs
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casanthranol or senna 30-90mg
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Stimulant laxatives that can be used only as acute treatment
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Biscodyl (diphenylmethane) Phenolphthalein (Diphenymathane), Caster Oil
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Biscodyl (diphenylmethane) & Phenolphthalein (Diphenymathane) onset
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6-10 hrs
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Phenolphthalein (Diphenymathane) may not give with
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Hemhrroids; may turn urine pink or stool red
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Dosing for caster oil
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1-5mL <2 5-15mL (2-12) 15-60mL (Adult)
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Adult dosing for biscodyl
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10mg
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Adult dosing for Phenolphthalein
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30-60mg
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Chronic treatment osmotic lacative
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10-20g lactulose
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onset of lactulose
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24-48hours
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Chronic treatment lubricant lacative
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mineral oil (OK in kids)
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Never used BLANK in drug induced constipation
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bulk forming laxative
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Drugs for opiod induced consipation
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methyneltrexone, naloxegol, alvimopan, lubiprostone
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Watch for hypokalemia with
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diarrhea
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Secretory diarrhea
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Persists when patient fasts
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Stops when patient fasts
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osmotic
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simethicone doses
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60-180 mg four times a day
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Cholestyramine off label use
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diarrhea 4g four times a day
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max dose for loperamide
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16mg MAX (4mg PO than 2 mg after each stool)
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Octreotide can be used for
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diarrhea 4-8 mg 'TID
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lomotil is given
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4 times a day
