Gastrointestinal medications

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Gastrointestinal medications

  1. 1. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug NameClass Neutralize - Treat indigestion, Contraindications: abdominal pain of unknown - Absorption: minimally absorbed gastric acid, reflux origin, heart failure, hypertension, and gastric outletInformation: - Distribution: distributed throughout the GI tract thereby esophagitis, and obstruction.Anti-ulceratives Precautions: potential high-sodium content; - Metabolism: unknown increasing pH peptic ulcers in the GI tract associated with acid rebound; possible milk-alkali - Excretion: excreted in feces; some may be - Bind dietary syndrome if high-dose calcium carbonate or sodiumAntacids phosphate in excreted in breast milk. bicarbonate; avoid antacid-analgesic combinations of renal failure - Antacids have many potential drug chronic pain syndrome; use with caution in (calcium interactions. Consult a drug reference for morealuminum pregnancy and renal failure. carbonate) complete information.hydroxide Side effects: constipation, diarrhea, electrolyte(AlternaGEL, - Use of aluminum-containing antacids may imbalancesAmphogel) result in increased effectiveness of benzodiazepines and decreased effectiveness of allopurinol, corticosteroids, chloroquine,aluminum diflunisal, ethambutol, histamine H2-receptorhydroxide and antagonists, penicillamine, digoxin, isoniazid,magnesium phenothiazines, ticlopidine, tetracyclines, andhydroxide thyroid hormone.(Gaviscon, - Use of calcium-containing antacids may resultGelusil, Maalox, in increased effectiveness of quinidine andMylanta) decreased effectiveness of fluoroquinolones, hydantoins, iron, salicylates, and tetracyclines.calcium - use of magnesium-containing antacids maycarbonate result in increased effectiveness of dicumarol,(Tums) quinidine, and sulfonylureas’ and decreased effectiveness of benzodiazepines, ticlopidine,magaldrate chloroquinine, histamine H2-receptor(aluminum- antagonists, penicillamine, corticosteroids,magnesium digoxin, hydantoins, iron, nitrofurantoin,complex) phenothiazines, and tatracyclines.[Riopan] - Use of magnesium and aluminum-containing antacids may result in increased effectiveness of levodopa, quinidine, valproic acid, andmagnesium sulfonylureas; and decreased effectiveness ofhydroxide (Mag- benzodiazepines, ticlopidine, captopril,Ox, Milk of corticosteroids, histamine H2-receptorMagnesia) antagonists, fluoroquinolones, hydantoins, iron, ketoconazole, penicillamine, phenothiazines, salicyaltes, and tatracyclines. - Antacids can cause premature dissolution of enteric-coated tablets. Give antacids as least 1 hour apart from enteric-coated tablets.12/24/2012 Page 1 of 16
  2. 2. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Name - Instruct the patient to shake the suspension well, or, if taking chewable tablets, to chew them thoroughly and then drink half a glass of water to promote passage to the stomach. - Evaluate the patient for epigastric or abdominal pain, frank bleeding, and occult bleeding.Class Inhibits - Long-term Contraindications: breast-feeding those with known - Absorption: most drugs absorbed rapidly and gastric acid treatment of hypersensitivity to individual agents or other H2- completely.Information: secretion by pathologic receptor antagonists.Histamine-2 - Distribution: widely distributed throughout inhibiting the hypersecretory Precautions: possible decreased clearance withreceptor body; cimetidine crosses placental barrier and action of conditions kidney or liver disease; reduce dosage for renalantagonists appears in breast milk. histamine at (Zollinger-Ellison impairment, including elderly; symptomatic response histamine-2 syndrome) does not exclude gastric malignancy; follow gastric - Metabolism: metabolized by the liver.cimetidine (H2) ulcer patients closely; reversible CNS effects may - Excretion: primarily excreted in bile. - Promote healing occur such as confusion or anxiety; in(Tagamet, receptors in - H2-receptor antagonists have many potential of duodenal and immunocompromised, may increase risk ofTagamet HB) gastric drug interactions. Consult a drug reference for gastric ulcers strongyloidiasis; use in pregnancy only when benefit parietal cells more complete information. - Decrease gastric outweighs risk to fetus.famotidine acid production - H2-receptor antagonists may increase plasma(Pepcid, Pepcid Side effects: headache, dizziness, confusion, mild and prevent ethanol levels.AC) diarrhea, rash. stress ulcers in - Antacids, anticholinergics, and severely ill metoclopramide may decrease absorption ofnizatidine (Acid) patients and these drugs. Avoid simultaneous those with reflux administration. esophagitis or - Inform phenylketonurics that some productsranitidine upper GI may contain phenylalanine.(Zantac) bleeding - H2-receptor antagonists may increase the - Treat heartburn, bioavailability of certain cephalosporins, such acid indigestion, as cephalexin, cefpodoxime, and cefuroxime. and sour stomach (over- - H2-receptor antagonists may impair oral the-counter absorption of ketoconazole and iron. Give iron preparations) at least 1 hour before H2-receptor antagonists. - prevention of - Cimetidine may cause increased serum levels aspiration and consequent toxicity of benzodiazepines, pneumonitis calcium channel blockers, tricyclic antidepressants, procainamide, lidocaine, oral - part of a anticoagulants, phenytoin, propranolol, multidrug quinidine, and theophylline. regimen to eradicate H. - Cimetidine administered with carmustine pylori in the increases the risk of bone marrow toxicity.12/24/2012 Page 2 of 16
  3. 3. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Name treatment of - Teach the patient that smoking worsens ulcer peptic ulcer disorders and counteracts the effects of H2- receptor antagonists. - Don’t give an antacid within 1 hour of administering drug; may decrease absorption of the drug. - Caution the patient about possible dizziness; recommend avoidance of hazardous activities that require alertness. - Evaluate for epigastric or abdominal pain, frank bleeding, and occult bleeding. - Teach the patient to avoid gastric irritants (smoking, alcohol, products containing aspirin, caffeine, NSAIDs. and foods that cause GI irritation), which may counteract the drug effects and worsen the ulcer.Class Blocks gastric - Treat erosive Contraindications: patients with known - Absorption: rapidly absorbed in the small acid esophagitis and hypersensitivity. intestine.Information: secretions by GERD Precautions: Pregnancy and breast-feeding;Proton pump symptomatic response does not exclude gastric - Distribution: highly protein-bound inhibiting acid - Treat duodenalinhibitors malignancy; vitamin B12 deficiency possible. - Metabolism: extensively metabolized in the pump in ulcer gastric Side effects: abdominal pain, nausea, vomiting, liver. parietal cells - Short-term diarrhea and rash. - Excretion: eliminated by kidneysesomeprazole treatment of(Nexium) - Proton pump inhibitors may interfere with active gastric ulcer absorption of ketoconazole, ampicillin, iron salts, digoxin, and cyanocobalamin.lansoprazole - Long-term(Prevacid) treatment of - Decreased bioavailability itraconzole or hypersecretory ketoconazole may result if used with PPIs; conditions avoid concomitant administration.omeprazole - Eradicate H. - More rapid dissolution and increased gastric(Prilosec, pylori infection side effects of enteric-coated salicylates mayPrilosec OTC) (esomeprazole, result if used with PPIs. lansoprazole, - Altered PT measures may result if warfarin ispantoprazole omeprazole, and used with PPIs; monitor INR and PT.(Protonix) rabeprazole) - May interfere with metabolism of diazepam, - Prevent and treat phenytoin, and warfarin, increasing their half-rabeprazole NSAID-related lives and plasma levels.(Aciphex) gastric ulcers - Monitor for diarrhea and abdominal pain. (lansoprazole) - Instruct the patient to swallow capsules whole and to not chew or crush them.12/24/2012 Page 3 of 16
  4. 4. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Name - Administer 1 hour before meals. - Instruct the patient to avoid gastric irritants (smoking, alcohol, products containing aspirin, caffeine, NSAIDs, and foods that cause GI irritation), which may counteract drug effects and worsen the ulcer.Class Protect - Short-term Contraindications: patient’s with known - Absorption: only 3-5% of drug is absorbed gastric treatment and hypersensitivity. after oral administrationInformation: mucosa by prevention of Precautions: pregnancy, breast-feeding and chronicLocal-acting renal failure. - Distribution: acts locally at ulcer site. coating the gastric, duodenaldrugs - Metabolism: unknown ulcer crater and stress ulcers Side effects: constipation - Excretion: excreted in feces.sucralfate - Binds with other drugs in GI tract; may(Carafate) decrease absorption of cimetidine, phenytoin, tetracycline, warfarin, and theophylline. - Antacids increase gastric pH and may decrease drug effectiveness. - Sucralfate decreases absorption of lansoprazole; separate doses of drugs by giving lansoprazole 30 minutes before sucralfate. - Give at least 2 hours apart from cimetidine, digoxin, phenytoin, tetracyclines, theophylline, or warfarin. - Don’t administer with an antacid; separate administration times by at least 30 minutes. - Administer drug at least 1 hour before meals and at bedtime for maximum effectiveness. - Evaluate for epigastric or abdominal pain, frank bleeding, occult bleeding and constipation. - Instruct the patient to avoid gastric irritants (smoking, alcohol, products containing aspirin, caffeine, NSAIDs, and foods that cause GI irritation), which may counteract drug effects and worsen the ulcer. - Know that sucralfate is poorly water-soluble; administering drug through an NG tube requires special preparation by the pharmacist.12/24/2012 Page 4 of 16
  5. 5. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug NameClass Inhibit GI - Adjunctive Contraindications: children, breast-feeding; angle- - Absorption: poorly absorbed from GI tract motility and therapy for peptic closure glaucoma; uncontrolled tachycardia; urinary (about 10-25%).Information: gastric ulcer disease or GI tract obstruction; hypersensitivity; severeCholinergic - Distribution: Rapidly distributed. secretions ulcerative colitis; myasthenia gravis; tachycardiablockers - Metabolism: Unknown. caused by cardiac insufficiency or thyrotoxicosis; acute or severe hemorrhage; or unstable - Excretion: Unknown.glycopyrrolate cardiovascular status - Use with similar-acting drugs causes additive(Robinul) Precautions: elderly, Down syndrome, brain anticholinergic effects. damage, spasticity, hypertension, hyperthyroidism, pregnancy. - Antacids may decrease absorption ofmepenzolate anticholineric antiulceratives.(Cantil) Side effects: tachycardia, dry mouth, constipation, urine retention, and urinary hesitancy - Evaluate for epigastric or abdominal pain, frank bleeding, and occult bleeding.methscopolamine - Instruct the patient to avoid gastric irritants(Pamine) (smoking, alcohol, caffeine, aspirin containing products, NSAIDs, and foods that cause GI irritation); may counteract drug effects andpropantheline worsen the ulcer.(Pro-Banthine)Class Bismuth - Adjunct to Contraindications: known hypersensitivity. - Absorption: misoprostol is extensively and subsalicylate: antibiotic therapy Misoprostol contraindicated in pregnancy or breast- rapidly absorbed.Information: reduces GI to eradicate H. feeding and those allergic to prostaglandinsMiscellaneous Precautions: pregnancy, breast-feeding, chronic - Distribution: unknown motility and pylori (bismuthantiulceratives renal failure; liver impairment. - Metabolism: unknown gastric salicylate) secretions - Prevent gastric Side effects: darkened tongue or stools (bismuth); - Excretion: unknownbismuth (Pepto- ulcers resulting diarrhea (most common), abdominal pain, flatulence, - Bismuth increases action of warfarin and oralBismol) from use of dyspepsia, infertility, nausea and vomiting, vaginal hypoglycemic agonists. Misoprostol: spotting, uterine cramping, and miscarriage replaces NSAIDs or treat - Bismuth and misoprostol decrease absorption duodenal ulcers (misoprostol).misoprostol gastric of tetracyclines.(Cytotec) prostaglandin not responding to - Administer misoprostol with food or after meals s and other medication and at bedtime to decrease the risk of enhances regimens diarrhea. natural local (misoprostol) - Observe for diarrhea. protective mechanisms - Evaluate for epigastric or abdominal pain, frank bleeding, and occult bleeding. - Instruct the patient to avoid gastric irritants (smoking, alcohol, caffeine, aspirin-containing products, NSAIDs, and foods that cause GI irritation); may counteract drug effects or worsen the ulcer.Class Adsorbents: - Antidote for oral Contraindications: activated charcoal - Absorption: not absorbed into body; acts contraindicated in patients with acute poisoning from12/24/2012 Page 5 of 16
  6. 6. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug NameInformation: attract and ingestion of mineral acids, alkalines, cyanide, ethanol, methanol, locally on GI tract and excreted whole.adsorbents, binds to toxins that can iron, inorganic acids, or organic solvents; pancrelipase contraindicated in hypersensitivity to - Distribution: not distributed.antiflatulents, toxins in GI lead to poisoning tract, thereby or overdose pork protein or enzymes acute exacerbation of - Metabolism: not metabolized.and digestants preventing (activated chronic pancreatic disease. - Excretion: excreted unchanged in feces. absorption charcoal) Precautions: pancrelipsase associate with colonic - Activated charcoal decreases absorption ofAdsorbents: fibrotic strictures, especially in cystic fibrosis; avoid oral medications.activated skin or mucous membrane exposure; possible Antiflatulents: - Treat conditions nausea, abdominal cramps, or diarrhea if dose - Antacids reduce effects of pancreaticcharcoal cause involving excessive; if pregnant use only if clearly needed; use enzymes. foaming excessive air or with caution in breast-feeding. - Pancreatic enzymes decrease absorption ofAntiflatulents: action in GI gas in the folic acid and iron. Side effects: blackened stools and constipationsimethicone tract, creating stomach or (activated charcoal); abdominal cramping, biliary - Know that a patient who has recently eaten will(Flatulex, Gas-X, a film on intestines, such colic, diarrhea and nausea (digestive enzymes). require an increased amount of activatedMaalox Anti- intestines that as gastric charcoal.gas, Mylanta helps to bloating, disperse diverticular - Be aware that multiple doses of activatedGas, Mylicon, mucus- disease, or charcoal may be needed to treat severePhazyme) enclosed gas spastic or poisoning involving certain drugs pockets and irritable colon (acetaminophen, digoxin, phenobarbital,Digestants: to prevent (simethicone) phenytoin, theophylline, carbamazepine,dehydrocholic their dapsone, and quinidine).acid, formation. - Shake simethicone well before administration - Treatpancreatic to thoroughly mix drug. constipation andenzymes Digestants: promote bile flow - Administer drug at appropriate time:(pancreatine, resembles (dehydrocholic o Simethicone: after meals and atpancrealipase, action of acid) bedtime[Pancreas], deficientlipase, protease, o Pancreatic enzyme: with meals substanceamylase) (bile acid, - Supplement o Dehydrocholic acid: after meals which deficient natural increases pancreatic output of bile enzymes, such in the liver, or as occurs in pancreatic patients with enzymes) pancreatitis or normally cystic fibrosis produced by (pancreatic the body. enzymes)Class Aprepitant, - Nausea and Contraindications: hypersensitivity to drug or other - Absorption: usually well absorbed from GI tract dronabinol, vomiting antidopaminergic derivatives; severe CNSInformation: - Distribution: widely distributed granisetronm, associated with depression, subcortical brain damage, bone marrowAntiemetics - Metabolism: extensively metabolized by liver ondansetron, chemotherapy depression, first trimester of pregnancy12/24/2012 Page 6 of 16
  7. 7. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Name palonosetron, (aprepitant, (chlorpromazine, perphenazine, prochlorperazine, - Excretion: excreted in urine and feces phenothiazine palonosetron, metoclopramide, promethazine, trimethobenzamide,aprepitant dimehydrinate). GI hemorrhage, obstruction, or - Additive CNS depression may result if alcohol,(Emend) s, and ondansetron, barbiturates, or other sedatives, opiates or trimethobenz granisetron, and perforation; pheochromocytoma; epilepsy, use of drugs that cause EPS (metoclopramide). Comatose other analgesics, or general anesthetics are amide: act on dronabinol) used with antidopaminergic.dimenhydrinate CNS to state; treatment of lower respiratory tract symptoms, - Motion sickness including asthma (promethazine).Do not use with - An acute encephalopathic syndrome may(Dramamine) prevent (dimenhydrinate, nausea and pimozide, terfenadine, astemizole, or cisapride result if lithium is used with antidopaminergics. meclizine) (aprepitant). Known or suspected QT prolongation vomiting - A lowered seizure threshold may result ifdronabinol - tube feedings (Droperidol). sensitivity to dronabinol, any antidopaminergics are used with(Marinol) (metoclopramide) cannabinoid or sesame oil (dronabinol) anticonvulsants. Dimenhydrate - Diabetic Precautions: associated with extrapyramidal , meclizine, - Patients receiving prolonged high-dosedroperidol gastroparesis reactions, tardive dyskinesia, cerebral edema, and therapy with antidopaminergics should(Inapsine) (metoclopramide) sensitivity reactions, including cholestatic jaundice, scopolamine: undergo periodic ophthalmologic elevated liver function studies, blood dyscrasias, reduce examinations. laryngeal edema, laryngospasm, bronchospasm, andgranisetron motion anaphylactoid reactions; sedation, seizures, - Avoid contact with oral solutions and injections(Kytril) sickness by hypotension, tachycardia, dizziness, syncope, ECG to prevent contact dermatitis. inhibiting changes and cardiac arrest, sudden death possible; if - The elderly are particularly sensitive to impulses from used with other antipsychotics, potential for adverse nervous system effects (such asmeclizine inner ear to neuroleptic malignant syndrome, including tardive dyskinesia, motor restlessness,(Antivert, the vestibular hyperthermia, rigidity, altered mental status, coma, parkinsonian features, and sedation),Bonine) pathway. hypertension, tachycardia, arrhythmia, anticholinergic effects, and cardiovascular rhabdomyolysis, and renal failure; associated with effects, such as orthostatic hypotension;metoclopramide leukopenia, pruritus, photosensitivity, urticarial, initiate drug at low doses and observe closely. Metocloprami(Reglan) eczema, exfoliative dermatitis, corneal and lens - Advise patient to exercise caution while driving de: increases changes, weight gain, hyperprolactinemial; use with or performing other tasks requiring alertness. the rate if caution if severe cardiovascular disorder, breastondansetron gastric - Avoid excessive exposure to ultraviolet light. cancer, hypocalcemic, severe asthma, emphysema,(Zofran) emptying and acute respiratory infection, history of seizures or - Increased phenytoin levels may result if enhances taking anticonvulsants; avoid use if orthostatic chlorpromazine used with phenytoin. gastroesophapalonosetron hypotension; if pregnant, use only if benefit - Increased levels of perphenazine may result if geal sphincter(Aloxi) outweighs risk to fetus; if breast-feeding, do not use used with drugs that inhibit hepatic CYP2D6, tone. drug (chlorpromazine, perphenazine, such as TCAs, fluoxetine, sertraline, andphenothiazines prochlorperazine, metoclopramide, promethazine, paroxetine.(chlorpromazine trimethobenzamide, dimenhydrinate). Associated with[Thorazine] , - Use of metoclopramide in Parkinson disease is rare hypersensitivity reactions, includingperphenazine relatively contraindicated. bronchospasm, shortness of breath, urticarial,[Trilafon]) - Increased rate of absorption of alcohol or hypotension, shock and anaphylaxis (ondansetron, granisetron, palonosetron, aprepitant, droperidol, cyclosporine may result if used withprochlorperazine dronabinol); if pregnant use only if benefit outweighs metoclopramide.(Compazine) risk to fetus; use with caution if breast-feeding. If - Decreased levels of cimetidine and digoxin severe hepatic impairment, adjust dose; if abdominal may result if used with metoclopramide. surgery, potential for masking ileus or gastric12/24/2012 Page 7 of 16
  8. 8. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Namepromethazine distention (ondansetron). use with caution if hepatic - Increased neuromuscular blockade may result(Phenergan) impairment; chronic continuous use not if metoclopramide used with succinylcholine. recommended(aprepitant); associated with reduced pulmonary pressure, QT prolongation, torsade de - Decreased levels of metoclopramide mayscopolamine pointes, and serious arrhythmias, potentially fatal; result if used with anticholinergics or narcotic(Scopace) screen for prolonged QT prior to initiation; monitor for analgesics. arrhythmias prior to and for 2 to 3 hours following - Metoclopramide releases catecholamines and drug administration; administer with extreme caution should be used with caution, if at all, with MAOthiethylperazine if cardiovascular disease, diuretic use, cardiac inhibitors.(Torecan) hypertrophy, hypokalemia, hypomagnesemia, heart - Impaired mental or physical abilities may result rate less than 50 beats per minute, treatment with from use of metoclopramide; use caution iftrimethobenza class I and III antiarrhythmics or MAO inhibitors, other driving or operating machinery.mide (Tigan) drugs known to decrease QT; observe for - Transient flushing without vital sign alteration hypotension and neuroleptic malignant syndrome; may occur with IV administration of high doses use with caution if renal or hepatic impairment; use in of metoclopramide. pregnancy only if benefit outweighs risk to fetus; use with caution if breast-feeding(droperidol); use with - Decreased vasopressor effect of ephedrine caution if cardiovascular disorder, history of may result if used with promethazine; do not substance abuse, mania, depression, schizophrenia, use ephedrine to treat hypotension associated concomitant sedatives, hypnotics, or other with promethazine. psychoactive drugs, pregnant, nursing, or elderly; - Use anticholinergics with caution in patients potential for abuse; if pregnant, use only if benefit taking promethazine. outweighs risk to fetus; not recommended if breast- - Increased incidence of EPS may result if feeding (dronabinol). promethazine is used with MAO inhibitors. Side effects: motor restlessness, hyperpyrexia, diaphoresis, drowsiness, erectile dysfunction, - Use promethazine with caution in patients with galactorrhea, urinary retention, decreased sweating, seizure disorders or who are using drugs that insomnia, restlessness, anxiety, agitation, euphoria, lower seizure thresholds such as narcotics or dry mouth, blurred vision, hyperthermia, hypothermia, local anesthetics. depression, headache, dizziness, weakness - Avoid use or promethazine in patients with (chlorpromazine, perphenazine, prochlorperazine, respiratory compromise such as COPD or metoclopramide, promethazine, trimethobenzanide, sleep apnea. dimenhydrinate); nausea, diarrhea, urinary frequency - Avoid prolonged ultraviolet exposure. and incontinence, rash, urticarial, amenorrhea, - Masking of ototoxic symptoms may result if impotence, hypotension, hypertension, drugs with ototoxic potential, such as certain supraventricular tachycardia, fluid retention, acute antibiotics, are used with dimenhydrinate. CHF, visual disturbances(metoclopramide);drowsiness, blurred - Do not inject dimenhydrinate intra-arterially. vision, dizziness, increased or decreased blood - Decreased levels and effect of ondansetron pressure, tachycardia, bradycardia, dry mouth, may result if used with rifampin. nausea, vomiting, asthma, nasal congestion, tremors, - Increased aprepitant levels may result if used photosensitivity, urticarial, dermatitis (promethazine); with drugs that inhibit CPY3A4 such as blurred vision, drowsiness, headache, muscle clarithromycin, diltiazem, ketoconazole, cramps, diarrhea, depression (trimethobenzamide);12/24/2012 Page 8 of 16
  9. 9. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Name drowsiness, dizziness, dry mouth, nose and throat; nefazodone, ritonavir, and troleandomycin. blurred vision, difficult or painful urination, headache, anorexia, nervousness, skin rash, restlessness, - Decreased aprepitant levels may result if used insomnia, thickened bronchial secretions, with drugs that induce CYP3A4 such as tachycardia, lassitude, nausea, excitation carbamazepine, phenytoin, and rifampin. (dimenhydrinate); hypotension, arrhythmias, - Increased levels of drugs that metabolized headache, EPS, chills, musculoskeletal pain, wound CYP3A4 (such as dexamethasone, problems, shivers (ondansetron); CNS stimulation, methylprednisolone, midazolam, triazolam, anorexia, nausea, vomiting, somnolence, leukopenia, paclitaxel, imatinib, vinblastine, and vincristine) anemia, thrombocytopenia, shivers, alopecia, may result of used with aprepitant. hypertension (granisetron); headache, constipation - Reduce dexamethasone and (palonosetron); dizziness, diarrhea, fatigue, hiccups, methylprednisone doses when used with stomatitis, dyspepsia (aprepitant); hypotension, aprepitant. tachycardia, dysphoria, drowsiness, restlessness, - Decreased levels of paroxetine and aprepitant hallucinations, EPS signs and symptoms (droperidol); may result if they are co-administered. tachycardia, palpitations, facial flush, anxiety, confusion, amnesia, ataxia, dizziness, euphoria, - Decreased levels of warfarin, tolbutamide, or paranoia, somnolence, nausea, vomiting, abdominal phenytoin may result if used with aprepitant. pain, asthenia (dronabinol) - Closely monitor INR in patients receiving warfarin. - Decreased efficacy or oral contraceptives may result if used with aprepitant. - Reserve droperidol for patients unresponsive to other adequate treatments. - Individualize dosage. Reduce dose for elderly or debilitated patients and in patients receiving other CNS depressants. - Increased risk of QT prolongation may result from the use of droperidol with class I or III antiarrhythmics, certain antihistamines, antimalarials. Calcium channel blockers, certain neuroleptics, antidepressants, and drugs that can cause hypokalemia or hypomagnesemia such as diuretics, laxatives, and drugs with mineralcorticoid properties. - Additive CNS effects may result if droperidol is used with barbiturates, tranquilizers, opioids, or general anesthetics. - Paradoxically increased droperidol-induced hypotension may result if droperidol is used with ephedrine. - Hypertension may result if droperidol is used12/24/2012 Page 9 of 16
  10. 10. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Name with fentanyl or other parenteral analgesics. - Monitor vital signs and EKG routinely. - Increase dose gradually to minimize potential for disturbing psychiatric symptoms. - Apprise patients of possible changes in mood and other adverse behavioral effects. - Closely observe patient, especially those with no prior experience with marijuana or dronabinol. - Patients using dronabinol should not drive, operate machinery, or engage in hazardous activity until individual response to drug and safety in performing these tasks are established. - Additive hypertension, tachycardia, or cardiotoxicity may result if dronabinol is used with amphetamines, cocaine, or sympathomimetics. - Additive tachycardia or drowsiness may result if dronabinol is used with anticholinergics or antihistamines. - Additive CNS effects may result if dronabinol is used with alcohol, sedatives, hypnotics, or psychomimetics. - Hypomanic reactions may result if dronabinol is used with disulfiram or fluoxetine. - Decreased levels of theophylline may result if theophylline is used with dronabinol.Class Camphorated - Control and Contraindications: Hypersensitivity to drug or its - Absorption: opium preparations are absorbed opium relieve symptoms components; Contraindicated in patients with systemically; others are absorbed readily formInformation: tincture, of acute or abdominal pain of unknown cause, especially if the GI tract, except for loperamide.Antidiarrheals accompanied by fever; hypersensitivity to difenoxin, chronic - Distribution: varies with drug. diphenoxylate nonspecific dicyclomine or anticholinergic drugs; narrow angle , and diarrhea. glaucoma, GI obstruction, ileus, severe ulcerative - Metabolism: metabolized by liver.bismuth (Pepto-Bismol) loperamide: colitis, toxic megacolon, hepatic or renal disease, - Excretion: opium preparations are excreted by - Treatment of obstructive uropathy, myasthenia gravis, myocardial slow intestinal irritable bowel kidneys; others are excreted primarily in feces. motility, ischemia, unstable cardiovascular status in acute (Bentyl, - Bismuth may decrease absorption ofcamphorated ultimately hemorrhage (dicyclomine); hypersensitivity to Donnatal) tetracyclines.opium tincture increasing diohenoxylate or atropine; diarrhea due to(Paregoric) pseudomembranous enterocolitis or enterotoxin- - Discontinue bismuth if used with other water salicylate containing products and ringing in12/24/2012 Page 10 of 16
  11. 11. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Name absorption producing bacteria; (diphenoxylate/atropine); the ears occurs. from stools hypersensitivity to loperamide, patients who mustdifenoxin (with avoid constipation (loperamide); glaucoma, bowel - Do not use bismuth of allergic to salicylatesatropine obstruction, paralytic ileus, severe ulcerative colitis, unless instructed to do so by a physician.[Motofen]) Bismuth, obstructive uropathy, unstable cardiovascular status - Increased effects of atenolol and digoxin may kaolin and in acute hemorrhage, hiatal hernia with reflux result if used with dicyclomine.diphenoxylate pectin esophagitis, acute intermittent porphyria, and patients - Decreased antipsychotic effects of(with atropine mixture, and in whom phenobarbital; produces excitement, phenothiazines may result if used with[Lomotil]) polycarbophil: restlessness dicyclomine. reduce fluid (phenobarbital/hycosamine/atropine/scopolamine); content of - Dicyclomine may increase anticholinergic side Precautions: fecal impaction possible if debilitatedkaolin and pectin stools effects of other medications including patient; potential for interference with radiologicmixture amantadine, phenothiazines, and TCAs. examinations (bismuth); associated with allergic(Kapectolin) reaction (including anaphylaxis), heat prostration is - Elderly patients are particularly prone to Octreotide: excitement, agitation and other adverse events used in a hot environment, and anticholinergic decreases when they use dicyclomine.loperamide psychosis (including confusion, disorientation, volume of(Imodium) memory loss, hallucinations, ataxia, euphoria, and - Use caution when driving or performing tasks gastric and coma); use with caution if renal or hepatic disease, that require alertness, coordination, or physical intestinal hypertension, coronary artery disease, arrhythmias, dexterity. secretionsoctreotide CHF, hiatal hernia with reflux, ileus, ulcerative colitis, and diarrhea - Local irritation may occur with use of(Sandostatin) prostatic hypertrophy, glaucoma, hyperthyroidism, secondary to parenteral dicyclomine. autonomic neuropathy, asthma, allergies, Down vasoactive - Dicyclomine is usually taken 30 to 60 minutes syndrome, brain damage, spastic paralysis, orpolycarbophil intestinal prior to meals. debilitated patients with chronic lung disease; if(FiberCon) tumors (such pregnant, use only if benefits outweigh risk to fetus; - Hypertensive crisis may result if as carcinoid do not use if breast-feeding (dicyclomine); if diphenoxylate/atropine is used with MAO tumors)dicyclomine ulcerative colitis, toxic megacolon possible; potential inhibitors.(Bentyl) for anaphylaxis, ileus, pancreatitis, dehydration, and - Diphenoxylate increases effect of MAO electrolyte imbalance; use with extreme caution if inhibitors, barbiturates, tranquilizers, and advanced hepatorenal disease or hepatic alcohol.phenobarbital/hyc impairment; addiction with high doses possible; ifosamine/atropine - Use caution when driving or performing tasks pregnant use only if benefit outweighs risk to fetus;/scopolamine that require alertness, coordination, or physical use caution if breast-feeding(Donnatal) dexterity while taking diphenoxylate. (dipehnoxylate/atropine); do not use if acute dysentery, including high fever and blood in stools; - If no improvement of acute diarrhea occurs potential for toxic megacolon if acute ulcerative colitis within 48 hours of loperamide therapy, or pseudomembranous colitis; stop drug rapidly if discontinue the drug. abdominal distention, constipation, or ileus occur; if - Octreotide may decrease blood level of hepatic impairment, monitor for CNS toxicity; if cyclosporine. pregnant, use only if clearly needed; use with caution - Dose adjustments of insulin, oral hypoglycemic if breast-feeding (loperamide); associated with agents, beta-blockers, calcium channel gallstones or sludge; if renal failure with dialysis, blockers, or drugs that control fluid and adjust octreotide dose; bradycardia, arrhythmias, electrolyte balance may be necessary during cardiac conduction abnormalities, EKG changes12/24/2012 Page 11 of 16
  12. 12. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Name (including prolonged QT interval), pancreatitis, use of octreotide. depressed vitamin B12 levels, hyperglycemia, hypoglycemia, or hypothyroidism possible; if - Monitor vitamin B12 levels during chronic pregnant use only if clearly needed; use with caution therapy with octreotide. if breast-feeding (octreotide); associated with heat - Increased effects of atenolol and digoxin may prostration in hot environment, drowsiness, blurred result if used with Donnatal. vision; use with caution if autonomic neuropathy, - Decreased antipsychotic effects of hepatic, or renal disease, hyper thyroidism, coronary phenothiazines may result if used with artery disease, CHF, arrhythmias, tachycardia, or Donnatal. hypertension; if pregnant use only if clearly needed; - Donnatal may increase anticholinergic side use with caution if breast-feeding effects of other medications including (phenobarbital/hycosamine/atropine/scopolamine); amantadine, phenothiazines, and TCAs. Side effects: darkening of tongue or stool (bismuth); - Donnatal may decrease the effects of palpitations, headache, flushing, drowsiness, anticoagulants. restlessness, tremor, confusion, urinary retention, impotence, dry mouth, constipation, blurred vision, - Caution patient’s taking Donnatal who are dilated pupils, nasal congestion, decreased sweating experiencing drowsiness or blurred vision (dicyclomine); dry skin or mucous membranes, against engaging in activities that are flushing, hyperthermia, tachycardia, urinary retention, hazardous or require metal alertness. dizziness, drowsiness, headache, malaise, euphoria, depression, confusion, anorexia, nausea, vomiting, abdominal discomfort, puritus, gum swelling, angioneurotic edema, urticarial (diphenoxylate/atropine); hypersensitivity reaction, abdominal distention or discomfort, nausea, vomiting, constipation, tiredness, drowsiness, dizziness, dry mouth (loperamide); diarrhea, abdominal pain or discomfort, flatulence, constipation, nausea, vomiting (octreotide); dry mouth, insomnia, dizziness, drowsiness, blurred vision, mental confusion, urinary retention, tachycardia, palpitations, nervousness, headache, constipation, allergic or idiosyncratic reactions, including anaphylaxis, decreased sweating, excitement, agitation, impotence (phenobarbital/hycosamine/atropine/scopolamine)Class Bulk-forming - Constipation Contraindications: hypersensitivity to drug or - Absorption: minimally absorbed laxatives: product components; persistent or severe abdominalInformation: - Bowel - Distribution: distributed in intestines increase pain of unknown cause, especially whenLaxatives preparation for accompanied by fever; bowel obstruction, fecal - Metabolism: metabolized by intestinal water content radiologic or of stools, impaction, symptoms or signs of appendicitis. microflora endoscopic Galactosemia (lactulose); colostomy, ileostomy,Bulk-forming forming a procedures - Excretion: excreted in feceslaxatives: viscous ulcerative colitis, diverticulitis (magnesium hydroxide); - Manage chronic - Lactulose use with nonabsrobale antacids may solution that concomitant use of mineral oil and docusate sodiummethylcellulose inhibit the desirable lactulose –induced12/24/2012 Page 12 of 16
  13. 13. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Name(Citrucel) promotes watery diarrhea (mineral oil). reduction in colonic pH. peristalsis (methylcellulose Precautions: use with caution if diabetes mellitus,polycarbophil monitor electrolyte imbalance (lactulose); use with - Patients undergoing electric cautery during(FiberCon) and improves and psyllium) colonoscopy or proctoscopy should first elimination caution if renal insufficiency, hypernatremia,psyllium - Adjunctive hyperphosphatemia, acidosis, hypocalcemia, or undergo thorough bowel cleansing with a rate. treatment in solution that is not fermented.(Fiberall, sodium restriction (sodium phosphate); can becomeKonsyl, managing habit-forming; may result in loss of normal bowel - Do not use with other laxatives with lactulose,Metamucil, Lubricant hepatic function (senna); use with caution in renal especially during the initial stages of treatmentPerdiem) laxatives: encephalopathy insufficiency) (magnesium hydroxide); may decrease for portal-systemic encephalopathy. increase (lactulose) absorption of fat-soluble vitamins; lipid pneumonia - Monitor electrolytes with sodium phosphate water may result from aspiration (mineral oil); consume a use.Lubricant retention in full glass (240 ml) of fluids with each doselaxatives: stools, - Urine or colonic mucosal discoloration may (methylcellulose and psyllium); altered fluid and prevent water result from use of senna compounds. electrolyte balance possible; use with caution in renalmineral oil (Fleet absorption insufficiency (magnesium citrate); if used with milk, - If used with magnesium hydroxide, decreasedmineral oil from stools, antacids, H2-receptor antagonists, or proton pump effect of benzodiazepines, corticosteroids,enema, and lubricate inhibitors, then gastric irritation or dyspepsia possible digoxin, hydantoins, iron, nitrofurantoin,Kondremul) and soften (bisacodyl) phenothiazines, tetracyclines, histamine H2- intestinal receptor antagonists, but increased effects of Side effects: nausea, vomiting, and abdominal contents. dicumarol, quinindine, and sulfonylureas.Hyperosmotic cramping; esophageal obstruction or intestinal obstruction (bulk-forming laxatives); lipid pneumonia - Magnesium hydroxide may later fluid andlaxatives: Hyperosmotic and nutritional deficiencies (lubricant laxatives); electrolyte balance. laxatives: cramps, distention, flatulence and belching (osmotic - Surfactants, including docusate, may facilitatelactulose increase laxatives); dehydration and electrolyte imbalances absorption of mineral oil, increasing toxicity of(Cephulac, water content (saline cathartic laxatives); possible permanent loss mineral oil.Chronulac) of stools and of colonic motility, laxative dependence, and - Avoid use of milk, antacids, H2-receptor soften stools; electrolyte imbalances with long-term use or abuse of antagonists, or proton pump inhibitors 1 to 2 lactulose also laxatives. hours before taking bisacodyl.Saline catharticlaxatives: inhibits - Swallow bisacodyl tablets whole. diffusion of ammoniamagnesium from thecitrate colon into the blood, reducingmagnesium serumhydroxide (Milk ammoniaof Magnesia) levels in patients withmagnesium liversulfate dysfunctionpolyethylene Saline12/24/2012 Page 13 of 16
  14. 14. GASTROINTESTINAL MEDICATIONS – GASTROINTESTINAL CORE GUIDE NURSING EDUCATION MODULE GenericIngredients and Major Effects Major Uses Contraindications, Precautions, and Side Effects Drug Interactions and Other Notes Drug Nameglycol and catharticelectrolytes laxatives:(GoLYTELY, draw waterHalfLytely, into theMiraLax) bowel, increasing the bulk ofsodium intestinalphosphates contents and(sodium stimulatingphosphate and peristalsis.sodiumbiphosphate[Fleet Phophso- Stimulantsoda]) laxatives: stimulates peristalsisStimulant and inhibitlaxatives: water and electrolytebisacodyl reabsorption(Dulcolax) from intestine.cascara sagrada Stool softeners: allow morecastor oil fluid and fat to penetrateglycerin feces.suppositories Producing a softer fecal mass.senna (Senokot)Stool softeners:docusate calcium(Surfak)docusatepotassium,docusate sodium12/24/2012 Page 14 of 16

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