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Ati flash cards 10, medications affecting digestion and nutrition

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Ati flash cards 10, medications affecting digestion and nutrition

  1. 1. Meds Affecting Digestion and Nutrition (General Key Points) N203 ATI (Unit 10) Digestion and Nutrition -
  2. 2. · GI tract is the route of administration and the target of action · GI effects are common (abdominal pain, constipation, nausea) · When peptic ulcers are caused by H. pylori, non-antibiotics promote healing but only antibiotics will cure the disease. · Drug therapy for peptic ulcers is directed at controlling symptoms, facilitating healing, lowering risk for complications, and preventing relapse · Prevention of emesis is more effective than treating it.
  3. 3. Histamine2 (H2) Receptor Agonists N203 ATI (Unit 10) Digestion and Nutrition -
  4. 4. Expected Action: Proto: ranitidine (Zantec) — Others: cimetidine (Tagamet), nizatidine (Axid), famotidine (Pepcid) · Selectively block H2 receptors in parietal cells to suppress gastric acid secretion Therapeutic Uses: · OTC for heartburn, sour stomach, and indigestion · Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger syndrome) · In conjunction with antibiotics to treat ulcers caused by H. pylori. Adverse Effects: ·  libido / impotence · CNS effects (lethargy, depression, confusion) -  frequent in elderly ĉ renal or liver dysfunction. Contraindications/Precautions: ♀ (B) · ·  risk of bacterial colonization of stomach and respiratory tract Interactions: · · Warfarin, phenytoin – metabolizing enzymes inhibited by cimetidine   levels · Concurrent use of antacids  absorption H2-receptor antagonists Education: · Stop drinking, stop smoking, eat smaller, more frequent meals · Ranitidine can be taken without regard to food
  5. 5. Proton Pump Inhibitor N203 ATI (Unit 10) Digestion and Nutrition -
  6. 6. Expected Action: Proto: omeprazole (Prilosec) — Others: pantoprazole (Protonix), lansoprazole (Prevacid), esomeprazole (Nexium) ·  gastric acid secretion by irreversible inhibition of enzyme that produces it. · Reduce basal and stimulated acid production Therapeutic Uses: · · Gastric/peptic ulcers / GERD / hypersecretory conditions (Zollinger syndrome) Adverse Effects: · Insignificant ĉ short-term treatment Contraindications/Precautions: ♀ (C) · ·  risk pneumonia d/t  pH promoting bacterial colonization Interactions: · · Delayed absorption of Ampicillin, digoxin, iron, ketoconazole if concurrent Education: · · IV pantoprazole may cause thrombophlebitis, headache, or diarrhea.
  7. 7. Sucralfate N203 ATI (Unit 10) Digestion and Nutrition -
  8. 8. Expected Action: Proto: Sucralfate (Carafate) · Acidic conditions Δ sucralfate to viscous gel that adheres to and protects ulcers. Therapeutic Uses: · Acute duodenal ulcers · Investigational use for gastric ulcers and GERD Adverse Effects: · No systemic effects · Avoid constipation by > 1500 cc  and  fiber Contraindications/Precautions: ♀ (B) · Interactions: · Antacids interfere with absorption of sucralfate. ·  absorption of phenytoin, digoxin, warfarin, ciprofloxacin Education: · Take on empty stomach, 4x per day
  9. 9. Antacids N203 ATI (Unit 10) Digestion and Nutrition -
  10. 10. Expected Action: Proto: Al(OH)3 gel (Amphojel), Others: AlCO3, Mg(OH)2 (Milk of Magnesia), NaHCO3 · Neutralize gastric acid and inactivate pepsin · Mucosal protection through stimulation of prostaglandin production Therapeutic Uses: · Peptic ulcer disease and GERD Adverse Effects: · Al/Ca compounds  constipation, Mg compounds  diarrhea · Na+-containing  fluid retention · Al(OH)3hypophosphatemia · Mg2+ compounds  toxicity with renal impairment. Contraindications/Precautions: ♀ (C) · GI perforation or obstruction Interactions: · · Aluminum-compounds bind to warfarin, tetracycline and  their absorption Education: · Chew tablets thoroughly then take with 8 oz water or milk · Frequency of administration makes compliance difficult
  11. 11. Prostaglandin E Analog N203 ATI (Unit 10) Digestion and Nutrition -
  12. 12. Expected Action: Proto: misoprostol (Cytotec) ·  acid secretion /  secretion of HCO3 - and mucus /  submucosal vasodilation. Therapeutic Uses: · Long-term NSAID therapy · Induce labor by causing cervical ripening. Adverse Effects: · Diarrhea and abdominal pain · Dysmenorrhea and spotting Contraindications/Precautions: ♀ (X) · Potential to become pregnant
  13. 13. Antiemetics (Types) N203 ATI (Unit 10) Digestion and Nutrition -
  14. 14. · Serotonin antagonists........................................................ondansetron (Zofran) · Dopamine antagonists........................................prochlorperazine (Compazine) · Glucocorticoids dexamethasone (Decadron) · Cannabinoids dronabinol (Marinol) · Anticholinergics scopolamine (Transderm Scop) · Antihistamine dimenhydrinate (Dramamine) Others · Granisetron (Kytril) · Promethazine (Phenergan) · Metoclopramide (Reglan) · Hydroxyzine (Vistaril) · Aprepitant (Emend)
  15. 15. Antiemetics (Action, Use, Effects, Interactions) N203 ATI (Unit 10) Digestion and Nutrition -
  16. 16. Agent: Action Use Ondansetron  SERR in CTZ & vagal nerve Chemo, radiation, postop Prochlorperazine  DOPR in CTZ Chemo, opioids, postop Dexamethasone Unknown VC = Combo for chemotherapy Dronabinol Unknown vomiting center Chemotherapy (CINV) Scopolamine  impulses: inner ear  VC Motion sickness Dimenhydrinate  HISR MUSR inner ear  VC Motion sickness Agent Adverse Effect Ondansetron Headache, diarrhea, dizziness Prochlorperazine EPS (Tx ĉ Benadryl or Ativan), hypotension, sedation, and anticholinergic effects. Dronabinol Dissociation, dysphoria, hypotension, tachycardia AntiCh, AntiHis Sedation, anticholinergic effects Interactions · CTZ = chemoreceptor trigger zone · CNS depressants / Antihypertensives / Anticholinergics  Additive Effects · Antagonists ĉ urinary retention, asthma, and narrow-angle glaucoma · Combo therapy allows lower doses of each  side effects
  17. 17. Laxatives N203 ATI (Unit 10) Digestion and Nutrition -
  18. 18. Agent: Action Use Bulk-forming {psyllium} Soften mass,  bulk – same as dietary fiber. diarrhea, control stool, promote defecation Surfactant {docusate}  H2O content Opioids, pain, straining, risk impaction, promote defecation Stimulant {bisacodyl}  peristalsis, H2O absorption ( colon,  intestine) Colonoscopy prep, short-term Tx d/t  opioid use Osmotic {Mg(OH) 3}  intestine H2O   mass  stretching   peristalsis Chemotherapy (CINV) Agent Adverse Effect All GI irritation All Rectal burningproctitis ( regular use of bisacodyl suppository) Mg2+ salts Accumulate toxic levels of magnesium ( in renal dysfunction) Na+ salts Accumulation: in heart disease and hypertension Interactions · Milk & antacids destroy enteric coating · Fecal impaction / bowel obstruction / ulcerative colitis / diverticulitis · Promote  fiber foods and > 1.5 L  daily
  19. 19. Antidiarrheals N203 ATI (Unit 10) Digestion and Nutrition -
  20. 20. Expected Action: Proto: diphenoxylate (Lomotil) Others: loperamide (Imodium), difenoxin (Motofen) · Activate opioid receptors in GI to  motility and  absorption of  & Na+ Adverse Effects: · At recommended doses, diphenoxylate has no CNS effects ·  diphenoxylate doses  typical opioid responses Contraindications/Precautions: ♀ (?) · ·  risk of megacolon with inflammatory bowel disorders  serious complications including perforated bowel. Interactions: · CNS depressants  depressive effect Education: · Encourage use of electrolyte replacement drinks · Avoid plain water (no electrolytes) and caffeine ( motility) · Manage dehydration (weight, VS, I&O) – 0.45% NS may be prescribed
  21. 21. Prokinetic Agents N203 ATI (Unit 10) Digestion and Nutrition -
  22. 22. Expected Action: Proto: metoclopramide (Reglan) ·  dopamine and serotonin receptors in CTZ  emesis · Augments action of acetylcholine to  upper GI motility Therapeutic Uses: · Postop and chemo-induced nausea and vomiting · GERD · Diabetic gastroparesis Adverse Effects: · EPS: Restlessness, spasms of face & neck. Minimize EPS with benzodiazepine like lorazepam (Ativan). · Diarrhea · Sedation Contraindications/Precautions: ♀ (?) · Seizure disorder ( seizure risk) · GI perforation or bleeding, bowel obstruction, and hemorrhage · Kids and older adults due to  risk of EPS Interactions: · Concurrent EtOH or CNS depressant:  seizure / sedation risks · Opioids and anticholinergics  effects of metoclopramide. Education: · Dose ≥ 10 mg  dilute in 50 mL D5W or Ringer’s; Infuse over 15m

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