GI deck 4 Flashcards
(53 cards)
Prokinetics MOA
Stimulate motility of the GI tract without stimulating gastric, biliary, or pancreatic secretions
Prokinetic drug
Metoclopramide
Metoclopramide phamacodynamics
Metoclopramide stimulates motility in the upper GI tract.
Metoclopramide also has some actions similar to the phenothiazines and dopamine antagonists.
Metoclopramide has a
Black Box warning due to risk of developing tardive dyskinesia.
Prokinetics are contraindicated in
gastrointestinal (GI) hemorrhage, mechanical obstruction, new surgery on the GI tract, or perforation.
prokinetics use cautiously in
patients with a history of depression.
Depression may occur, including suicidal ideation.
porkineitcs are used more on a
short term basis
Prokinetics ADR
Tardive dyskinesia Depression, dizziness Diarrhea Hypoglycemia in patients with diabetes Rare: galactorrhea, amenorrhea, gynecomastia, impotence secondary to hyperprolactinemia
Prokinetics Additive ___
CNS depression occurs when used with other CNS depressants.
Prokineticcs increased risk of
EPS occurs with other drugs that have the potential for EPS.
Prokineitcs drugs with
anticholinergic effects reverse the action of metoclopramide.
Prokinetics clinical use and dosing
GERD
Adults: 10 mg 30 minutes before meals
Diabetic gastroparesis
10 mg 30 minutes before meals and at bedtime for 2 to 8 weeks
In patients with continuous complete remission below 40 mL/minute, their therapy initiated at approximately half the recommended dosage
Prokinetics monitoring
Renal function
New-onset movement disorder
Depression or suicidal ideation
Prokineitcs patient education
Administration
Take 30 minutes before meals.
Do not double doses.
Prokinetics ADR
Drowsiness
Additive CNS depression when taken with CNS depressants (alcohol)
Reporting any involuntary movements
Prokinetics lifestyle managment
GERD related lifestlyle changes
PPI (proton pump inhibitors) are
Drowsiness
Additive CNS depression when taken with CNS depressants (alcohol)
Reporting any involuntary movements
PPI are used for
erosive gastritis, GERD, and Zollinger-Ellison syndrome and as part of a treatment of active PUD, especially duodenal ulcers caused by Helicobacter pylori
PPI MOI
Reduce H+ secretion by inhibition of the H+/K+/adenosine triphosphatase (ATPase) enzyme system at the secretory surface of the parietal cell
Decrease in acid secretion lasts for up to 72 hours after each dose
PPI precautions and contraindications
Extensively metabolized in the liver; use cautiously in patients with hepatic dysfunction and in older adults
PPI pregnancy
category B or C
Congenital anomalies have been reported.
Use with caution.
PPI Children
Esomeprazole, omeprazole, and lansoprazole approved for short-term use in children as young as 1 year of age
Pantoprazole not approved in children 5 years of age and younger and rabeprazole not approved in children age less than 12 years
PPI ADR
Risk for significant nutrient deficiencies: iron, vitamin B12, and calcium
Long term PPI use increases
Long-term PPI use increases risk for osteoporosis and increased hip fractures
Long-term PPI therapy increases risk of Clostridium difficile, Salmonella, and Camphylobacter infections
