Material, Vincent M.(Drug Study in GastroIntestinal System)-converted.pdf

In Partial Fulfillment
Of The Requirements for the Subject
Pharmacology
AY 2020 – 2021
Submitted by:
Vincent M. Material
BSN 2
Submitted to:
Ms. Maria Teresa Ira Bandelaria, MAN, RN, MHoA
NCM 107 Clinical Instructor
December 3, 2020
DRUG STUDY
Lipa City Colleges
College of Nursing

Antacid preparations serve to neutralize gastric acid after it is
secreted. These still-helpful agents have a continuing role in
treating mild, occasional heartburn and supplementing
prescription drugs in more severe disease. They are traditional,
cheap, handy, and relatively safe – although they are not without
risks and side effects can occur.

DRUG DATA MECHANISM OF
ACTION
INDICATIONS CONTRAINDICATIONS ADVERSE
REACTIONS
DOSAGE NURSING ACTIONS &
CONSIDERATIONS
Generic
Name:
lansoprazole
Brand Name:
Prevacid
CLASSIFICA-
TION:
Pharmacologic
class: Gastric
acid pump
inhibitor
Therapeutic
class: Antiulcer
drug
Pregnancy risk
category B
Inhibits activity
of proton pump
in gastric
parietal cells,
decreasing
gastric acid
production
➣Active duodenal
ulcer
➣Maintenance of
healed duodenal
ulcer
➣H. pylori
eradication, to
reduce risk of
duodenal ulcer
recurrence
➣Benign gastric
ulcer
➣Gastric ulcer
associated with
NSAIDs
➣To reduce risk
of NSAID-
associated gastric
ulcer
➣Gastroesophage
al reflux disease
➣Erosive
esophagitis
➣To maintain
healing of erosive
esophagitis
➣Pathologic
● Hypersensitivity to
drug or its
components
Use cautiously in:
● phenylketonuria
(orally disintegrating
tablets), severe
hepatic impairment
● elderly patients
● pregnant or
breastfeeding
patients
● children younger
than age 18.
• CNS: headache,
confusion,
anxiety,
malaise,
paresthesia,
abnormal
thinking,
depression,
dizziness,
syncope,
cerebrovascul
ar accident
• CV: chest pain,
hypertension,
hypotension,
myocardial
infarction,
shock
• EENT: visual
field deficits,
otitis media,
tinnitus,
epistaxis
• GI: nausea,
diarrhea,
abdominal pain,
cholelithiasis,
ulcerative colitis,
Dosages
➣Active duodenal ulcer
Adults: 15 mg P.O. daily
for 4 weeks
➣Maintenance of healed
duodenal ulcer
➣H. pylori eradication, to
reduce risk of duodenal
ulcer recurrence
Adults: In triple therapy,
30 mg lansoprazole
P.O., 1 g amoxicillin P.O.,
and 500 mg
clarithromycin P.O. q 12
hours for 10 or 14 days.
In dual therapy, 30 mg
lansoprazole P.O. and 1 g
amoxicillin P.O. q 8 hours
for 14 days.
➣Benign gastric ulcer
for up to 8 weeks
➣Gastric ulcer associated
Patient monitoring
● Monitor for GI adverse
reactions.
● Assess nutritional
status and fluid balance
to identify significant
problems.
Patient teaching
● Instruct patient to
take before meals.
● If patient has difficulty
swallowing, tell him to
open delayed-release
capsule and sprinkle
contents onto small
amount of soft food
(such as applesauce
or pudding). Emphasize
that he must not crush
or chew drug.
● Tell patient to take
orally disintegrating
tablet by placing it on
tongue and letting it
disintegrate.
take oral suspension

hypersecretory
conditions
(including
Zollinger-Ellison
syndrome)
➣Frequent
heartburn (two or
more times a
week)
esophageal
ulcer,
hematemesis,
stomatitis,
dysphagia, GI
hemorrhage
• GU: renal
calculi, erectile
dysfunction,
Abnormal
menses, breast
tenderness,
gynecomastia
• Hematologic:
anemia
• Musculoskelet
al: hip, wrist,
spine fractures
(with long-term
daily use)
• Respiratory:
cough,
bronchitis,
asthma
• Skin: urticaria,
alopecia, acne,
pruritus,
photosensitivity
with NSAIDs
Adults: 30 mg P.O. once
daily for up to 8 weeks
➣To reduce risk of
NSAID-associated gastric
ulcer
for up to12 weeks
➣Gastroesophageal reflux
disease
Adults and children
ages 12 to 17:
15 mg P.O. daily for up to
8 weeks
Children ages 1 to 11
weighing more
than 30 kg (66 lb): 30
mg P.O. daily for up to 12
weeks
weighing 30 kg
(66 lb) or less: 15 mg
P.O. daily for up to 12
weeks
➣Erosive esophagitis
Adults and children
ages 12 to 17: 30 mg
weeks. Some patients
may require 8 additional
weeks.
by emptying packet
contents into container
with 2 tbsp water. Tell
him to stir contents well
and drink immediately.
● Advise patient to
minimize GI upset by
eating small, frequent
servings of food and
drinking plenty of fluids.
● As appropriate, review
all other significant
and life-threatening
adverse reactions and
interactions, especially
those related to the
drugs, foods, and herbs
mentioned above.

weighing more than 30
kg (66 lb): 30 mg P.O.
weighing 30 kg
weeks
➣To maintain healing of
erosive esophagitis
➣Pathologic
hypersecretory conditions
(including Zollinger-Ellison
syndrome)
Adults: Initially, 60 mg
P.O. daily, to a maximum
of 90 mg P.O. b.i.d.
Divide daily dosages over
120 mg.
➣Frequent heartburn (two
or more times a week)
Adults: 15 mg P.O.
(delayed-release
capsule) daily up to 14
days
Dosage adjustment
● Significant hepatic
insufficiency

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
cimetidine
Brand Name:
Tagamet HB
CLASSIFICA-
TION:
Pharmacologic
class:
Histamine2-
receptor
antagonist
Therapeutic
class: Antiulcer
drug
Pregnancy risk
category B
Competitively
inhibits
histamine
action at
histamine2-
receptor sites of
gastric parietal
cells, thereby
inhibiting
gastric acid
secretion
➣Active duodenal
ulcer (short-term
therapy)
➣Active benign
gastric ulcer
(shortterm
therapy)
➣Gastric
hypersecretory
conditions (such
as Zollinger-
Ellison syndrome)
intractable ulcers
➣Heartburn; acid
indigestion
➣Erosive
gastroesophageal
reflux
disease
drug
● Alcohol intolerance
Use cautiously in:
● renal impairment
● pregnant or
breastfeeding
patients.
• CNS: confusion,
dizziness,
drowsiness,
hallucinations,
agitation,
psychosis,
depression,
anxiety,
headache
• GI: diarrhea
• GU: reversible
erectile
dysfunction,
gynecomastia
Availability
Oral liquid: 200 mg/5 ml,
300 mg/5 ml
Tablets: 200 mg, 300 mg,
400 mg, 600 mg, 800 mg
Dosages
(short-term therapy)
Adults and children
older than age 16:
800 mg P.O. at bedtime,
or 300 mg P.O. q.i.d. with
meals and at bedtime, or
400 mg P.O. b.i.d.
Maintenance dosage is 400
mg P.O. at bedtime.
➣Active benign gastric
ulcer (shortterm therapy)
Adults and children
older than age 16:
800 mg P.O. at bedtime or
300 mg P.O. q.i.d. with
meals and at bedtime
➣Gastric hypersecretory
conditions (such as
Zollinger-Ellison
Patient monitoring
● Monitor creatinine
levels in patients with
renal insufficiency or
failure.
● Assess elderly or
chronically ill patients
for confusion (which
usually resolves once
drug therapy ends).
Patient teaching
● Inform patient with
gastric ulcer that ulcer
may take up to 2
months to heal. Advise
him not to discontinue
therapy, even if he feels
better, without first
consulting prescriber.
Ulcer may recur if
therapy ends too soon.
● Advise patient not to
take over-thecounter
cimetidine for more
than 2 weeks
continuously, except
with prescriber’s advice
and supervision.

syndrome)
intractable ulcers
Adults and children
older than age 16:
➣Erosive
gastroesophageal reflux
disease
Adults and children
older than age 16:
1,600 mg P.O. daily in
divided doses (800 mg
b.i.d. or 400 mg q.i.d.) for
12 weeks
➣Heartburn; acid
indigestion
Adults and children
older than age 16:
200 mg (two tablets of
over-thecounter product
only) P.O. up to b.i.d.
Give maximum dosage no
longer than 2 weeks
continuously, unless
directed by prescriber.
Dosage adjustment
● Renal impairment
drugs, tests, foods,
herbs, and behaviors
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
famotidine
Brand Name:
Pepcid
CLASSIFICA-
TION:
Pharmacologic
class:
Histamine2-
receptor
antagonist
Therapeutic
class: Antiulcer
drug
Pregnancy risk
category B
Blocks action of
histamine at
histamine2-
receptor sites in
gastric parietal
cells, inhibiting
gastric acid
secretion
and stabilizing
pepsin
➣Active duodenal
ulcers and benign
gastric ulcers
➣Prophylaxis of
duodenal ulcers
➣Gastroesophage
al reflux disease
➣Gastric
hypersecretory
conditions (such
as Zollinger-
Ellison syndrome)
➣Hospitalized
patients with
pathologic
hypersecretory
conditions or
ulcers; patients
who can’t take
oral drugs
➣Prevention or
treatment of
heartburn, acid
indigestion, and
sour stomach
(Pepcid AC only)
drug or other
histamine2-
receptor antagonists
Use cautiously in:
with prolonged
QT interval and
seizures (very rare)
● pregnant or
breastfeeding
patients.
• CNS: dizziness,
headache,
paresthesia,
asthenia,
fatigue,
insomnia,
somnolence,
psychic
disturbances
• CV: palpitations,
arrhythmias,
AV block
• GI: nausea,
vomiting,
diarrhea,
constipation,
dry mouth,
anorexia,
cholestatic
jaundice,
abdominal pain
• GU: decreased
libido
• Hematologic:
agranulocytosi
s,
pancytopenia,
leukopenia,
Availability
Gelcaps: 10 mg
Oral suspension: 40 mg/5
ml
Solution for injection: 10
mg/ml, 20 mg/50 ml of
normal saline solution
Tablets: 10 mg, 20 mg, 40
mg
Tablets (chewable): 10 mg
Tablets (orally
disintegrating): 20 mg,
40 mg
Dosages
➣Active duodenal ulcers
and benign gastric ulcers
daily at bedtime or 20 mg
P.O. b.i.d. for up to 8
weeks
➣Prophylaxis of duodenal
ulcers
daily at bedtime
Patient monitoring
● Assess patient for GI
signs and symptoms.
● Monitor blood urea
nitrogen and creatinine
renal impairment.
✓ Monitor patient for
prolonged QT interval
and seizures, which
have been reported
very rarely in patients
with impaired renal
function whose
famotidine dosage or
dosing interval may not
have been adjusted
appropriately. Also
monitor patient for
arrhythmia and AV
block.
signs and symptoms of
epidermal necrolysis,
Stevens-Johnson
syndrome, and
hematologic or
respiratory changes.

thrombocytop
enia (rare)
• Hepatic: liver
enzyme
abnormalities,
• hepatitis
• EENT: orbital
edema,
conjunctival
• redness, tinnitus
• Musculoskelet
al:
musculoskeletal
pain,muscle
cramps,
arthralgia
• Respiratory:
bronchospasm
, interstitial
pneumonia
• Skin: flushing,
acne, dry skin,
rash, urticaria,
alopecia,
pruritus;
epidermal
necrolysis and
Stevens-
Johnson
syndrome
(very rare)
• Other: altered
taste, fever,
pain at injection
disease
Adults: 20 mg P.O. b.i.d.
for up to 6 weeks.
Maximum dosage is 40 mg
b.i.d. for up to 12 weeks.
Children ages 1 to 16: 1
mg/kg P.O. daily in two
divided doses, to a
maximum of 40 mg b.i.d.
Infants ages 3 months
to 1 year: 0.5 mg/kg P.O.
b.i.d. for up to 8 weeks
Infants younger than
age 3 months: 0.5 mg/kg
P.O. once daily for up to 8
Weeks
conditions (such as
Zollinger-Ellison
syndrome)
P.O. q 6 hours, increased
as needed to 160 mg q 6
Hours
➣Hospitalized patients
with pathologic
or ulcers; patients who
can’t take oral drugs
Adults: 20 mg I.V. q 12
hours
Patient teaching
● Tell patient that drug
is most effective when
taken at bedtime.
● Inform patient that
pain relief may not
begin until several days
after therapy starts.
✓ Instruct patient to
take drug exactly as
prescribed and to
immediately report
cardiovascular signs and
symptoms, seizures,
and hematologic or
● Tell female patient to
inform prescriber if she
is pregnant of
breastfeeding.
tests mentioned above.

site, hyper
sensitivity
reactions
including
anaphylaxis
and
angioedema
➣Prevention or treatment
of heartburn, acid
indigestion, and sour
stomach (Pepcid AC only)
Adults: For prevention, 10
mg P.O. 1 hour before
eating, or 10-mg chewable
tablet 15 minutes before
eating, to a maximum of
20 mg/24 hours for up to
2 weeks. For symptomatic
treatment, 10 mg P.O.
once or twice daily.
Dosage adjustment

An antiflatulent (or deflatulent) agent is a drug used for the
alleviation or prevention of excessive intestinal gas, i.e.,
flatulence.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
simethicone
Brand Name:
GasAid
CLASSIFICA-
TION:
Pharmacologic
class:
Methylated
linear siloxane
mixture
Therapeutic
class:
Antiflatulent,
antifoam agent
Pregnancy risk
category NR
Causes gas
bubbles to
coalesce and
allows gas to
pass through GI
tract via
belching or
passing of
flatus. Silicone
antifoam
spreads on
surface of
aqueous liquids,
forming a film
of low surface
tension that
causes foam
bubbles to
collapse.
➣Excess gas in
GI tract after
surgery or from
air swallowing,
dyspepsia, peptic
ulcer, or
diverticulitis
drug
● Intestinal
perforation or
obstruction
Use cautiously in:
● abdominal pain of
unknown cause
(especially when
accompanied by
fever).
None significant Availability
Capsules: 95 mg, 125 mg
Capsules (liquid-filled): 125
mg, 166 mg
Drops: 40 mg/0.6 ml, 40 mg/1
ml, 95 mg/1.425 ml
Suspension: 40 mg/0.6 ml, 50
mg/5 ml
Tablets: 60 mg, 62.5 mg, 80
mg, 95 mg
Tablets (chewable): 40 mg, 80
mg, 125 mg, 150 mg, 166 mg
Dosages
➣Excess gas in GI tract after
surgery or from air swallowing,
dyspepsia, peptic ulcer, or
diverticulitis
Adults and children older
than age 12:
40 to 125 mg P.O. q.i.d. after
meals and at bedtime, up to
500mg/day
mg P.O. q.i.d., up to 240
mg/day
Children younger than age
2: 20 mg P.O. q.i.d.
Patient
monitoring
● Monitor GI status
to assess drug
efficacy.
Patient teaching
● Tell patient to
take after meals
and at bedtime as
needed.
● Caution patient
not to take dose
higher than
indicated on
package unless
prescriber approves.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
activated
charcoal
Brand Name:
Actidose
CLASSIFICA-
TION:
Pharmacologic
class: Carbon
residue
Therapeutic
class:
Antiflatulent,
Antidote
Pregnancy risk
category C
Binds to
poisons, toxins,
irritants, and
drugs, forming
a barrier
between
particulate
material and GI
mucosa that
inhibits
absorption of
this material in
GI tract. As an
antiflatulent,
reduces
intestinal gas
volume and
relieves
related
discomfort.
➣Poisoning
➣Flatulence
None
Use cautiously in:
● patients who have
aspirated corrosives
or hydrocarbons and
are vomiting.
• GI: nausea,
vomiting,
diarrhea,
constipation,
black stools,
intestinal
obstruction
Availability
Capsules: 260 mg
Granules: 15 g/120 ml
Liquid: 15 g/120 ml, 50
g/240 ml, 208 mg/1 ml
Oral suspension: 12.5 g/60
ml, 15 g/75 ml, 25 g/120 ml,
30 g/120 ml, 50 g/240 ml
Powder: 15, 30, 40, 130, 240
g/container
Dosages
➣Poisoning
Adults: 25 to 100 g P.O. (or
1 g/kg, or about 10 times the
amount of poison ingested)
as a suspension in 120 to
240 ml (4 to 8 oz) of water
Children: Initially, 1 to 2
g/kg P.O. (or 10 times the
amount of poison ingested)
as a suspension in 120 to
240 ml (4 to 8 oz) of water
➣Flatulence
Adults: 600 mg to 5 g P.O.
as a single dose, or 975 mg
to 3.9 g in divided doses
Patient monitoring
● Monitor patient for
constipation.
● If patient vomits
soon after receiving
dose, ask prescriber if
dose should be
repeated.
Patient teaching
drink six to eight
glasses of fluid daily
to prevent
constipation.
● Tell patient that
stools will be black as
charcoal is excreted
from body.
● As appropriate,
review all other
significant
interactions,
especially
drugs and foods
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
lansoprazole
Brand Name:
Prevacid
CLASSIFICA-
TION:
Pharmacologic
class: Gastric
acid pump
inhibitor
Therapeutic
class: Antiulcer
drug
Pregnancy risk
category B
Inhibits activity
of proton pump
in gastric
parietal cells,
decreasing
gastric acid
production
➣Active duodenal
ulcer
➣Maintenance of
healed duodenal
ulcer
➣H. pylori
eradication, to
reduce risk of
duodenal ulcer
recurrence
➣Benign gastric
ulcer
➣Gastric ulcer
associated with
NSAIDs
➣To reduce risk
of NSAID-
associated gastric
ulcer
➣Gastroesophage
al reflux disease
➣Erosive
esophagitis
➣To maintain
healing of erosive
esophagitis
➣Pathologic
hypersecretory
drug or its
components
Use cautiously in:
● phenylketonuria
tablets), severe
hepatic impairment
● pregnant or
breastfeeding
patients
than age 18.
• CNS: headache,
confusion,
anxiety,
malaise,
paresthesia,
abnormal
thinking,
depression,
dizziness,
syncope,
cerebrovascul
ar accident
• CV: chest pain,
hypertension,
hypotension,
myocardial
infarction,
shock
• EENT: visual
field deficits,
otitis media,
tinnitus,
epistaxis
• GI: nausea,
diarrhea,
abdominal pain,
cholelithiasis,
ulcerative colitis,
esophageal
Dosages
for 4 weeks
duodenal ulcer
reduce risk of duodenal
ulcer recurrence
Adults: In triple therapy,
30 mg lansoprazole
P.O., 1 g amoxicillin P.O.,
and 500 mg
clarithromycin P.O. q 12
hours for 10 or 14 days.
In dual therapy, 30 mg
lansoprazole P.O. and 1 g
amoxicillin P.O. q 8 hours
for 14 days.
for up to 8 weeks
➣Gastric ulcer associated
with NSAIDs
Patient monitoring
● Monitor for GI adverse
reactions.
status and fluid balance
to identify significant
problems.
Patient teaching
take before meals.
● If patient has difficulty
swallowing, tell him to
open delayed-release
contents onto small
amount of soft food
(such as applesauce
or pudding). Emphasize
that he must not crush
or chew drug.
disintegrate.
by emptying packet

conditions
(including
Zollinger-Ellison
syndrome)
➣Frequent
heartburn (two or
more times a
week)
ulcer,
hematemesis,
stomatitis,
dysphagia, GI
hemorrhage
• GU: renal
calculi, erectile
dysfunction,
Abnormal
menses, breast
tenderness,
gynecomastia
• Hematologic:
anemia
• Musculoskelet
al: hip, wrist,
spine fractures
(with long-term
daily use)
• Respiratory:
cough,
bronchitis,
asthma
alopecia, acne,
pruritus,
photosensitivity
NSAID-associated gastric
ulcer
for up to12 weeks
disease
Adults and children
ages 12 to 17:
8 weeks
weighing more
than 30 kg (66 lb): 30
weeks
weighing 30 kg
weeks
Adults and children
ages 12 to 17: 30 mg
weeks. Some patients
may require 8 additional
weeks.
contents into container
with 2 tbsp water. Tell
him to stir contents well
minimize GI upset by
eating small, frequent
servings of food and
drugs, foods, and herbs
mentioned above.

kg (66 lb): 30 mg P.O.
weighing 30 kg
weeks
erosive esophagitis
➣Pathologic
(including Zollinger-Ellison
syndrome)
P.O. daily, to a maximum
of 90 mg P.O. b.i.d.
Divide daily dosages over
120 mg.
or more times a week)
Adults: 15 mg P.O.
(delayed-release
capsule) daily up to 14
days
Dosage adjustment
insufficiency

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
bismuth
subsalicylate
Brand Name:
Pepto-Bismol
CLASSIFICA-
TION:
Pharmacologic
class:
Adsorbent
Therapeutic
class:
Antidiarrheal,
antibiotic,
antiulcer drug
Pregnancy risk
category C
Promotes
intestinal
adsorption of
fluids and
electrolytes and
decreases
synthesis of
intestinal
prostaglandins.
Adsorbent
action removes
irritants from
stomach and
soothes irritated
bowel lining.
Also shows
antibacterial
activity to
eradicate
Helicobacter
pylori.
➣Adjunctive
therapy for mild
to moderate
diarrhea, nausea,
abdominal
cramping,
heartburn, and
indigestion
accompanying
diarrheal illnesses
➣Ulcer disease
caused by H.
pylori
aspirin
● Elderly patients
with fecal impaction
● Children or
adolescents during or
after recovery from
chickenpox or flulike
illness
Use cautiously in:
● diabetes mellitus,
gout
● patients taking
concurrent aspirin
● pregnant or
breastfeeding
patients
● infants.
• EENT: tinnitus,
tongue
discoloration
• GI: nausea,
vomiting,
diarrhea,
constipation,
gray-black
stools, fecal
impaction
• Respiratory:
tachypnea
• Other:
salicylate
toxicity
Availability
Liquid: 130 mg/15 ml, 262
mg/15 ml, 525 mg/15 ml
(maximum strength)
Tablets: 262 mg
Tablets (chewable): 262
mg, 300 mg
Dosages
➣Adjunctive therapy for
mild to moderate diarrhea,
nausea, abdominal
cramping, heartburn, and
indigestion accompanying
diarrheal illnesses
Adults: Two tablets or 30
ml P.O.(15 ml of maximum
strength) q 30 minutes, or
two tablets or 60 ml
(30 ml of extra/maximum
strength) q 60 minutes as
needed. Don’t exceed
4.2 g in 24 hours.
Children ages 9 to 12:
One tablet or 15 ml P.O.
(7.5 ml of maximum
strength) q 30 to 60
minutes. Don’t exceed
2.1 g in 24 hours.
Patient monitoring
● Monitor fluid intake
and electrolyte levels.
● Monitor stool
frequency and
appearance.
● Assess infants and
debilitated patients for
fecal impaction.
Patient teaching
chew tablets or dissolve
them in mouth before
swallowing.
drug may turn stools
gray-black temporarily.
● Tell patient to notify
prescriber if he has
diarrhea with fever for
more than 48 hours.
drugs and tests
mentioned above.

ml (5 ml of maximum
strength) P.O. q 30 to 60
1.4 g in 24 hours.
ml (2.5 ml of maximum
strength) P.O. q 30 to 60
704 mg in 24 hours.
➣Ulcer disease caused by
H. pylori
Adults: Two tablets or 30
ml P.O. q.i.d.
(15 ml of maximum
strength)

H₂ antagonists, sometimes referred to as H2RAs and also
called H₂ blockers, are a class of medications that block the
action of histamine at the histamine H₂ receptors of the parietal
cells in the stomach. This decreases the production of stomach
acid.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
famotidine
Brand Name:
Pepcid
CLASSIFICA-
TION:
Pharmacologic
class:
Histamine2-
receptor
antagonist
Therapeutic
class: Antiulcer
drug
Pregnancy risk
category B
Blocks action of
histamine at
histamine2-
receptor sites in
gastric parietal
cells, inhibiting
gastric acid
secretion
and stabilizing
pepsin
➣Active duodenal
ulcers and benign
gastric ulcers
➣Prophylaxis of
duodenal ulcers
➣Gastroesophage
al reflux disease
➣Gastric
hypersecretory
conditions (such
as Zollinger-
Ellison syndrome)
➣Hospitalized
patients with
pathologic
hypersecretory
conditions or
ulcers; patients
who can’t take
oral drugs
➣Prevention or
treatment of
heartburn, acid
indigestion, and
sour stomach
(Pepcid AC only)
drug or other
histamine2-
receptor antagonists
Use cautiously in:
with prolonged
QT interval and
seizures (very rare)
● pregnant or
breastfeeding
patients.
• CNS: dizziness,
headache,
paresthesia,
asthenia,
fatigue,
insomnia,
somnolence,
psychic
disturbances
• CV: palpitations,
arrhythmias,
AV block
• GI: nausea,
vomiting,
diarrhea,
constipation,
dry mouth,
anorexia,
cholestatic
jaundice,
abdominal pain
• GU: decreased
libido
• Hematologic:
agranulocytosi
s,
pancytopenia,
leukopenia,
Availability
Gelcaps: 10 mg
Oral suspension: 40 mg/5
ml
mg/ml, 20 mg/50 ml of
normal saline solution
Tablets: 10 mg, 20 mg, 40
mg
Tablets (orally
disintegrating): 20 mg,
40 mg
Dosages
➣Active duodenal ulcers
and benign gastric ulcers
daily at bedtime or 20 mg
P.O. b.i.d. for up to 8
weeks
➣Prophylaxis of duodenal
ulcers
daily at bedtime
Patient monitoring
● Assess patient for GI
signs and symptoms.
● Monitor blood urea
nitrogen and creatinine
renal impairment.
prolonged QT interval
and seizures, which
have been reported
very rarely in patients
with impaired renal
function whose
famotidine dosage or
dosing interval may not
have been adjusted
appropriately. Also
monitor patient for
arrhythmia and AV
block.
epidermal necrolysis,
Stevens-Johnson
syndrome, and
hematologic or

thrombocytop
enia (rare)
• Hepatic: liver
enzyme
abnormalities,
• hepatitis
• EENT: orbital
edema,
conjunctival
• redness, tinnitus
• Musculoskelet
al:
musculoskeletal
pain,muscle
cramps,
arthralgia
• Respiratory:
bronchospasm
, interstitial
pneumonia
• Skin: flushing,
acne, dry skin,
rash, urticaria,
alopecia,
pruritus;
epidermal
necrolysis and
Stevens-
Johnson
syndrome
(very rare)
• Other: altered
taste, fever,
pain at injection
disease
for up to 6 weeks.
Maximum dosage is 40 mg
b.i.d. for up to 12 weeks.
mg/kg P.O. daily in two
divided doses, to a
maximum of 40 mg b.i.d.
Infants ages 3 months
to 1 year: 0.5 mg/kg P.O.
b.i.d. for up to 8 weeks
Infants younger than
age 3 months: 0.5 mg/kg
P.O. once daily for up to 8
Weeks
conditions (such as
Zollinger-Ellison
syndrome)
P.O. q 6 hours, increased
as needed to 160 mg q 6
Hours
➣Hospitalized patients
with pathologic
or ulcers; patients who
can’t take oral drugs
Adults: 20 mg I.V. q 12
hours
Patient teaching
● Tell patient that drug
is most effective when
taken at bedtime.
pain relief may not
begin until several days
after therapy starts.
✓ Instruct patient to
take drug exactly as
prescribed and to
immediately report
cardiovascular signs and
symptoms, seizures,
and hematologic or
● Tell female patient to
inform prescriber if she
is pregnant of
breastfeeding.
tests mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
cimetidine
Brand Name:
Tagamet HB
CLASSIFICA-
TION:
Pharmacologic
class:
Histamine2-
receptor
antagonist
Therapeutic
class: Antiulcer
drug
Pregnancy risk
category B
Competitively
inhibits
histamine
action at
histamine2-
receptor sites of
gastric parietal
cells, thereby
inhibiting
gastric acid
secretion
➣Active duodenal
ulcer (short-term
therapy)
➣Active benign
gastric ulcer
(shortterm
therapy)
➣Gastric
hypersecretory
conditions (such
as Zollinger-
Ellison syndrome)
intractable ulcers
➣Heartburn; acid
indigestion
➣Erosive
gastroesophageal
reflux
disease
drug
Use cautiously in:
● pregnant or
breastfeeding
patients.
• CNS: confusion,
dizziness,
drowsiness,
hallucinations,
agitation,
psychosis,
depression,
anxiety,
headache
• GI: diarrhea
• GU: reversible
erectile
dysfunction,
gynecomastia
Availability
Oral liquid: 200 mg/5 ml,
300 mg/5 ml
Tablets: 200 mg, 300 mg,
400 mg, 600 mg, 800 mg
Dosages
(short-term therapy)
Adults and children
older than age 16:
800 mg P.O. at bedtime,
or 300 mg P.O. q.i.d. with
meals and at bedtime, or
400 mg P.O. b.i.d.
Maintenance dosage is 400
mg P.O. at bedtime.
➣Active benign gastric
ulcer (shortterm therapy)
Adults and children
older than age 16:
800 mg P.O. at bedtime or
conditions (such as
Patient monitoring
● Monitor creatinine
renal insufficiency or
failure.
● Assess elderly or
chronically ill patients
for confusion (which
usually resolves once
drug therapy ends).
Patient teaching
● Inform patient with
gastric ulcer that ulcer
may take up to 2
months to heal. Advise
him not to discontinue
therapy, even if he feels
better, without first
consulting prescriber.
Ulcer may recur if
therapy ends too soon.
take over-thecounter
cimetidine for more
than 2 weeks
continuously, except
with prescriber’s advice

Zollinger-Ellison
syndrome)
intractable ulcers
Adults and children
older than age 16:
➣Erosive
gastroesophageal reflux
disease
Adults and children
older than age 16:
1,600 mg P.O. daily in
divided doses (800 mg
b.i.d. or 400 mg q.i.d.) for
12 weeks
➣Heartburn; acid
indigestion
Adults and children
older than age 16:
200 mg (two tablets of
over-thecounter product
only) P.O. up to b.i.d.
Give maximum dosage no
longer than 2 weeks
continuously, unless
directed by prescriber.
Dosage adjustment
and supervision.
drugs, tests, foods,
herbs, and behaviors
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
ranitidine
hydrochloride
Brand Name:
Zantac
CLASSIFICA-
TION:
Pharmacologic
class:
Histamine2-
receptor
antagonist
Therapeutic
class: Antiulcer
drug
Pregnancy risk
category B
Reduces gastric
acid secretion
and
increases gastric
mucus and
bicarbonate
production,
creating a
protective
coating
on gastric
mucosa
➣Active duodenal
ulcer
➣To maintain
healing of
duodenal ulcers
➣Benign gastric
ulcer
➣Active duodenal
and gastric ulcers
➣To maintain
healing of
duodenal and
gastric ulcers
➣Erosive
esophagitis
➣Gastroesophage
al reflux disease
➣Pathologic
hypersecretory
conditions,
including
Zollinger-Ellison
syndrome
➣Hospitalized
patients with
pathologic
hypersecretory
conditions,
drug or its
components
(with some oral
products)
● History of acute
porphyria
Use cautiously in:
● renal or hepatic
impairment, heart
rhythm disturbances,
phenylketonuria
(effervescent tablets)
● pregnant or
breastfeeding
patients.
• CNS: headache,
agitation,
anxiety
• GI: nausea,
vomiting,
diarrhea,
constipation,
abdominal
discomfort or
pain
• Hematologic:
reversible
granulocytope
nia and
thrombocytop
enia
• Hepatic:
hepatitis
• Skin: rash
• Other: pain at
I.M. injection
site, burning or
itching at I.V.
site,
hypersensitivity
reaction
Availability
Capsules (liquid-filled): 150
mg, 300 mg
mg/ml in 2-, 6-, and 40-ml
vials
Solution for injection (pre-
mixed): 50 mg/50 ml in
0.45% sodium chloride
Syrup: 15 mg/ml
Tablets: 150 mg, 300 mg
Tablets (effervescent): 150
mg
Dosages
Adults: 150 mg or 10 ml
P.O. b.i.d., or 300 mg or 20
ml P.O. daily, or 50 mg
I.V. or I.M. q 6 to 8 hours
duodenal ulcers
P.O.
Patient monitoring
● Assess vital signs.
● Monitor CBC and
liver function tests.
Patient teaching
● Tell patient he may
take oral drug with or
without food. Advise
him to take once-
daily prescription
drug at bedtime.
dissolve EFFERdose
in 6 to 8 oz of water
before taking.
● Caution patient to
avoid driving and
other hazardous
activities until he
knows how drug
affects concentration
and alertness.
● Tell patient smoking
may decrease drug
effects.
● As appropriate,
review all other

including
Zollinger-Ellison
syndrome;
intractable
duodenal ulcers;
patients
who can’t
receive oral drugs
P.O. b.i.d. For maintenance,
150 mg or 10 ml P.O. or 50
mg I.V. or I.M. q 6 to 8
hours.
➣Active duodenal and gastric
ulcers
Children ages 1 month to
16 years: 2 to 4 mg/kg/day
P.O., up to a maximum of
300 mg/day
duodenal and gastric ulcers
P.O., up to a maximum of
150 mg/day
P.O. q.i.d.
16 years: 5 to 10 mg/kg
P.O. daily in two divided
doses
disease
P.O. b.i.d.
16 years: 5 to10 mg/kg P.O.
daily in two divided doses
significant and life-
threatening adverse
reactions and
interactions,
especially
drugs, tests, herbs,
and behaviors
mentioned above.

➣Pathologic hypersecretory
conditions, including
Zollinger-Ellison syndrome
P.O. b.i.d., adjusted
according to patient’s
needs. In severe cases, up to
6 g/day may be needed.
Continue therapy as long as
indicated.
➣Hospitalized patients with
pathologic
hypersecretory conditions,
including Zollinger-Ellison
syndrome; intractable
duodenal ulcers; patients
who can’t receive oral drugs
Adults: 50 mg I.M. q 6 to 8
hours, or 50 mg intermittent
I.V. bolus q 6 to 8 hours, or
50 mg intermittent I.V.
infusion q 6 to 8 hours.
I.V. in divided doses q 6 to 8
hours, up to a maximum of
50 mg q 6 to 8 hours
Dosage adjustment
● Renal or hepatic
impairment
● Debilitated patients

Proton-pump inhibitors are members of a class of medications
whose main action is a profound and prolonged reduction of
stomach acid production. Within the class of medications, there is
no clear evidence that one agent works better than another. They
are the most potent inhibitors of acid secretion available.

DRUG DATA MECHANISM
OF ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
lansoprazole
Brand Name:
Prevacid
CLASSIFICA-
TION:
Pharmacologi
c class:
Gastric acid
pump inhibitor
Therapeutic
class:
Antiulcer drug
Pregnancy risk
category B
Inhibits
activity of
proton pump
in gastric
parietal cells,
decreasing
gastric acid
production
➣Active
duodenal ulcer
➣Maintenance
of healed
duodenal
ulcer
➣H. pylori
eradication, to
reduce risk
of duodenal
ulcer
recurrence
➣Benign
gastric ulcer
➣Gastric ulcer
associated with
NSAIDs
➣To reduce
risk of NSAID-
associated
gastric ulcer
➣Gastroesopha
geal reflux
disease
➣Erosive
esophagitis
➣To maintain
healing of
drug or its
components
Use cautiously in:
● phenylketonuria
tablets), severe
hepatic impairment
● pregnant or
breastfeeding patients
than age 18.
• CNS: headache,
confusion,
anxiety,
malaise,
paresthesia,
abnormal
thinking,
depression,
dizziness,
syncope,
cerebrovascul
ar accident
• CV: chest pain,
hypertension,
hypotension,
myocardial
infarction,
shock
• EENT: visual
field deficits,
otitis media,
tinnitus,
epistaxis
• GI: nausea,
diarrhea,
abdominal pain,
cholelithiasis,
ulcerative colitis,
Availability
Capsules (delayed-release): 15
mg, 30 mg
Granules for oral suspension
(delayedrelease,
enteric-coated): 15 mg, 30 mg
Prevpac (combination product
for Helicobacter
pylori infection): daily pack
containing two 30-mg
lansoprazole capsules, four
500-mg amoxicillin capsules,
and two 500-mg clarithromycin
tablets
Prevacid NapraPAC 375
(combination product for
reducing risk of ulcers from
nonsteroidal anti-inflammatory
drugs
[NSAIDs]): weekly pack
containing seven 15-mg
Prevacid capsules and
fourteen 375-mg Naprosyn
tablets
Prevacid NapraPAC 500
(combination product for
reducing risk of ulcers from
NSAIDs): weekly pack
Patient monitoring
● Monitor for GI
adverse reactions.
status and fluid
balance to identify
significant problems.
Patient teaching
take before meals.
● If patient has
difficulty swallowing,
tell him to open
delayed-release
contents onto small
amount of soft food
(such as applesauce
or pudding).
Emphasize that he
must not crush or
chew drug.
disintegrate.

erosive
➣Frequent
heartburn (two
or more
times a week)
esophagitis
➣Pathologic
hypersecretory
conditions
(including
Zollinger-Ellison
syndrome)
esophageal
ulcer,
hematemesis,
stomatitis,
dysphagia, GI
hemorrhage
• GU: renal
calculi, erectile
dysfunction,
abnormal
menses, breast
tenderness,
gynecomastia
• Hematologic:
anemia
• Musculoskelet
al: hip, wrist,
spine fractures
(with long-term
daily use)
• Respiratory:
cough,
bronchitis,
asthma
alopecia, acne,
pruritus,
photosensitivity
containing seven 15-mg
Prevacid capsules and
fourteen 500-mg Naprosyn
tablets
Prevacid SoluTab (delayed-
release,
orally disintegrating tablet): 15
mg, 30 mg
Dosages
Adults: 15 mg P.O. daily for 4
weeks
duodenal ulcer
reduce risk of duodenal ulcer
recurrence
Adults: In triple therapy, 30
mg lansoprazole P.O., 1 g
amoxicillin P.O., and 500 mg
clarithromycin P.O. q 12 hours
for 10 or 14 days. In dual
therapy, 30 mg lansoprazole
P.O. and 1 g amoxicillin P.O. q
8 hours for 14 days.
Adults: 30 mg P.O. daily for up
to 8 weeks
by emptying packet
contents into
container with 2 tbsp
water. Tell him
to stir contents well
and drink
immediately.
minimize GI upset
by eating small,
frequent servings of
food and drinking
plenty of fluids.
● As appropriate,
review all other
significant and life-
threatening adverse
reactions and
interactions,
especially
drugs, foods, and
herbs mentioned
above.

➣Gastric ulcer associated with
NSAIDs
Adults: 30 mg P.O. once daily
for up to 8 weeks
➣To reduce risk of NSAID-
associated gastric ulcer
Adults: 15 mg P.O. daily for up
to 12 weeks
disease
Adults and children ages 12
to 17: 15 mg P.O. daily for up
to 8 weeks
weighing more than 30 kg
(66 lb): 30 mg P.O. daily for
up to 12 weeks
weighing 30 kg (66 lb) or
less: 15 mg P.O. daily for up
to 12 weeks
Adults and children ages 12
to 17: 30 mg P.O. daily for up
to 8 weeks. Some patients may
require 8 additional weeks.
weighing more than 30 kg
(66 lb): 30 mg P.O. daily for
up to 12 weeks

weighing 30 kg (66 lb) or
less: 15 mg P.O. daily for up
to 12 weeks
➣To maintain healing of erosive
esophagitis
➣Pathologic hypersecretory
conditions (including Zollinger-
Ellison syndrome)
Adults: Initially, 60 mg P.O.
daily, to a maximum of 90 mg
P.O. b.i.d. Divide daily dosages
over 120 mg.
➣Frequent heartburn (two or
more times a week)
Adults: 15 mg P.O. (delayed-
release capsule) daily up to 14
days
Dosage adjustment
insufficiency

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
omeprazole
magnesium
Brand Name:
Prilosec
CLASSIFICA-
TION:
Pharmacologic
class: Proton
pump inhibitor
Therapeutic
class: Antiulcer
drug
Pregnancy risk
category C
Reduces gastric
acid secretion
and increases
gastric mucus
and bicarbonate
production,
creating
protective
coating on
gastric mucosa
and easing
discomfort from
excess gastric
acid
➣Gastro
esophageal reflux
disease
➣Erosive
esophagitis
➣Short-term
treatment of
active duodenal
ulcer
➣To reduce risk
of duodenal ulcers
caused by
Helicobacter
pylori
➣Gastric ulcers
➣Pathologic
hypersecretory
conditions,
including
Zollinger-Ellison
syndrome
➣Frequent
heartburn (two or
more episodes a
week)
drug or its
components
Use cautiously in:
● hepatic disease
● hypomagnesemia
● concurrent use of
clopidogrel (avoid
use)
● pregnant or
breastfeeding
patients
● children (safety not
established).
• CNS: dizziness,
headache,
asthenia
• GI: nausea,
vomiting,
diarrhea,
constipation,
abdominal pain
• Metabolic:
hypomagne
semia
• Musculoskelet
al: back pain;
fractures of hip,
wrist, spine
(with long-term
daily use)
• Respiratory:
cough, upper
respiratory
tract infection
• Skin: rash
Availability
Capsules (delayed-
release): 10 mg, 20 mg,
40 mg
Powder for oral suspension
(delayedrelease):
2.5 mg, 10 mg in packets
Tablets (delayed-release):
20 mg
Dosages
disease
Adults: 20 mg P.O.
(capsules, powder) daily
for 4 weeks
Adults: 20 mg P.O.
(capsules, powder)
daily for 4 to 8 weeks
➣Short-term treatment of
active duodenal ulcer
Adults: 20 mg P.O.
(capsules, powder) daily
for 4 weeks. Some
patients may need 4
Patient monitoring
● Assess vital signs.
● Check for abdominal
pain, emesis, diarrhea,
or constipation.
● Evaluate fluid intake
and output.
● Watch for elevated
liver function test
results (rare).
● Monitor magnesium
level before starting
drug and periodically
thereafter in patients
expected to be on long-
term treatment or who
take proton pump
inhibitors with other
drugs such as digoxin or
drugs that may cause
hypomagnesemia.
Patient teaching
● Tell patient to take 30
to 60 minutes before a
meal, preferably in
morning.

additional weeks of
therapy.
duodenal ulcers caused by
Helicobacter pylori
Adults: 40 mg P.O.
(capsules) daily in
morning, given with
clarithromycin t.i.d. for 2
weeks; then 20 mg daily
for 2 weeks
➣Gastric ulcers
Adults: 40 mg P.O.
(capsules) daily for 4 to 8
weeks
➣Pathologic
hypersecretory conditions,
syndrome
P.O. (capsules) daily; may
increase up to 120 mg
t.i.d. Divide daily dosages
above 80 mg.
or more episodes a week)
Adults ages 18 and
older: 20 mg P.O. (OTC
tablets, capsules, or
powder) daily for 14 days
swallow capsules or
tablets whole and not to
chew or crush them. If
he can’t swallow
capsule, tell him he may
open it, carefully
sprinkle and mix entire
contents into 1 tbsp of
cool applesauce, and
swallow immediately
with glass of water.
● Instruct patient on
how to use delayed-
release oral suspension:
Empty contents of a
2.5-mg packet of
powder into a container
with 5 ml of water or
10-mg packet of powder
into a container with 15
ml of water; don’t use
other liquids or foods.
Stir and allow drug to
thicken for 2 to
minutes. Stir well and
drink within 30 minutes.
If any drug remains
after drinking, add more
water to container, stir,
● Inform patient taking
OTC delayedrelease
tablets for heartburn
that full effect may take

1 to 4 days. Advise him
not to take tablets for
more than 14 days
without consulting
health care professional.
avoid St John’s wort
while taking this drug.
avoid driving and other
hazardous activities
until he knows how drug
and alertness.
drugs and tests
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
esomeprazole
magnesium
Brand Name:
Nexium
CLASSIFICA-
TION:
Pharmacologic
class: Proton
pump inhibitor
Therapeutic
class: Antiulcer
agent
Pregnancy risk
category C
Reduces gastric
acid production
by inhibiting
enzyme activity
in gastric
parietal cells,
preventing
transport of
hydrogen ions
into gastric
lumen
➣Treatment of
gastroesophageal
reflux disease
(GERD); healing
of erosive
esophagitis
➣Treatment of
GERD;
maintenance of
healing of erosive
esophagitis
➣Symptomatic
GERD
➣Helicobacter
pylori eradication
to decrease risk
of duodenal ulcer
recurrence
➣Treatment of
pathological
hypersecretory
conditions
including
Zollinger-Ellison
syndrome
proton pump
Inhibitors
Use cautiously in:
● severe hepatic
impairment
● increased risk of
hip, wrist, and spine
fractures
● pregnant or
breastfeeding
patients
than age 18 (safety
not established).
• CNS: headache,
dizziness,
asthenia,
vertigo, apathy,
anxiety,
paresthesia,
insomnia,
abnormal
dreams
• EENT: sinusitis,
epistaxis
• GI: nausea,
vomiting,
diarrhea,
constipation,
abdominal pain,
flatulence, dry
mouth
• Metabolic:
hypomagne
semia
• Musculoskelet
al: hip, wrist,
spine fractures
(with long-term
daily use)
• Respiratory:
upper
Availability
Capsules (delayed-
release): 20 mg, 40 mg
Powder for delayed-release
oral suspension: 2.5-mg,
5-mg, 10-mg, 20-mg, 40-
mg packets
Dosages
➣Treatment of
gastroesophageal
reflux disease (GERD);
healing of erosive
esophagitis
Children ages 1 month
to younger than 1 year
weighing 3 kg (6.5 lb)
to 5 kg: 2.5 mg P.O. daily
for up to 6 weeks
Adults: 20 to 40 mg P.O.
once daily for 4 to 8 weeks
weighing more than 7.5
kg to 12 kg (16.5 to 26
lb): 10 mg P.O. daily for
up to 6 weeks
Patient monitoring
● Monitor neurologic
status, especially for
dizziness, headache,
paresthesia, and
asthenia.
● Watch for signs and
symptoms of EENT and
respiratory infections.
● Assess nutritional and
hydration status in light
of adverse GI effects.
● Check for rash and
other signs of
hypersensitivity.
● Monitor liver function
test results if patient is
on long-term therapy.
● Continue to monitor
patients periodically
who are expected to be
on prolonged treatment
or who take proton
pump inhibitors with
drugs such as digoxin or
drugs that may cause
hypomagnesemia.

respiratory tract
infection, cough
• Skin: rash,
inflammation,
urticaria,
pruritus,
alopecia, dry
skin
kg (11 lb) to 7.5 kg: 5
weeks
weighing 20 kg (44 lb)
or more: 10 or 20 mg
P.O. daily for 8 weeks
weighing less than 20
kg (44 lb): 10 mg P.O.
daily for 8 weeks
➣Treatment of GERD;
maintenance of healing of
erosive esophagitis
daily
➣Symptomatic GERD
daily for 4 weeks
20 or 40 mg P.O. daily for
up to 8 weeks
8 weeks
➣Helicobacter pylori
eradication to decrease
risk of duodenal ulcer
recurrence
Patient teaching
take drug 1 hour before
or 2 hours after a meal.
● If patient has trouble
swallowing capsule, tell
him to open it, sprinkle
pellets into soft food
(such as applesauce),
and take right away.
recognize and report
signs or symptoms of
hypomagnesemia.
and alertness.
● Advise female patient
to tell prescriber if she’s
pregnant of
breastfeeding.
drugs and tests
mentioned above.

daily for 10 days, given in
combination with
amoxicillin 1,000 mg b.i.d.
for 10 days and with
clarithromycin 500 mg
b.i.d. for 10 days
➣Treatment of
pathological
syndrome
➣Risk reduction of NSAID-
associated gastric ulcer
Adults: 20 or 40 mg P.O.
once daily for up to 6
months

Antidiarrheals are the name given to certain types of medicines
that stop or slow diarrhea. Antidiarrheals only relieve the
symptoms of diarrhea, such as an increased frequency and
urgency when passing stools, they do not eliminate the cause of
it.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
loperamide
hydrochloride
Brand Name:
Imodium
CLASSIFICA-
TION:
Pharmacologic
class: Piperidine
derivative
Therapeutic
class:
Antidiarrheal
Pregnancy risk
category B
Inhibits
peristalsis of
intestinal wall
musculature
and intestinal
contents.
Also reduces
fecal volume,
increases
fecal bulk, and
minimizes fluid
and electrolyte
loss.
➣Acute diarrhea
➣Acute diarrhea
(treated with
overthe-counter
loperamide)
➣Chronic
diarrhea
drug
● Abdominal pain of
unknown cause
(especially with
fever)
● Acute diarrhea
caused by
enteroinvasive
Escherichia coli,
Salmonella, or
Shigella
● Acute ulcerative
colitis
● Bloody diarrhea
with temperature
above 38.3 °C (101
°F) (with OTC
product)
● Pseudo
membranous colitis
associated with
broad-spectrum
antiinfectives
● Children younger
than age 6
Use cautiously in:
• CNS:
drowsiness,
dizziness
• GI: nausea;
vomiting;
constipation;
abdominal pain,
distention, or
discomfort; dry
mouth; toxic
megacolon (in
patients with
acute
ulcerative
colitis)
• Other: allergic
reactions
Availability
Capsules: 2 mg
Solution: 1 mg/5 ml
Tablets: 2 mg
Dosages
➣Acute diarrhea
P.O., then 2 mg after
each loose stool. Usual
maintenance dosage is 4
to 8 mg P.O. daily in
divided doses, not to
exceed 16 mg daily.
or weighing more than
30 kg (66 lb): Initially, 2
mg P.O. t.i.d., then 1
mg/10 kg after each loose
stool, not to exceed 6 mg
daily
Children ages 6 to 8 or
weighing 20 to 30 kg
(44 to 66 lb): Initially, 2
mg P.O.b.i.d., then 1
Patient monitoring
✓ Watch for signs and
symptoms of abdominal
distention, which may
signal toxic megacolon
in patient with
ulcerative colitis.
● Assess bowel
movements to evaluate
drug efficacy and
determine need for
repeat doses.
● Monitor stool cultures
as indicated.
● Check stool for occult
blood as indicated.
● Evaluate fluid intake
and output.
● Stay alert for CNS
effects, especially in
children.
Patient teaching
● Stress importance of
maintaining high fluid
intake to prevent
dehydration.
✓ Instruct patient or

● hepatic disease
● pregnant or
breastfeeding
patients
● children.
daily
Children ages 2 to 5 or
weighing 13 to 20 kg
(29 to 44 lb): Initially, 1
mg P.O. t.i.d., then 1
daily
➣Acute diarrhea (treated
with overthe-counter
loperamide)
Adults and children
ages 12 and older:
Two caplets with 4 to 8 oz
water after first loose
stool, then one caplet
(with 4 to 8 oz water)
after each subsequent
loose stool. Don’t exceed
four caplets in 24 hours.
Or give equivalent dosage
in liquid form.
who weigh 27 to
43 kg (60 to 95 lbs):
One caplet with 4 to 8 oz
stool, then 1⁄2 caplet
(with 4 to 8 oz water)
after each subsequent
loose stool. Don’t exceed
three caplets in 24 hours.
Or give equivalent dosage
parents to report fever,
mucus in stool, or
history of hepatic
disease before using
drug.
✓ Caution patient or
parents to discontinue
drug if symptoms
worsen or diarrhea lasts
longer than 2 days.
drugs, herbs, and
behaviors mentioned
above.

in liquid form.
who weigh 22 to
27 kg (48 to 59 lbs):
One caplet with 4 to 8 oz
stool, then 1⁄2 caplet with
4 to 8 oz water after each
subsequent loose stool.
Don’t exceed two caplets
in 24 hours. Or give
equivalent dosage in
liquid form.
Children younger than
age 6: Consult physician.
➣Chronic diarrhea
P.O., then 2 mg after
each loose stool; reduce
dosage as tolerated.
Don’t exceed 16 mg
daily for more than 10
days.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
diphenoxylate
hydrochloride
and atropine
sulfate(co-
phenotrope )
Brand Name:
Lomotil
CLASSIFICA-
TION:
Pharmacologic
class:
Anticholinergic,
meperidine
congener
Therapeutic
class:
Antidiarrheal
Acts on smooth
muscle of GI
tract by
decreasing
peristalsis,
which inhibits
motility. (Small
amount of
atropine is
added to reduce
abuse
potential.)
➣Diarrhea ● Hypersensitivity to
drug
● Obstructive
jaundice
● Diarrhea
associated with
pseudomembranous
colitis or entero
toxinproducing
bacteria
● Angle-closure
glaucoma
● Concurrent MAO
inhibitor use
● Children younger
than age 2
Use cautiously in:
● inflammatory
bowel disease;
prostatic
hypertrophy; severe
hepatic disease
(use with extreme
caution)
● concurrent use of
drugs that cause
physical
• CNS: dizziness,
confusion,
drowsiness,
headache,
insomnia,
nervousness
• CV: tachycardia
• EENT: blurred
vision, dry eyes
• GI: nausea,
vomiting,
constipation,
epigastric
distress, ileus,
dry mouth
• GU: urinary
retention
• Skin: flushing
Availability
Liquid: 2.5 mg
diphenoxylate and
0.025 mg atropine/5 ml
Tablets: 2.5 mg
diphenoxylate and
0.025 mg atropine
Dosages
➣Diarrhea
P.O. three to four
times daily, then 5
mg/day as needed
(not to exceed 20
mg/day). Decrease
dosage when desired
response occurs.
Children: Initially, 0.3 to
0.4 mg/kg P.O. (liquid
only) daily in four divided
doses. Decrease dosage
when desired response
occurs.
Dosage adjustment
● Elderly patients
Patient monitoring
✓ Assess for and report
abdominal distention
and signs or symptoms
of decreased peristalsis.
● Watch for signs and
symptoms of
dehydration.
● Assess frequency and
consistency of bowel
movements.
Patient teaching
report persistent
diarrhea.
and alertness.
● Tell patient that
prolonged use may lead
to dependence.

Controlled
substance
schedule V
Pregnancy risk
category C
dependence; history
of physical drug
dependence
● pregnant or
breastfeeding
patients
● children (safety not
established in
children younger
than age 12).
drugs, tests, herbs, and
behaviors mentioned
above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
octreotide
acetate
Brand Name:
Sandostatin
CLASSIFICA-
TION:
Pharmacologic
class:
Somatostatin
Analog
Therapeutic
class:
Antidiarrheal
Pregnancy risk
category B
Suppresses
secretion of
serotonin,
serotonin
metabolites,
and gastro
hepatic
peptides,
increasing fluid
and electrolyte
absorption from
GI tract. Also
suppresses
growth
hormone,
insulin, and
glucagon.
➣Diarrhea and
flushing
associated with
carcinoid tumors
➣Diarrhea caused
by vasoactive
intestinal peptide
tumors (VIPomas)
➣Acromegaly
drug or its
components
Use cautiously in:
● gallbladder
disease, renal
impairment,
hyperglycemia or
hypoglycemia,
fat malabsorption
● pregnant or
breastfeeding
patients
● children.
• CNS: dizziness,
drowsiness,
fatigue,
headache,
weakness
• CV: edema,
bradycardia,
conduction
abnormalities,
arrhythmias
• EENT: vision
disturbances
• GI: nausea,
vomiting,
diarrhea,
abdominal
pain,
cholelithiasis, fat
malabsorption
• Skin: flushing
• Metabolic:
hypothyroidism,
hyperglycemia,
hypoglycemia
• Other: injection
site pain
Availability
Depot injection: 10 mg, 20
mg, 30 mg
Injection: 0.05 mg/ml, 0.1
mg/ml, and 0.5 mg/ml in
1-ml ampules; 0.2 mg/ml
and 1 mg/ml in 5-ml vials
Dosages
➣Diarrhea and flushing
associated with carcinoid
tumors
Adults: 100 to 600 mcg
(Sandostatin)
subcutaneously or I.V.
daily in two to four
divided doses for 2 weeks.
Then, depending on
response, 20 mg (LAR
Depot) I.M. q 4 weeks for
2 months.
➣Diarrhea caused by
vasoactive intestinal
peptide tumors (VIPomas)
(Sandostatin)
Patient monitoring
● Assess bowel sounds
and stool frequency
and consistency.
● Monitor vital signs and
fluid intake and output.
Stay alert for
dehydration or edema.
● Evaluate diabetic
patient for
hypoglycemia or
hyperglycemia.
● Know that in women
with active acromegaly,
normalization of growth
hormone and insulin-
like growth factor-1
may restore fertility.
Patient teaching
● Tell patient being
treated for carcinoid
tumor to keep track of
number of daily stools
or flushing episodes.
weigh himself daily and
report significant

daily in two to four
divided doses for 2 weeks.
Then, depending on
2 months.
➣Acromegaly
(Sandostatin)
two or three times daily.
Then, depending on
3 months. Then adjust
based on growth hormone
levels.
Dosage adjustment
changes.
● Advise female with
childbearing potential to
use adequate
contraception while
taking drug.
● If patient will use drug
at home, teach correct
methods for injection,
storage, and needle
disposal.
affects concentration,
vision, and alertness.
drugs, tests, and foods
mentioned above.

Laxatives are substances that either loosen stool or stimulate a
bowel movement. They can also accelerate intestinal transit,
which helps speed up the movement of the digestive tract to
spur a bowel movement.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
bisacodyl
Brand Name:
Dulcolax
CLASSIFICA-
TION:
Pharmacologic
class: Stimulant
Laxative
Therapeutic
class: Laxative
Pregnancy risk
category B
Unclear.
Thought to
stimulate
colonic
mucosa,
producing para
sympathetic
reflexes that
enhance
peristalsis and
increase water
and electrolyte
secretion,
thereby causing
evacuation of
colon.
➣Constipation;
bowel cleansing
for childbirth,
surgery, and
endoscopic
examination
drug
● Intestinal
obstruction
● Gastroenteritis
● Appendicitis
Use cautiously in:
● hypersensitivity to
tannic acid
● severe
cardiovascular
disease, anal or
rectal fissures
● pregnant or
breastfeeding
patients.
• CNS: dizziness,
syncope
• GI: nausea,
vomiting,
diarrhea (with
high doses),
abdominal pain,
burning
sensation in
rectum (with
suppositories),
laxative
dependence,
protein-losing
enteropathy
• Metabolic:
hypokalemia,
fluid and
electrolyte
imbalances,
tetany,
alkalosis
• Musculoskelet
al: muscle
weakness (with
excessive use)
Availability
Enema: 0.33 mg/ml, 10
mg/ml
Powder for rectal solution:
1.5 mg bisacodyl and 2.5 g
tannic acid
Suppositories (rectal): 5
mg, 10 mg
Tablets (enteric-coated): 5
mg
Dosages
➣Constipation; bowel
cleansing for childbirth,
surgery, and endoscopic
examination
Adults and children
ages 12 and older:
5 to 15 mg P.O. or 10 mg
P.R. as a single dose
Children older than age
3: 5 to 10 mg or 0.3
mg/kg P.O. as a single
dose
Children ages 2 and
older: 5 to 10 mg
P.R. as a single dose
Children younger than
Patient monitoring
● Assess stools for
frequency and
consistency.
● Monitor patient for
electrolyte imbalances
and dehydration.
Patient teaching
swallow (not chew)
enteric-coated tablets
no sooner than 1 hour
before or after ingesting
antacids or dairy
products. Tell him not
to chew tablets.
use bisacodyl or other
laxatives habitually
because this may lead
to laxative dependence.
● Suggest other ways to
prevent constipation,
such as by eating more
fruits, vegetables, and
whole grains to increase
dietary bulk and by

age 2: 5 mg P.R. as a
single dose
drinking 8 to 10 glasses
of water daily.
drugs, tests, and foods
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
calcium
polycarbophil
Brand Name:
Equalactin
CLASSIFICA-
TION:
Pharmacologic
class: Bulk-
forming
Agent
Therapeutic
class: Laxative
Pregnancy risk
category NR
Absorbs water,
thereby
expanding and
increasing bulk
and moisture
content
of stool;
increased bulk
promotes
peristalsis
and bowel
movement.
➣Constipation
➣Diarrhea;
irritable bowel
syndrome
● GI obstruction
● Difficulty
swallowing
Use cautiously in:
● pregnant or
breastfeeding
patients
● children.
• CV: chest pain
• GI: nausea,
vomiting,
abdominal pain,
flatulence, rectal
bleeding,
intestinal
obstruction
• Respiratory:
difficulty
breathing
• Other: laxative
dependence
Availability
Tablets: 500 mg
Tablets (chewable): 500
mg, 1,250 mg
Dosages
➣Constipation
Adults and children
ages 12 and older:
1 g P.O. q.i.d. as needed.
Maximum dosage is 6 g
daily.
500 mg P.O. one to three
times daily as needed.
daily.
500 mg P.O. b.i.d. as
needed. Maximum dosage
is 1.5 g daily.
➣Diarrhea; irritable bowel
syndrome
Adults and children
ages 12 and older:
1 g P.O. q.i.d. as needed.
Patient monitoring
difficulty breathing and
intestinal obstruction.
● Assess for rectal
bleeding and for failure
to respond to drug.
● Monitor fluid intake
and output, and assess
hydration status
regularly.
Patient teaching
take each dose with at
least 8 oz of water or
other fluid.
space doses at least
2 hours apart from
other drugs.
✓ Urge patient to seek
immediate medical
attention if he
experiences chest pain,
vomiting, difficulty
breathing, or rectal

daily.
500 mg P.O. one to three
times daily as needed.
Maximum dosage is 3 g in
a 24-hour period.
500 mg P.O. b.i.d. as
needed. Maximum dosage
is 1.5 g daily.
bleeding.
● Advise patient to tell
prescriber if he’s taking
other drugs or if he has
abdominal pain, nausea,
vomiting, or a sudden
change in bowel habits
lasting 2 weeks or
longer.
drugs and herbs
mentioned above.

Most patients are given antinausea medication, called
an antiemetic, before chemotherapy is
administered. Antiemetics are used to block the nerve impulse
that travels from the blood or stomach to the brain (where the
vomiting center is located).

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
dolasetron
mesylate
Brand Name:
Anzemet
CLASSIFICA-
TION:
Pharmacologic
class: Selective
serotonin
subtype 3 (5-
HT3) receptor
antagonist
Therapeutic
class:
Antiemetic
Pregnancy risk
category B
Blocks serotonin
activation at
receptor sites in
vagal nerve
terminals and in
chemoreceptor
trigger zone in
CNS, decreasing
the vomiting
reflex
➣Chemotherapy-
induced nausea
and vomiting
➣Prevention or
treatment of
postoperative
nausea and
vomiting
drug
● Arrhythmias
Use cautiously in:
● risk factors for
prolonged cardiac
conduction intervals
● pregnant or
breastfeeding
patients
(safety not
established).
• CNS: headache
(increased in
cancer
patients),
dizziness,
fatigue, syncope
• CV: bradycardia,
tachycardia,
ECG changes,
hypertension,
hypotension
• GI: diarrhea,
constipation,
dyspepsia,
abdominal pain
• GU: urinary
retention,
oliguria
• Skin: pruritus,
rash
• Other: chills,
fever, decreased
appetite
Availability
Injection: 12.5 mg/0.625-
ml ampules,
20 mg/ml in 5-ml vials
Tablets: 50 mg, 100 mg
Dosages
➣Chemotherapy-induced
nausea and vomiting
Adults: 100 mg P.O. 1
hour before chemotherapy
or 1.8 mg/kg I.V. 30
minutes before
chemotherapy
1.8 mg/kg P.O. within 1
hour before chemotherapy
or 1.8 mg/kg I.V. (not to
exceed 100 mg) 30
minutes before
chemotherapy
➣Prevention or treatment
of postoperative nausea
and vomiting
Adults: 100 mg P.O.
within 2 hours before
surgery or 12.5 mg I.V. 15
Patient monitoring
● Monitor closely for
excessive diuresis.
✓ Watch for ECG
changes, including
prolonged PR interval
and widened QRS
complex, especially in
patients receiving
antiarrhythmics
concurrently.
Patient teaching
take drug 1 to 2 hours
before chemotherapy.
drug commonly causes
headache.
drugs and tests
mentioned above.

minutes before cessation
of anesthesia (for
prevention) or as soon as
nausea or vomiting begins
(for treatment)
1.2 mg/kg P.O. (up to 100
mg/dose) within 2 hours
before surgery or 0.35
mg/kg I.V. (up to 12.5
mg) 15 minutes before
cessation of anesthesia
(for prevention) or as soon
as nausea or vomiting
begins (for treatment)

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
dronabinol
Brand Name:
Marinol
CLASSIFICA-
TION:
Pharmacologic
class:
Cannabinoid
Therapeutic
class:
Antiemetic
Controlled
substance III
Pregnancy risk
category B
Unknown. May
exert antiemetic
effect
by inhibiting
vomiting control
mechanism
in medulla
oblongata.
➣Prevention of
nausea and
vomiting caused
by chemotherapy
➣Appetite
stimulant
cannabinoids or
sesame oil
● Breastfeeding
Use cautiously in:
● hypertension, heart
disease, bipolar
disorder,
schizophrenia, drug
abuse,
seizures
● pregnant patients.
• CNS:
drowsiness,
anxiety,
impaired
coordination,
irritability,
depression,
headache,
hallucinations,
memory loss,
paresthesia,
ataxia, paranoia,
disorientation,
nightmares,
speech
difficulties,
syncope,
suicidal
ideation
• CV: tachycardia,
hypotension,
hypertension
• EENT: visual
disturbances,
tinnitus
• GI: dry mouth
• Skin: facial
flushing,
Availability
Capsules: 2.5 mg, 5 mg,
10 mg
Dosages
➣Prevention of nausea
and vomiting caused by
chemotherapy
Adults and children:
Initially, 5 mg/m2P.O. 1 to
3 hours before
chemotherapy. Repeat
dose q 2 to 4 hours after
chemotherapy, up to four
to six doses per day. If 5-
mg/m2 dose is ineffective
and patient has no
significant adverse
reactions, dosage may be
increased in increments of
2.5 mg/m2 to a maximum
dosage of 15 mg/m2.
➣Appetite stimulant
Adults and children:
Initially, 2.5 mg P.O.
b.i.d.May reduce dosage to
2.5 mg/day given as a
Patient monitoring
● Monitor vital signs for
hypotension and
tachycardia.
✓ Check for adverse
CNS reactions. Report
significant depression,
paranoid reaction, or
emotional lability.
● Monitor nutritional
status and hydration.
Patient teaching
● Teach patient about
drug’s significant
adverse CNS and
cardiovascular effects.
Emphasize that he
should take it only as
prescribed and needed.
✓ Advise patient (and
significant other) to
immediately report
depression, suicidal
thoughts, paranoid
reactions, seizures, and
other serious CNS
reactions.

diaphoresis single evening or bedtime
dose. Maximum dosage is
10 mg P.O. b.i.d.
and alertness.
drugs and behaviors
mentioned above.

ACTION
REACTIONS
CONSIDERATIONS
Generic
Name:
trimetho-
benzamide
hydrochloride
Brand Name:
Tigan
CLASSIFICA-
TION:
Pharmacologic
class:
Anticholinergic
Therapeutic
class:
Antiemetic
Pregnancy risk
category C
Unclear.
Thought to
block dopamine
receptors and
emetic impulses
in
chemoreceptor
trigger zone,
preventing
nausea and
vomiting.
➣Nausea and
vomiting
drug
● Parenteral form in
children
Use cautiously in:
● renal impairment,
arrhythmias,
encephalitis,
gastroenteritis,
dehydration,
electrolyte
imbalances
● concurrent alcohol
use
● elderly or
debilitated patients
● pregnant or
breastfeeding
patients
● children with
known or suspected
viral illnesses.
• CNS:
drowsiness,
dizziness,
headache,
depression,
disorientation,
parkinsonian
symptoms,
coma, seizures
• CV: hypotension
• EENT: blurred
vision
• Hematologic:
blood
dyscrasias
• Hepatic:
jaundice
• Musculoskelet
al: muscle
cramps,
opisthotonos
• Skin: rash,
urticaria,
flushing
• Other: pain and
stinging at I.M.
injection site,
hypersensitivity
Availability
Capsules: 300 mg
Injection: 100 mg/ml in 2-
ml ampoules and prefilled
syringes and in 20-ml vials
Dosages
➣Nausea and vomiting
Adults: 300 mg P.O. three
to four times daily or 200
mg I.M. three to four
times daily
Dosage adjustment
Patient monitoring
● Monitor neurologic
status, especially
for parkinsonian
symptoms and other
serious adverse
reactions.
● Assess CBC and liver
function tests. Watch
for blood dyscrasias and
jaundice.
● Evaluate injection site
for pain and stinging.
● Closely monitor
patient’s nutritional and
hydration status. Report
continuing nausea.
Patient teaching
● Advise patient to take
as needed for nausea
and vomiting, but only
as prescribed.
● Tell patient to contact
prescriber promptly if
nausea persists despite
therapy.

reaction minimize nausea and
vomiting by eating
small, frequent servings
of healthy food and
avoid alcohol.
until drug effects are
known.
drugs and behaviors
mentioned above.

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