Pharm II Unit 4 GI drugs – Flashcards
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What are the categories of GI Drugs?
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PPI H2 Receptor Antagonists Antacids GI Stimulants Antiemetics
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What is the prototype drug for PPI?
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omeprazole (Prilosec)
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What are the pharmacodynamics of omeprazole (Prilosec)? (2)
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• Antisecretory • Elevates pH
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What are the pharmacokinetics of omeprazole (Prilosec)? (2)
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• Enteric coated granules • Metabolized by CYP450 system
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What are the uses of omeprazole (Prilosec)? (4)
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• Peptic ulcers • CERD • Erosive esophagitis • Chronic hypersecretory conditions
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What are the common adverse effects of omeprazole (Prilosec)? (2)
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• HA • Diarrhea
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What is the lifespan alert for omeprazole (Prilosec)? (1)
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• Breast feeding: not recommended
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What are the nursing interventions for omeprazole (Prilosec)? (4)
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• Interacts with other drugs metabolized by CYP450 system • Administer for recommended time • Take before meals • Do not crush or chew
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What is prototype drug for H2 Receptor Antagonists?
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ranitidine (Zantac)
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What are the pharmacodynamics of ranitidine (Zantac)
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• Antisecretory
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What are the uses for ranitidine (Zantac)? (6)
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• GERD • Duodenal ulcer • Gastric ulcer • Pathologic hypersecretory conditions • Prevention of upper GI bleeding • Heartburn/acid indigestion (OTC strength only)
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What is the common adverse effect of ranitidine (Zantac)? (1)
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• Generally well tolerated
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What is the serious adverse effect of ranitidine (Zantac)? (4)
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• Neutropenia • Agranulocytosis • Thrombocytopenia • Autoimmune hemolytic or aplastic anemia
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What are the Nursing Interventions of ranitidine (Zantac)? (3)
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• Give at least 2 hours apart from antacids • Do not substitute OTC drugs forms for prescription forms • Avoid alcohol, caffeine, spicy food, products containing aspirin or ibuprofen, and smoking
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What is the prototype drug for antacids?
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aluminum hydroxide w/ magnesium hydroxide (Maalox, Mylanta)
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What is the pharmacodynamic of Maalox, Mylanta? (1)
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• Raises gastric pH
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What is the pharmacokinetic of Maalox, Mylanta?
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• Minimal absorption from GI tract
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What are the uses of Maalox, Mylanta? (3)
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• GERD • Peptic ulcers • Prevents stress ulcer bleeding
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What is the contraindication of Maalox, Mylanta? (1)
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CRF
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What are the common adverse effects of Maalox, Mylanta? (2)
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• Diarrhea: Mg • Constipation: aluminum
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What is the serious adverse effect of Maalox, Mylanta? (1)
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• Potential electrolyte imbalance
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What are the nursing interventions for Maalox, Mylanta? (3)
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• Interacts with many drugs due to increased pH and urine pH • Administer 2 hours after other drugs • Do not substitute this drug for prescription drugs to treat peptic ulcer disease
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What is the prototype drug for GI Stimulants?
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metoclopramide (Reglan)
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What are the pharmacodynamics of metoclopramide (Reglan)? (2)
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• Increases peristalsis & gastric emptying • Antiemetic effect
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What are the uses for metoclopramide (Reglan)? (6)
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• GI stimulant: o Diabetic gastric stasis o GERD • Antiemetic o Post-surgery o Chemotherapy
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What is the contraindication for metoclopramide (Reglan)? (1)
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• When stimulation may be dangerous
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What is the common adverse effect for metoclopramide (Reglan)? (1)
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• CNS complaints
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What are the serious adverse effects of metoclopramide (Reglan)? (2)
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• Tardive dyskinesia • Severe depression
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What is the lifespan alert for metoclopramide (Reglan)? (1)
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• Older women: more likely to experience tardive dyskinesia
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What are the Nursing Interventions for metoclopramide (Reglan)? (2)
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• Give 30 minutes before meals or chemotherapy • Monitor for depression, Parkinson-like symptoms, extrapyramidal effects, tardive dyskinesia (if note hold drug and contact prescriber)
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What is the prototype drug for Antiemetics?
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ondansetron (Zofran)
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What is the pharmacodynamic of ondansetron (Zofran)? (1)
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• Prevents N/V
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What are the pharmacokinetics of ondansetron (Zofran)? (2)
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• 75% protein bound • Metabolized by CYP450 system
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What are the uses for ondansetron (Zofran)? (4)
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• Prevents N/V o Chemotherapy o Radiation o Certain post-operative states
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What are the common adverse effects of ondansetron (Zofran)? (3)
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• HA • Constipation • Malaise
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What are the serious adverse effects of ondansetron (Zofran)? (3)
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• Arrhythmias • Hypotension • Extrapyramidal effects
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What is the nursing intervention for ondansetron (Zofran)? (1)
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• Administer 30 minutes before treatment
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What are the categories of drugs to treat the Lower GI Tract?
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Laxatives Saline Hyperosmotic Irritable Bowel Syndrome Inflammatory Bowel Disease Digestive Enzymes Drugs for Weight Loss (Lipase Inhibitors)
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What is the prototype drug for Laxatives?
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Magnesium hydroxide (Milk of Magnesia)
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What is the pharmacodynamics of magnesium hydroxide (Milk of Magnesia)? (1)
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• Attracts & retains water in intestinal lumen
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What are the pharmacokinetics of magnesium hydroxide (MOM)? (2)
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• Poorly absorbed • Local effect
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What are the uses for magnesium hydroxide (MOM)? (1)
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• Short-term for constipation
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What are the contraindications for magnesium hydroxide (MOM)? (2)
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• Acute abdomen • Renal failure
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What are the common adverse effects of magnesium hydroxide (MOM)? (1)
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• Overactive GI activity
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What is the serious adverse effect of magnesium hydroxide (MOM)? (1)
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• Fluid & electrolyte imbalance
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What are the Nursing Interventions for magnesium hydroxide (MOM)? (3)
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• Drink glass of water after administration • Not for long-term use • Increase fiber, activity, water
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What is the prototype drug for saline hyperosmotic?
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Lactulose (Cephulac)
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What are the pharmacodynamics of lactulose (Cephulac)? (2)
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• Attracts and retains water in the intestinal lumen of the colon. Lactulose is metabolized by bacteria into acids and carbon dioxide. These products increase the oncotic pressure in the colon and draw water into the stool. • The acids formed also draw ammonia into the stool for evacuation. This action is used to decrease blood ammonia levels in hepatic coma and hepatic encephalopathy.
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What is the Pharmacokinetic of lactulose (Cephulac)?
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• Can be given by enema or orally
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What are the uses for lactulose (Cephulac)? (3)
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• Hepatic encephalopathy • Hepatic coma • Constipation
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What is the contraindication for lactulose (Cephulac)? (1)
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• Acute abdomen
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What are the common adverse effects of lactulose (Cephulac)? (1)
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• Diarrhea, overactive GI activity
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What is the serious adverse effect of lactulose (Cephulac)?
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• Fluid and electrolyte imbalance
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What are the nursing interventions for lactuose (Cephulac)? (4)
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• Safety issue with increase GI activity and patients with decreased or impaired LOC secondary to hepatic disease. • Not for long-term use with constipation. • Teach patient s/s of dehydration and electrolyte imbalances. • Monitor hydration status of patient.
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What is the prototype drug for Irritable Bowel Syndrome?
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aldosterone (Lotronex)
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What are the pharmacodynamics of alosterone (Lotronex)? (2)
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• Blocks the 5-HT receptor. It alters visceral sensation, decreasing abdominal discomfort and pain. • Lengthens the transit time in the bowel and creases chloride and water secretion.
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What are the pharmacokinetics of alosterone (Lotronex)? (2)
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• Rapidly absorbed. Absorption is increased when taken with food. • Can be taken with or without food.
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What are the uses for alosterone (Lotronex)? (2)
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• Only drug for treatment of women with IBS-D. • Not used in patients who have constipation with disease?
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What are the contraindications for alosterone (Lotronex)? (3)
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• Not administered to anyone with IBS-Constipation • Contraindicated for anyone with a history of chronic constipation. • Should not be given to persons with a history of: GI perforation, ischemic colitis, Crohns disease or ulcerative colitis, active diverticulitis.
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What is the common adverse effect of alosterone (Lotronex)? (1)
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• Major adverse effect is constipation.
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What are the serious adverse effects of alosterone (Lotronex)? (2)
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• Constipation can lead to obstruction, perforation, impaction and toxic mega colon. • Can develop ischemic colitis- s/s: rectal bleeding, bloody diarrhea, abdominal pain.
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What are the lifespan alerts for alosterone (Lotronex)? (3)
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• Not established in pediatric patients. • Older adults may be at increased risk for constipation. • Effectiveness in men not yet known.
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What are the nursing interventions for alosterone (Lotronex)? (3)
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• Educate client about possible adverse effects. • Instruct clients to report any constipation, rectal bleeding, bloody diarrhea, or new or worseining abdominal pain. • Encourage to drink sufficient fluids.
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What is the prototype drug for inflammatory bowel disease?
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mesalamine (Asacol) 5 ASA preparation
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What are the pharmacodynamics of mesalamine (Asacol) 5 ASA preparation? (2)
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• Action unknown • Possible inhibition of pathways resulting in decreasing production of prostaglandin, leukotrienes.
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What is the pharmacokinetic of mesalamine (Asacol) 5 ASA preparation?
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• Available in tablet, capsule, suppository and rectal suspension.
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What are the uses of mesalamine (Asacol) 5 ASA preparation?
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• Patients with ulcerative colitis and proctosigmoiditis. • Off label use for management of Crohns.
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What are the contraindications for mesalamine (Asacol) 5 ASA preparation?
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• Contraindicated in clients with hypersensitivity to salicylates. • In clients with active peptic ulcer disease. • Use cautiously in patients with renal and hepatic impairment.
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What is the common adverse effect of mesalamine (Asacol) 5 ASA preparation?
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• Diarrhea, abdominal pain, cramps, flatulence, nausea, and headache.
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What are the serious adverse effects of mesalamine (Asacol) 5 ASA preparation? (4)
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• Rare- blood dyscrasias • exacerbation of colitis, • pericarditis, • renal impairment or hepatotoxicity
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What is the prototype drug for digestive enzymes?
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pancrelipase (Pancrease)
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What is the pharmacodynamic of pancrelipase (Pancrease)?
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• Pancrelipase contains the enzymes lipase, protease, and amylase which are responsible for the final phase of digestion.
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What are the pharmacokinetics of pancrelipase (Pancrease)? (2)
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• Absorption, distribution, metabolism and excretion of this drug are unknown. • Drug is enteric coated as drug is affected by gastric acid.
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What are the uses for pancrelipase (Pancrease)? (4)
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• Use as enzymatic replacement therapy for patients with deficient exocrine pancreatic secretions: cystic fibrosis, chronic pancreatitis, ductal obstructions • Used for pancreatic insufficiency and steatorrhea from malabsorption syndrome. • Can be used for patients who have had pancreatectomy, gastrectomy or post-GI surgery such as Billroth II. • Can be used as a test to evaluate pancreatic function.
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What are the contraindications for pancrelipase (pancrease)? (3)
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• Contraindicated in patients who are hypersensitive to pork protein or enzymes. • Not used by patients with acute pancreatitis or acute exacerbations of chronic pancreatitis. • Use gloves when preparing, as the powder may cause skin irritation. Inhaling the powder irritates the nasal mucosa and respiratory tract.
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What are the common adverse effects of pancrelipase (Pancrease)? (2)
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• Large dose may cause nausea, abdominal cramps, and diarrhea. • Hyperuricosuria and hyperuricemia have occurred with high doses.
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What are the Nursing Interventions for pancrelipase (Pancrease)? (3)
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• Do not crush or chew tablets. • Take before or with meals • Avoid breathing powder and skin contact
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What is the prototype drug for weight (Lipase Inhibitors)?
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orlistat (xenical)
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What are the pharmacodynamics of orlistat (Xenical)?
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• Reversible lipase inhibitor. Decreases the absorption of dietary fats. • Prevents the formation of active gastric and pancreatic lipases. Inactivated enzymes cannot break down fats.
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What are the pharmcokinetics of orlistat (Xenical)? (3)
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• Little absorbed in to the systemic circulation. • Oral administration. • Action primarily in the GI tract.
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What are the uses for orlistat (Xenical)? (3)
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• Used to manage obesity • Alli- is available over the counter. • Used in conjunction with a weight loss diet and exercise program.
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What are the contraindications for orlistat (Xenical)? (3)
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• Contraindicated if patients have chronic malabsorption syndrome or cholestasis. • Hypersensitivity to drug. • Organic cause of obesity such as hypothyroidism should be ruled out.
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What are the common adverse effects of orlistat (Xenical)? (5)
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• Oily spotting • Flatus with discharge of stool • Increased defecation. • Fecal incontinence. • Others not common:
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What are the Nursing Interventions for orlistat (Xenical)? (3)
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• Limit dietary fat. Calories from fat should be no more than 30% of daily calories. • Take with all meals containing fat • Take a multivitamin with fat-soluble vitamins (these should be separated from drug by at least 2 hours)
