Cimetidine (Tagamet)

H2 receptor antagonist

Antiulcer agent

Works on parietal cells (histamine receptors)
Suppresses gastric acid secretion

Used for duodenal and gastric ulcers, aspiration pneumonitis, OB pts

Food slows absorption (full effect still takes place, just takes longer)

S/E: Antiandrogen effects, CNS effects (confusion, hallucinations)

Give slowly IV to avoid hypotension

Dose an hour apart from antacids

Omeprazole (Prilosec), Esomeprazole (Nexium), Pantoprazole (Protonix)

Proton Pump Inhibitors

Antiulcer agents

Prilosec: Gets dissolved in duodenum, moves to parietal cells, suppresses gastric acid secretion

Usually given 2-3x/day

Used for treating ulcers, GERD.

Can inc risk for gastric cancer if given prophylactically for GERD

S/E: HA, N/V, interferes with antiretrovirals for HIV pts, certain antifungals

Nexium: met. slower than prilosec. Dosing is less frequent (once per 24 hrs)

Protonix: Doesn't interact with other drugs

Sucralfate (Carafate)

Misc. Drugs

Antiulcer agents

Aluminum hydroxide and a form of sugar

Physical protective coating: covers ulcer craters

Lasts about 6 hrs (usually given 4x/day)

90% elimination in stool

Used for duodenal ulcers

S/E: Constipation. Antacids dec absorption of drug (Take half hour apart)

Can slow absorption of theophylline, digoxin, coumadin, cipro (Take 2 hrs apart)

Misoprostol (Cytotec)

Misc. Drugs

Antiulcer agents

Analog of prostaglandin E1

Exogenous source of prostaglandins

Used for ulcers b/c of NSAIDS

Used for cervical ripening to start uterine contractions (Can cause spontaneous abortion in pregnancy that isnt full term)

S/E: Diarrhea and abd pain

Ondansetron (Zofran)

Serotonin receptor antagonist

Antiemetic

Blocks vagal stimulation and serotonin receptors

Added w/ dexamethasone = additive effect

Used for CINV, anesthesia, radiation

Prevents acute emesis

S/E: HA, diarrhea, dizziness. No EPS b/c it does not block dopamine receptors.

Prochlorperazine (Compazine), Promethazine (Phenergan)

Dopamine antagonist

Antiemetics

Blocks dopamine receptors in the CTZ

Used to prevent emesis from surgery or chemo

S/E: Anticholeneric effects, sedation/dizziness, EPS (dystonic-type reactions)

Phenergan more sedative than compazine

Give slowly IV (to avoid hypotension)

Scopolamine patch (Transderm)

Anticholinergic

Antiemetic

Helps prevent motion sickness

Muscarinic antagonist

Used pre-op to prevent postop N/V (Put behind ear evening before surgery)

S/E: Anticholinergic effects (drying of secretions)

Dimenhydrinate (Dramamine), Hydroxizine (Vistaril)

Antihistamines

Antiemetics

Dramamine: OTC. Vistaril: Prescription

Blocks histamine receptors

Used most often for motion sickness

S/E: Sedation (blocking h1 receptors), anticholinergic effects (blocking muscarinic receptors)

Less effective than the patch

Aprepitant (Emend)

Substance P/Neurokinin antagonist

Antiemetic

Blocks receptors in CTZ

Used for CINV. Good for acute/delayed nausea

Usually taken w/ serotonin receptor antagonist and dexamethasone

Well absorbed. 1/2 life: 9-13 hrs.

S/E: fatigue, hiccups, dizziness, diarrhea

Neuroleptic can be given for hiccups

Potential for liver injury if given long term

Dilantin dec levels of emend; emend can inc dexamethasone; can dec effectiveness of coumadin and oral contraceptives

Metoclopramide (Reglan)

Prokinetic agent

Antiemetic

Blocks serotonin and dopamine receptors

Inc GI motility (Makes stomach empty quicker)

Orally, preop. IV, postop.

Used with DM pts with gastroporesis, CINV, N/V from opioids, radiation therapy pts

S/E: Sedation, diarrhea (high doses), Can cause EPS (Ask pt if they have RLS)

Contraindicated in pts with bowel obstructions, GI hemorrhaging, and perforation

Psyllium (Metamucil)

Bulk-forming Laxative

Temporary tx of constipation. Also for diverticulosis, IBS

Inc bulk --> stimulates colon --> Inc peristalsis -->stimulation -->defectation

Give with H20 to help bulk-formatin

S/E: Esophageal obstruction can occur if given with inadequate amt of fluids

Not absorbed, so s/e are rare

Docusate Sodium (Colace)

Surfactant Laxative

Inhibits fluid absorption, stimulates secretion of H20 and electrolytes into the intestines

Produces soft stool several days after onset of tx

Bisacodyl (Dulcolax), Senna

Stimulant Laxative

Inc motility, inc H20 and electrolytes into the intestines

Used for opioid-induced constipation and constipation resulting from slow intestinal transit

Can be administered orally or rectally

Magnesium Hydroxide (Milk of Magnesia)

Osmotic Laxative

Poorly absorbed salts whose osmotic action draws h20 into the intestines -->fecal mass softens and swells --> stretching of intestinal wall -->stimulates peristalsis

Results in about 2-6 hrs

High-dose therapy is used to empty bowels prior to surgery

Can cause substantial loss of h20. Pts should increase fluid intake to avoid dehydration. Mg can accumulate to toxic levels in pts with renal dysfunction.

Mineral Oil

Lubricant

Useful when administered by enema to treat fecal impaction

Laxative action is produced by lubrication

Glycerin Suppository

Misc. Laxative

Osmotic agent that softens and lubricates hardened/impacted feces

Evacuation occurs about 30 min after suppository insertion

Useful for re-establishing normal bowel function following termination of chronic laxative use

Laxative abuse/dependence

Educate pts about normal bowel function to correct misconceptions

Good bowel habits (consistent time for BM's)

Exercise after meals

Inc fluids and fiber (fruits, veggies, bran)

Use laxatives only when clearly necessary, and briefly in lowest doses