GI Flashcards
(26 cards)
ANTACIDS
Metallic
Basic
Agents with highest ANC
fasting- reduce acidity for
after meal- reduced for
metallic- ca, al, mg
basic- hydroxide, bicarbonate, carbonate
Sodium bicarbonate and calcium carbonate (suspensions)
20-40 minutes
2-3 hours
ANTACIDS PRECAUTIONS
Ca- based
Mg-based
Al-based
ca- requires vitamin d - hypercalcemic or renal calculi
mg- renal failure
al- renal failure or dialysis- worsens dialysis osteomalacia
*sodium content for HTN CHF RENAL
ANTACID ADR
mg
al and ca
USE
hyperacidity
pud
gerd
diarrhea
constipation
(maalox has both neutralizes effects)
hyperacidity- QID
PUD- used after meals and bedtime, adjunct
combined anacids alum/mag
GERD- every 30-60 until subside
-
-
Absorbent (keolin/pectin, pepto bismal)
Opiates- diphenoxylate with atropine (lomotil); difenoxin with atropine (motofen); loperamide (imodium) SCHEDULE V
Anticholinergics (atropine)
ANTIDIARRHEAL PRECAUTIONS/ADRS
Special populations
Bismuth salicylate
Opiods (tid or qid)
use caution with all in elderly
contraindicated in children
pregnancy category C except Imodium is B (lactation use caution)
bismuth- reye syndrome children with flu like illness can turn tongue black-idiosyncratic risk of toxicity with aspirin risk for hypoglycemia
Opioids- decrease intestinal motility can lead to toxic megacolon
diphenoxylate and difenoxin with atropine- anticholinergic and CNS effects
CYTOPROTECTIVE AGENTS
DOSING QID
carafate- binds to ulcer tissue
- no precautions, cat B
- constipation
- decreases absorption
cytotec (misoprostol)- prostaglandin analog replaces prostaglandins (NSAIDS)
- RENAL
- PREGNANCY X- DO NOT GIVE abortifacient
- diarrhea, menstrual
- mag- increase diarrhea
CYTOPROTECTIVE EDUCATION
misoprostol
carafate
misoprostol take with food- if diarrhea greater than a week contact provider, cat X
carafate on empty stomach, constipation prevention
ANTIEMETICS - - - - -
Antihistamines (benadryl, vistaril) Phenothiazines (compazine, phenergan) Cannabinoids (marinol) 5ht3 receptor antagonists (SETRONS- ondansetron, palonosetron) Misc.- tigan
ANTIEMETICS
antihistamine cons.
phenothiazines cons.
cannabinoids cons.
5ht3-
anticholinergic- caution in elderly
extrapyramidal reactions- do not give in parkinsons
promethazine- fatal resp depression in <2 and long term use can lead to bone marrow depression and blood dyscrasias
euphoria, depression, somnolence, CV (palp, tach, hypotension) SEIZURE LIKE ACTIVITY- contraindicated in seizure d/o; may cause behavior changes
constipation, fatigue, dizziness, diarrhea, RARE CV(tachy, brady, hypotension QT prolongation) CAN mask progressive ileus
ANTIEMETIC USE
n/v gastroenteritis or d/t drugs use:
motion sickness
vomiting d/t gastroparesis
5ht3- low side effect
phenothiazine (not in children) initial short term
dramamine or meclizine 1 to 2 hours before
prokinetic
ANTIEMETIC THINK…
additive cns or anticholinergic effects- elderly
Histamine2 Receptor Antagonists - - - - -
use
TIDINE Cimetidine Ranitidine Famotidine Nizatidine
reduce gastric acid secretion NPO, GERD, prophylaxis
h2ra CONSIDERATIONS
caution with
Special populations
ADR
renal disease- adj needed, NIZATIDINE and RANITIDINE (possible hepatic)
Pregnancy Category B
Children- RANITIDINE AND FAMOTIDINE approved for infants and children
Antiandrogenic (gynecomastia, impotance esp. with cimetidine)
CNS (confusion, agitation, psychosis, depression, disorientation)
Hematological (rare but severe- agranulocytosis, granulocytopenia, aplastic anemia)
h2ras CONSIDERATIONS CONT
Interactions
USE
Education
Interactions- cimetidine CYP dont use
If long term use or high dose MONITOR LIVER
GERD BID (not infants) PUD- not primary, step down therapy RENAL DOSING
Take with meals
Separate antacids by 30 to hour
Drowsiness
Smoking/alcohol
PROKINETICS
action
ex.
Precautions
Special population
stimulate motility of GI tract without stimulating secretions
Metoclopramide (Reglan)
Black box warning- tardive dyskinesia, do not give to parkinsons
Any GI problems suspected do not give (bleed, obstruction, perforation)
History of depression- caution (possible SI)
RENAL DEPRESSION
Pregnancy Category B
PROKINETICS
ADRS
Interactions
Dosing consideration
tardive dyskinesia, depression dizziness, diarrhea
HYPOGLYCEMIA in diabetes
Rare- galactorrhea, amenorrhea, gynecomastia, impotence
Anticholinergics reverse action (trying to speed up motility anticholinergic is slowing it down)
Increased risk EPS with other drugs that can cause EPS
CrCl below 40 initiate at half daily dose
PROKINETICS EDUCATION
30 mins before meals do not double dose drowsy additive cns with cns depressants (alcohol) report involuntary movements
PPI
precautions
esp. special pop
antisecretory-
LIVER
PREGNANCY B or C (use caution, anomalies)
ELDERY
can mask s/s gastric cancer
Children
Esomeprazole, omeprazole, and lansoprazole approved shorte term in children >1
Pantoprazole and rabeprazole only for children >12
PPI cont
risk for ________
long term use ______
Interaction with ___
nutrient deficiencies (iron, b12, calcium–osteoporosis) and microbial pathogens (pneumonia, c.diff) d/t decreased acidic environment
plavix- decrease effectiveness (omeprazole)
Atazanivir, indinavir, nelfinavir- decrease effectiveness
MONITOR WARFARIN PTS
LAXATIVES
types
stimulants- senna cascara bisacodyl castors oil
osmotics- mag hydroxide, mag citrate, sodium phosphate, polyethylene glycol
bulk producing- psyllium, methylcellulose, and polycarbophil
lubricants- mineral oil
surfactants- docusate sodium, docusate calcium
hyperosmolar-glycerine, lactulose
LAXATIVES
Precautions contraindications
contraindicated in
magnesium hydroxide contraindicated in
rapid response short term use DOC
Slower response
Pregnancy?
presence n/v or abdominal pain
renal dysfunction
stimulant DOC (senna, cascara, bisacodyl, castor oil) or osmotic (mag hydroxide, mag citrate, polytethylene)
bulk forming
bulk forming
GERD
STEP UP THERAPY
STEP DOWN
Antacid/lifestyle
H2 receptor antagonist 4-8 weeks (if resolves cont. for 12 weeks)
PPI 4-8 weeks (if better step back down, if symptoms return start back on PPI, no improvement after this refer)
PPI and lifestyle for 8 weeks (symptom free 4 weeks step down to h2ra) if not relieved increase PPI to BID for 4-8 weeks (sx free 4 weeks step back down to once a day and reassess in 6-12 months)
if symptoms arent relieved after 8 weeks refer
Pediatric GERD
h2ra or PPI
PUD tx
- Lifestyle OTC antacids and h2 blockers
- H.pylori testing and PPI
- Tx h. pylori or figure out cause
