Anti-diarrheals
Stops further occurrence of diarrhea. Notable medicines are Loperamide "Immodium", Diphenoxylate Hcl with Atropine "Lomotil", Bismuth
... [Show More] subsalicylate "Pepto bismul"
Pepto s/e: black stools and tongue
Laxatives
Used to ease or stimulate defecation
Soften the stool
Increase stool volume
Hasten fecal passage through the intestine
Facilitate evacuation from the rectum
*Misuse comes from misconceptions of what constitutes normal bowel function
Fiber Laxatives
absorbs water, softening feces and increasing their mass. Can be digested by colonic bacteria, whose subsequent growth increases fecal mass. ex. Bran, veggies and fruits.
Meds: mehylcellulose, psyllium, polycarbophil
Surfactant Laxatives
Meds: Docusate sodium (Colace)
Docusate calcium (Surfak)
temporary treatment of constipation
* avoid if narrowing of intestines
Give with a full glass of water or juice
Stimulant Laxatives
bisacodyl: (tablets: give at night to have BM in am , no crushing or chewing, no milk or antacids;Suppositories: BM within 15-60 min, may cause proctitis);
senna: BM 6-12 hours after. May cause pink or brown urine.
castor oil: acts on small intestine 2-6 hour BM. Limit to only when prep for radiology procedures. Chill and mix in juice.
* easily abused,
Give with a full glass of water.
Osmotic Laxatives
Salts draw water into the intestine causing fecal mass to soften and swell stimulating peristalsis. Low dose 6-12 hours, high dose 2-6 hours.
magnesium hydroxide,
magnesium citrate,
polyethylene glycol,
lactulose (can be used to lower blood ammonia in liver disease)
* Increase fluid intake. Not good for kidney disease. Sodium phosphate exacerbates cardiac disease.
Miscellaneous Laxatives
Lubiprostone, mineral oil, glycerin suppository, polyethylene glycol- electrolyte solution, Sodium picosulfate / magnesium oxide/anhydrous citric acid
antiemetic
a medication that is administered to prevent or relieve nausea and vomiting
Ondesetron
Class: 5HT3 receptor antagonist
Zofran
Indication: Chemotherapy N/V, postoperative N/V, radiation induced N/V
Oral or Parental
* Prolonges QT interval (leading to torsades de pointes)
Glucocorticoids used as antiemetic
Not approved by FDA. Solumedrol and dexamethasone. Given IV.
Metoclopramide (Reglan)
controls post-op NV
suppresses emesis and increases upper GI mobility
Cannabinoids
Dronabinol (marinol) and Nabilone (cesamet). Suppresses CINV.
Alosetron (Lotronex)
Used for IBS-D in women that has lasted > 6 months
Blocks 5-HT3 receptors resulting in firm stool and decrease in urgency and frequency of defecation
Can cause constipation
PPIs
Proton-pump inhibitors - pronounced and long-lasting reduction of gastric acid production - destroyed by stomach acid (take on empty stomach) - work really well - "attack from the back" - used as a controller
Ex. Omeprazole (Prilosec)
Mesalamine
treats ulcerative colitis
Ranitidine (Zantac)
H2 receptor antagonist. Potent inhiitor of gastric acid secretion
Indications: GERD, ulcers, H. pylori, reflux, indigestion
ADR: Pain, constipation, diarrhea, headache. Can cause jaundice
Ulcers treatment
likely caused by H. pylori. Treat with antibiotic and pepto bismol, proton pump inhibitors (prilosec, prevacid, aciphex, nexium, protonix), H-2 blockers (zantac, pepcid, tagamet, nazatidine), antacids, and cytoprotective agens (carafate, cytotec)
irritable bowel syndrome (IBS)
periodic disturbances of bowel function, such as diarrhea and/or constipation, usually associated with abdominal pain. Intermittent diarrhea and constipation with pain.
Treat and prevent symptoms:
Antispasmodics, bulk forming agents, antidiarreheals and tricyclic antidepressants.
Alosetron (Lotronex)
Used for IBS-D in women that has lasted > 6 months
Blocks 5-HT3 receptors resulting in firm stool and decrease in urgency and frequency of defecation
Can cause constipation / bowel obstruction and perforation
Eluxadoline (Viberzi)
Mu/Kappa opioid receptor agonist and delta opioid receptor antagonist in the gut used to treat IBS prone diarrhea
Lubiprostone (Amitiza)
Used for IBS-C and chronic constipation
Increases fluid secretion in intestine, promotes motility
Can cause diarrhea, nausea (take w/ food)
Crohn's disease
a chronic autoimmune disorder that can occur anywhere in the digestive tract; however, it is most often found in the ileum and in the colon
Sulfasalazine (Azulfidine)
5-aminosalicylate,, DMARD
Decrease inflammation by inhibiting prostaglandin synthesis
Used for IBD (Crohn's, UC), RA
Can cause agranulocytosis, hemolytic and macrocytic anemia,, hepatic dusfunction, bone marrow suppression
Mesalamine
Treats ulcerative colitis and mild to moderate IBD
Olsalazine (Dipentum)
IBD Management - Salicylate Derivative
Balsalazide (Colazal)
IBD Management - Salicylate Derivative
Cyclosporine
Immunosuppressant
Methyltrexate
Immunossuppressant. Can promote short-term remission and reduce need for glucocorticoids in patients with Crohn's disease
Immunomodulating drugs
Medications that therapeutically alter a patient's immune response to malignant tumor cells
Drugs that modify the body's own immune response so that it can destroy various viruses and cancerous cells
Second line agents in inflammatory bowel.
Infliximab (Remicade)
Monoclonal Antibody that binds to tumor necrosis factor (TNF) & neutralizes its activity by preventing it from binding to the cell membrane in the blood. It is an immunosuppressant & is indicated for treatment of active Crohn disease & ulcerative colitis & is generally reserved for moderate - severe cases. It is given in IV form & the vials need to be refrigerated.
Metronidazole (Flagyl)
1. Used to treat anaerobic infections
2. DO NOT USED ALCOHOL (antabuse effect will be nauseous)
treats mild to moderate crohns diease.
Ciprofloxacin (Cipro)
Antibiotic, treats crohns, used with infliximab.
Ulcer treatment
usually includes medication to decrease stomach acid production like antacids; if bacteria is cause, antibiotics may be needed; avoid smoking and drinking
Dextromethorphan
-Antitussive (antagonizes NMDA glutamate receptors).
-Synthetic codeine analog. Has mild opioid effect when used in excess.
-Naloxone can be given for overdose. Mild abuse potential. -May cause serotonin syndrome if combined with other serotonergic agents
2nd generation antihistamines
Fexofenadine, loratadine, and cetirizine
non sedating
less crossing of blood brain barrier, does not suppress CNS
Take daily to prevent allergic reaction.
First Generation histamine- 1 antagonists
inhibit allergic reactions of inflammation, redness, and itching caused by the release of histamine
Can be used with cold symptoms.
Anticholinergic property (dry mouth, urinary hesitancy)
CNS depressant (sleepiness)
Caution in Asthmatic patients (thickens bronchial secretions impairing breathing)
Ex. diphenhydramine, promethazine, chlorpheniramine
Nasal Decongestants
Shrink mucosal membranes and reduces fluid secretion, should not be used for more than 48 hours
Afrin, Phenylephrine, pseudophedrine
antitussives/expectorants
Control cough, promote elimination of mucus
Ex: dextromethorphan, codeine, guaifenesin
Codeine (decreases the frequency and intensity of cough)
Digoxin (Lanoxin)
Cardiac glycoside
Positive inotrope, negative chronotrope and dromotrope
Used for HF, a-fib
Can cause dysrhythmias, bradycardia, GI effects (EARLY), vision changes (EARLY)
Hypokalemia = toxicity; hyperkalemia = decreased effects
Avoid verapamil
Hold if pulse < 60
Therapeutic level = 0.5-2.0ng/mL
Antidote: cholestyramine or Digibind
Interacts w/ many meds and bran, oats, sunflower seeds.
Statins
lower cholesterol in the blood and reduce its production in the liver by blocking the enzyme that produces it. Most effective. Reduces LDS and increases HDL. Oral, absorbed 30-90%.
S/e: headache, rash, GI, muscle pain.
Rhabdomyolysis
dissolution of striated muscle (caused by trauma, extreme exertion, or drug toxicity; in severe cases renal failure can result)
Hepatotoxicity
damage to the liver. Elevated transaminase levels, jaundice (rare). Check LFT's. Avoid statins in alcohol-induced hepatitis.
Colesevelam (Welchol)
bile acid sequestrants used for antilipemic meds. bile acid sequestrants reduce LDL.
Colestipol (Colestid)
bile acid sequestrant (older agent). Decreases fat absorpion and may decrease uptake of fat-soluble vitamins.
Nitroglycerin (Nitrostat)
take up to 3 tabs during single episode
place under tongue
store in original container
discard on expiration date
May be taken on a schedule.
Take prior to exercise / sexual activity
Calcium Channel Blockers
agents that inhibit the entry of calcium ions into heart muscle cells, causing a slowing of the heart rate, a lessening of the demand for oxygen and nutrients, and a relaxing of the smooth muscle cells of the blood vessels to cause dilation; used to prevent or treat angina pectoris, some arrhythmias, and hypertension
Ex. Nifedipine, amlodipine, Nicardipine, Diltiazam, Verapamil
No grapefruit juice, Nsaids
ACE inhibitors
"PRIL"
ex. Captopril, Enalapril, Afosiopril
Antihypertensive. Blocks ACE in lungs from converting angiotensin I to angiotensin II (powerful vasoconstrictor). Decreases BP, Decreased Aldosterone secretions, Sodium and fluid loss.
Check BP before giving (hypotension)
*Orthostatic Hypotension
Diuretics
medications administered to increase urine secretion in order to rid the body of excess water and salt
Thiazide is first line for hypertension.
Loop Diuretics are common - monitor for hypokalemia
Beta Blockers
decrease heart rate and dilate arteries by blocking beta receptors
"olol" in the end. Ex. propanolol, atenolol, metoprolol
Treat:
Irregular heart rhythm (arrhythmia)
Heart failure
Chest pain (angina)
Heart attacks
Migraine
Certain types of tremors
May cause edema, fatigue, weight gain, depression
Nitroprusside
Short acting; increase cGMP via direct release of NO. Can cause cyanide toxicity (releases cyanide)
a vasodilator that works by relaxing the muscles in your blood vessels to help them dilate (widen). This lowers blood pressure and allows blood to flow more easily through your veins and arteries.
Given IV and titrated for therapeutic dose.
Spironolactone (Aldactone)
a potassium-sparing diuretic (water pill)that prevents your body from absorbing too much salt and keeps your potassium levels from getting too low.
used to treat heart failure, high blood pressure (hypertension), or hypokalemia (low potassium levels in the blood).
Furosemide (Lasix)
loop diuretic (water pill) that prevents your body from absorbing too much salt. This allows the salt to instead be passed in your urine.
Lasix is used to treat fluid retention (edema) in people with congestive heart failure, liver disease, or a kidney disorder such as nephrotic syndrome. Also used to treat high blood pressure
High doses can cause hearing loss.
Hydrochlorothiazide
a thiazide diuretic (water pill) that helps prevent your body from absorbing too much salt, which can cause fluid retention.
HCTZ treats fluid retention (edema) in people with congestive heart failure, cirrhosis of the liver, or kidney disorders, or edema caused by taking steroids or estrogen. This medication is also used to treat high blood pressure (hypertension).
No digoxin or nsaids. [Show Less]