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NurseReview.Org Pharmacology Bullet Review

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Information about NurseReview.Org Pharmacology Bullet Review

Published on November 11, 2007

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Pharmacology Bullet Review Nursing Board Examination Review

Drug classification Nursing process applied to pharmacology Pharmacokinetics Pharmacodynamics

 

Diuretics Comparison Hypokalemia Ototoxicity Loop of Henle 3. Loop diuretics Hypovolemia & hypotension Glomerulus 5. Osmotic diuretic Hyperkalemia Distal tubule 4. Potassium sparing Hyperuricemia Hypokalemia Proximal tubule 2. Thiazide and thiazide like Acidosis Proximal tubule 1. Carbonic anhydrase inhibitor Special Side effect (s) Major site of action Diuretic class

Diuretics Comparison Hypercalcemia 3. Loop diuretics Increased ICP LITHIUM TOXICITY 5. Osmotic diuretic CHF taking digoxin 4. Potassium sparing Nephrolithiasis due to calcium stones Hypocalcemia 2. Thiazide and thiazide like Mountain sickness Meniere’s disease 1. Carbonic anhydrase inhibitor Special Uses Diuretic class

Thiazides Prototype: Hydrochloro thiazide 1. Bendroflume thiazide 2. Ben thiazide 3. Chloro thiazide (Diuril) 4. Hydroflume thiazide 5. Methylclo thiazide 6. Trichlorme thiazide

Prototype: Hydrochloro thiazide

1. Bendroflume thiazide

2. Ben thiazide

3. Chloro thiazide (Diuril)

4. Hydroflume thiazide

5. Methylclo thiazide

6. Trichlorme thiazide

Thiazide-like 1. Indapamide 2. Quinethazone 3. Metolazone 4. Chlorthalidone

1. Indapamide

2. Quinethazone

3. Metolazone

4. Chlorthalidone

Thiazides Pharmacodynamics These drugs BLOCK the chloride pump This will keep the Chloride and Sodium in the distal tubule to be excreted into the urine Potassium is also flushed out!!

Pharmacodynamics

These drugs BLOCK the chloride pump

This will keep the Chloride and Sodium in the distal tubule to be excreted into the urine

Potassium is also

flushed out!!

Thiazide Special Pharmacodynamics: Side effects Hypokalemia DECREASED calcium excretion  hypercalcemia DECREASED uric acid secretion  hyperuricemia Hyperglycemia

Special Pharmacodynamics: Side effects

Hypokalemia

DECREASED calcium excretion  hypercalcemia

DECREASED uric acid secretion  hyperuricemia

Hyperglycemia

Loop Diuretics Prototype: Furosemide 1. Bumetanide 2. Ethacrynic acid 3. Torsemide

Prototype: Furosemide

1. Bumetanide

2. Ethacrynic acid

3. Torsemide

Loop Diuretics Pharmacodynamics High-ceiling diuretics BLOCK the chloride pump in the ascending loop of Henle SODIUM and CHLORIDE reabsorption is prevented Potassium is also excreted together with Na and Cl

Pharmacodynamics

High-ceiling diuretics

BLOCK the chloride pump in the ascending loop of Henle

SODIUM and CHLORIDE reabsorption is prevented

Potassium is also excreted together with Na and Cl

Loop Diuretics

Loop Diuretics Special Pharmacodynamics: side-effects Hypokalemia Bicarbonate is lost in the urine INCREASED calcium excretion  Hypocalcemia Ototoxicity- due to the electrolyte imbalances

Special Pharmacodynamics: side-effects

Hypokalemia

Bicarbonate is lost in the urine

INCREASED calcium excretion  Hypocalcemia

Ototoxicity- due to the electrolyte imbalances

Potassium sparing diuretics Prototype: Spironolactone 1. Amiloride 2. Triamterene

Prototype: Spironolactone

1. Amiloride

2. Triamterene

Potassium sparing diuretics Pharmacodynamics Spironolactone is an ALDOSTERONE antagonist Triamterene and Amiloride BLOCK the potassium secretion in the distal tubule Diuretic effect is achieved by the sodium loss to offset potassium retention

Pharmacodynamics

Spironolactone is an ALDOSTERONE antagonist

Triamterene and Amiloride BLOCK the potassium secretion in the distal tubule

Diuretic effect is achieved by the sodium loss to offset potassium retention

Potassium sparing diuretics

Potassium sparing diuretics Pharmacokinetics: Side effects HYPERkalemia! Avoid high potassium foods: Bananas Potatoes Spinach Broccoli Nuts Prunes Tomatoes Oranges Peaches

Pharmacokinetics: Side effects

HYPERkalemia!

Avoid high potassium foods:

Bananas

Potatoes

Spinach

Broccoli

Nuts

Prunes

Tomatoes

Oranges

Peaches

Osmotic Diuretics Prototype: Mannitol 1. Glycerin 2. Isosorbide 3. Urea

Prototype: Mannitol

1. Glycerin

2. Isosorbide

3. Urea

Osmotic Diuretics Pharmacodynamics Mannitol is a sugar not well absorbed in the nephron  osmotic pull of water  diuresis

Pharmacodynamics

Mannitol is a sugar not well absorbed in the nephron  osmotic pull of water  diuresis

Osmotic Diuretics Pharmacokinetics: side effects Sudden hypovolemia Important for the nurse to warm the solution to allow the crystals to DISSOLVE in the bottle!

Pharmacokinetics: side effects

Sudden hypovolemia

Important for the nurse to warm the solution to allow the crystals to DISSOLVE in the bottle!

Carbonic Anhydrase Inhibitors Prototype: Acetazolamide 1. Methazolamide

Prototype: Acetazolamide

1. Methazolamide

Carbonic Anhydrase Inhibitors Pharmacodynamics Carbonic Anhydrase forms sodium bicarbonate BLOCK of the enzyme results to slow movement of hydrogen and bicarbonate into the tubules plus sodium is lost in the urine

Pharmacodynamics

Carbonic Anhydrase forms sodium bicarbonate

BLOCK of the enzyme results to slow movement of hydrogen and bicarbonate into the tubules

plus sodium is lost in the urine

Carbonic Anhydrase Inhibitors Pharmacokinetics: side effects Metabolic ACIDOSIS happens when bicarbonate is lost Hypokalemia

Pharmacokinetics: side effects

Metabolic ACIDOSIS happens when bicarbonate is lost

Hypokalemia

The Nursing Process and the diuretics ASSESSMENT Assess the REASON why the drug is given: ______ ______ ______ ______

ASSESSMENT

Assess the REASON why the drug is given:

______

______

______

______

The Nursing Process and the diuretics ASSESSMENT The nurse must elicit history of allergy to the drugs Allergy to sulfonamides may contraindicate the use of thiazides Assess fluid and electrolyte balance Assess other conditions like gout, diabetes, pregnancy and lactation

ASSESSMENT

The nurse must elicit history of allergy to the drugs

Allergy to sulfonamides may contraindicate the use of thiazides

Assess fluid and electrolyte balance

Assess other conditions like gout, diabetes, pregnancy and lactation

The Nursing Process and the diuretics ASSESSMENT Physical assessment Vital signs Special electrolyte and laboratory examination Assess symptom of body weakness which may indicate hypokalemia

ASSESSMENT

Physical assessment

Vital signs

Special electrolyte and laboratory examination

Assess symptom of body weakness which may indicate hypokalemia

The Nursing Process and the diuretics Nursing Diagnosis Fluid volume deficit related to diuretic effect Alteration in urinary pattern Potential for injury (ototoxocity, hypotension) Knowledge deficit

Nursing Diagnosis

Fluid volume deficit related to diuretic effect

Alteration in urinary pattern

Potential for injury (ototoxocity, hypotension)

Knowledge deficit

The Nursing Process and the diuretics IMPLEMENTATION Administer IV drug slowly Safety precaution for dizziness/hypotension Provide potassium RICH foods for most diuretics, with the exception of spironolactone Provide skin care, oral care and urinary care

IMPLEMENTATION

Administer IV drug slowly

Safety precaution for dizziness/hypotension

Provide potassium RICH foods for most diuretics, with the exception of spironolactone

Provide skin care, oral care and urinary care

The Nursing Process and the diuretics IMPLEMENTATION Monitor DAILY WEIGHT- to evaluate the effectiveness of the therapy Monitor urine output, cardiac rhythm. Serum electrolytes ADMINISTER in the MORNING! Administer with FOOD!

IMPLEMENTATION

Monitor DAILY WEIGHT- to evaluate the effectiveness of the therapy

Monitor urine output, cardiac rhythm. Serum electrolytes

ADMINISTER in the MORNING!

Administer with FOOD!

The Nursing Process and the diuretics EVALUATION: for effectiveness of therapy Weight loss Increased urine output Resolution of edema Decreased congestion Normal BP

EVALUATION: for effectiveness of therapy

Weight loss

Increased urine output

Resolution of edema

Decreased congestion

Normal BP

CNS DRUGS

The ANXIOLYTICS AND HYPNOTICS These drugs are used to change the individual’s responses to the environment.

These drugs are used to change the individual’s responses to the environment.

The ANXIOLYTICS AND HYPNOTICS The medications that can prevent the feelings of tension and fear are called ANXIOLYTICS. Anti-anxiety drugs

The medications that can prevent the feelings of tension and fear are called ANXIOLYTICS.

Anti-anxiety drugs

The ANXIOLYTICS AND HYPNOTICS The drugs that can calm individuals making them unaware of the environment are called SEDATIVES.

The drugs that can calm individuals making them unaware of the environment are called SEDATIVES.

The ANXIOLYTICS AND HYPNOTICS The drugs that can induce sleep are called HYPNOTICS.

The drugs that can induce sleep are called HYPNOTICS.

The ANXIOLYTICS AND HYPNOTICS The drugs in this class are the BENZODIAZEPINES BARBITURATES

The drugs in this class are the

BENZODIAZEPINES

BARBITURATES

Use of The Drugs Clinical indications for the use of the anxiolytics, sedatives and hypnotics 1. Prevention of anxiety 2. Formation of sedative state 3. Induction of sleep

Clinical indications for the use of the

anxiolytics, sedatives and hypnotics

1. Prevention of anxiety

2. Formation of sedative state

3. Induction of sleep

The BENZODIAZEPINES The benzodiazepines are the most frequently used anxiolytic drugs. These agents prevent anxiety states without causing much sedation, with less physical dependence than other agents.

The benzodiazepines are the most frequently used anxiolytic drugs.

These agents prevent anxiety states without causing much sedation, with less physical dependence than other agents.

The BENZODIAZEPINES The following are the benzodiazepines Alprazolam (Xanax) Chlordiazepoxide (Librium ) clonazepam clorazepate Diazepam (Valium) estazolam flurazepam lorazepam midazolam oxazepam quazepam temazepam triazolam

The following are the benzodiazepines

Alprazolam (Xanax)

Chlordiazepoxide (Librium )

clonazepam

clorazepate

Diazepam (Valium)

estazolam

flurazepam

lorazepam

midazolam

oxazepam

quazepam

temazepam

triazolam

The BENZODIAZEPINES Special uses Panic attack Alprazolam (Xanax) Alcohol withdrawal Chlordiazepoxide (Librium) Status epilepticus Diazepam (Valium)

The BENZODIAZEPINES The Mechanism of Action of the Benzodiazepines These agents act on the Limbic system and the RAS (reticular activating system) to make the GABA ( Gamma-aminobutyric acid) more effective causing interference with neuron firing.

The Mechanism of Action of the Benzodiazepines

These agents act on the Limbic system and the RAS (reticular activating system) to make the GABA ( Gamma-aminobutyric acid) more effective causing interference with neuron firing.

The BENZODIAZEPINES The Mechanism of Action of the Benzodiazepines The GABA is an inhibitory neurotransmitter. This will result to an anxiolytic effect at lower doses than required for sedation/hypnosis.

The Mechanism of Action of the Benzodiazepines

The GABA is an inhibitory neurotransmitter.

This will result to an anxiolytic effect at lower doses than required for sedation/hypnosis.

The BENZODIAZEPINES These agents are indicated for the treatment of anxiety disorders alcohol withdrawal hyperexcitability, and agitation pre-operative relief of anxiety and tension and in induction of balanced anesthesia.

These agents are indicated for the treatment of

anxiety disorders

alcohol withdrawal

hyperexcitability, and agitation

pre-operative relief of anxiety and tension and in induction of balanced anesthesia.

The BENZODIAZEPINES Pharmacodynamics: The adverse effects CNS effects= sedation, drowsiness, depression, lethargy, blurred vision GIT= dry mouth, constipation , nausea, vomiting CVS= Hypotension or hypertension, arrhythmias, palpitations, and respiratory difficulties. Hematologic= blood dyscrasias and anemia GU= urinary retention, hesitancy, loss of libido and sexual functions changes.

Pharmacodynamics: The adverse effects

CNS effects= sedation, drowsiness, depression, lethargy, blurred vision

GIT= dry mouth, constipation , nausea, vomiting

CVS= Hypotension or hypertension, arrhythmias, palpitations, and respiratory difficulties.

Hematologic= blood dyscrasias and anemia

GU= urinary retention, hesitancy, loss of libido and sexual functions changes.

The BENZODIAZEPINES Nursing Considerations: Maintain patients on bed for at least 3 hours after drug administration. Instruct to avoid hazardous activities like driving and machine operation. Instruct to avoid consuming ALCOHOL while taking the drug .

Nursing Considerations:

Maintain patients on bed for at least 3 hours after drug administration.

Instruct to avoid hazardous activities like driving and machine operation.

Instruct to avoid consuming ALCOHOL while taking the drug .

The BENZODIAZEPINES Nursing Considerations: Provide comfort measures to help patients tolerate drug effects- instruct to urinate before taking drug give high fiber foods use side-rails and assistance with ambulation. Have available FLUMAZENIL as an antidote for benzodiazepine overdose.

Nursing Considerations:

Provide comfort measures to help patients tolerate drug effects-

instruct to urinate before taking drug

give high fiber foods

use side-rails and assistance with ambulation.

Have available FLUMAZENIL as an antidote for benzodiazepine overdose.

The BARBITURATES These are also anxiolytics and hypnotics with a greater likelihood of producing sedation, with increase risk of addiction and dependence.

These are also anxiolytics and hypnotics with a greater likelihood of producing sedation, with increase risk of addiction and dependence.

The BARBITURATES The following are the barbiturates amobarbital aprobarbital butabarbital mephobarbital pentobarbital Phenobarbital secobarbital

The following are the barbiturates

amobarbital

aprobarbital

butabarbital

mephobarbital

pentobarbital

Phenobarbital

secobarbital

The BARBITURATES The Mechanism of Action of the Barbiturates They depress the motor output from the brain. The results of their MOA are sedation, hypnosis and anesthesia, and if extreme, coma.

The Mechanism of Action of the Barbiturates

They depress the motor output from the brain.

The results of their MOA are sedation, hypnosis and anesthesia, and if extreme, coma.

The BARBITURATES Clinical indications of the Barbiturates Relief of anxiety manifestations For sedation For patients with insomnia For pre-anesthesia seizures/epilepsy The rapid acting barbiturates are also used for the treatment of acute manic reactions and status epilepticus

Clinical indications of the Barbiturates

Relief of anxiety manifestations

For sedation

For patients with insomnia

For pre-anesthesia

seizures/epilepsy

The rapid acting barbiturates are also used for the treatment of acute manic reactions and status epilepticus

The BARBITURATES Pharmacodynamics: The Adverse effects CNS= CNS depression , somnolence , vertigo, lethargy, ataxia, paradoxical excitement, anxiety and hallucinations. GIT= nausea, vomiting, constipation/diarrhea and epigastric pain CVS= bradycardia, Hypotension and syncope. Respi= serious hypoventilation, respiratory depression and laryngospasms Others= hypersensitivity and Stevens-Johnson syndrome.

Pharmacodynamics: The Adverse effects

CNS= CNS depression , somnolence , vertigo, lethargy, ataxia, paradoxical excitement, anxiety and hallucinations.

GIT= nausea, vomiting, constipation/diarrhea and epigastric pain

CVS= bradycardia, Hypotension and syncope.

Respi= serious hypoventilation, respiratory depression and laryngospasms

Others= hypersensitivity and Stevens-Johnson syndrome.

The BARBITURATES Nursing Considerations Provide stand-by life support facilities in cases of severe respiratory depression or hypersensitivity reaction. Taper the drug gradually after long-term therapy to avoid withdrawal syndrome. Provide comfort measures including small frequent meals, access to bathroom facilities, high-fiber foods, environmental control, safety precaution and skin care.

Nursing Considerations

Provide stand-by life support facilities in cases of severe respiratory depression or hypersensitivity reaction.

Taper the drug gradually after long-term therapy to avoid withdrawal syndrome.

Provide comfort measures including small frequent meals, access to bathroom facilities, high-fiber foods, environmental control, safety precaution and skin care.

The CNS stimulants These are drugs used to treat certain disorders exogenous obesity attention-deficit hyperactivity disorders (ADHD) narcolepsy

These are drugs used to treat certain disorders

exogenous obesity

attention-deficit hyperactivity disorders (ADHD)

narcolepsy

The CNS stimulants What is unusual is the ability of the CNS stimulants to CALM hyperactive children, which allows them to focus on one activity for a longer period.

What is unusual is the ability of the CNS stimulants to CALM hyperactive children, which allows them to focus on one activity for a longer period.

The CNS stimulants The following are the CNS stimulants: 1. Methylphenidate (Ritalin)= most commonly used for ADHD 2. Dextroamphetamine= a CNS stimulant that is used for short tem therapy for obesity. 3. Modafinil= used for narcolepsy 4. Pemoline= used for ADHD

The following are the CNS stimulants:

1. Methylphenidate (Ritalin)= most commonly used for ADHD

2. Dextroamphetamine= a CNS stimulant that is used for short tem therapy for obesity.

3. Modafinil= used for narcolepsy

4. Pemoline= used for ADHD

The CNS stimulants The Mechanism of Action These agents act as to stimulate the cortical and reticular activating system (RAS) of the brain. This is by releasing neurotransmitters from the nerve cells leading to increased stimulation of the post-synaptic neurons.

The Mechanism of Action

These agents act as to stimulate the cortical and reticular activating system (RAS) of the brain.

This is by releasing neurotransmitters from the nerve cells leading to increased stimulation of the post-synaptic neurons.

The CNS stimulants The paradoxical effect of calming hyperexcitability through CNS stimulation seen in ADHD is believed to be related to the increased stimulation of an IMMATURE Reticular Activating System leading to the ability to be more selective in response to incoming stimuli.

The paradoxical effect of calming hyperexcitability through CNS stimulation seen in ADHD is believed to be related to the increased stimulation of an IMMATURE Reticular Activating System leading to the ability to be more selective in response to incoming stimuli.

The CNS stimulants Pharmacodynamics: Adverse effects of the CNS stimulants CNS= nervousness, insomnia , dizziness, headache, and blurred vision GIT= anorexia , nausea and weight loss CVS= hypertension, tachycardia arrhythmias, and angina Others= rashes, physical/psychological dependence.

Pharmacodynamics: Adverse effects of the CNS stimulants

CNS= nervousness, insomnia , dizziness, headache, and blurred vision

GIT= anorexia , nausea and weight loss

CVS= hypertension, tachycardia arrhythmias, and angina

Others= rashes, physical/psychological dependence.

The CNS stimulants Implementation The nurse must ensure that the drug is only given to the indicated conditions Administer the drug before 6 pm to reduce the effect of insomnia BEST given AFTER meals to prevent the effect of anorexia Consult with school personnel to monitor the patient under therapy Provide safety measures such as side-rails and assisted ambulation

Implementation

The nurse must ensure that the drug is only given to the indicated conditions

Administer the drug before 6 pm to reduce the effect of insomnia

BEST given AFTER meals to prevent the effect of anorexia

Consult with school personnel to monitor the patient under therapy

Provide safety measures such as side-rails and assisted ambulation

The CNS stimulants Evaluation Evaluate the effectiveness of the drug: Calming effect in the patient with ADHD Alertness for patients with narcolepsy

Evaluation

Evaluate the effectiveness of the drug:

Calming effect in the patient with ADHD

Alertness for patients with narcolepsy

The Anti-epileptics These agents, also called anticonvulsants, are used to treat epileptic conditions. Hydantoins, Barbiturates, benzodiazepines, Succinimides and many others are given to a specific type of seizure.

These agents, also called anticonvulsants, are used to treat epileptic conditions.

Hydantoins, Barbiturates, benzodiazepines, Succinimides and many others are given to a specific type of seizure.

Anti-epileptics Agents for treating TONIC-CLONIC SEIZURES 1. Hydantoins Phenytoin Ethotoin Fosphenytoin Mephenytoin 2. Benzodiazepines Diazepam Clonazepam Clorazepate 3. Barbiturates Phenobarbital

Agents for treating TONIC-CLONIC SEIZURES

1. Hydantoins

Phenytoin

Ethotoin

Fosphenytoin

Mephenytoin

2. Benzodiazepines

Diazepam

Clonazepam

Clorazepate

3. Barbiturates

Phenobarbital

Anti-epileptics Agents for treating ABSENCE SEIZURES 1. Succinimides a. Ethosuximide b. Methsuximide c. Phensuximide 2. Valproic Acid 3. Zosinamide

Agents for treating ABSENCE SEIZURES

1. Succinimides

a. Ethosuximide

b. Methsuximide

c. Phensuximide

2. Valproic Acid

3. Zosinamide

Anti-epileptics Agents for treating Partial FOCAL SEIZURES 1. Carbamazepine 2. Gabapentin 3.Lamotrigine 4. Tiagabine 5. Topiramate

Agents for treating Partial FOCAL SEIZURES

1. Carbamazepine

2. Gabapentin

3.Lamotrigine

4. Tiagabine

5. Topiramate

The hydantoins These agents are utilized for general seizures because they can depress the central nervous system. They affect the entire brain and reduce the chance of sudden electrical outburst that causes seizures. These agents generally are less sedating than other anti-epileptics .

These agents are utilized for general seizures because they can depress the central nervous system.

They affect the entire brain and reduce the chance of sudden electrical outburst that causes seizures.

These agents generally are less sedating than other anti-epileptics .

The hydantoins Mechanism of Action of the Hydantoins These agents STABILIZE the nerve cell membrane throughout the brain reducing and limiting the excitability and conduction through nerve pathways.

Mechanism of Action of the Hydantoins

These agents STABILIZE the nerve cell membrane throughout the brain reducing and limiting the excitability and conduction through nerve pathways.

The hydantoins Clinical Indications of the hydantoins Tonic-clonic seizures Status epilepticus For the prevention of seizures in neurosurgery For muscle relaxation.

Clinical Indications of the hydantoins

Tonic-clonic seizures

Status epilepticus

For the prevention of seizures in neurosurgery

For muscle relaxation.

The hydantoins Contraindications and Precautions Hydantoins are NOT given to pregnant patient because it can cause fetal hydantoin syndrome .

Contraindications and Precautions

Hydantoins are NOT given to pregnant patient because it can cause fetal hydantoin syndrome .

The hydantoins Pharmacodynamics: Adverse effects of the Hydantoins CNS effects- depression, confusion, drowsiness, lethargy, fatigue GIT- GI upset, constipation, dry mouth , GINGIVAL HYPERPLASIA , severe liver toxicity which are all related to cellular toxicity. SKIN- hirsutism and coarsening of the facial skin Bone Marrow depression

Pharmacodynamics: Adverse effects of the Hydantoins

CNS effects- depression, confusion, drowsiness, lethargy, fatigue

GIT- GI upset, constipation, dry mouth , GINGIVAL HYPERPLASIA , severe liver toxicity which are all related to cellular toxicity.

SKIN- hirsutism and coarsening of the facial skin

Bone Marrow depression

The hydantoins Implementation Administer the drug with food to alleviate GI irritation Discontinue the drug at any sign of hypersensitivity reaction, severe liver dysfunction and severe skin rashes. Provide meticulous mouth oral care Rule out pregnancy and advise women to use contraceptive measures to prevent pregnancy.

Implementation

Administer the drug with food to alleviate GI irritation

Discontinue the drug at any sign of hypersensitivity reaction, severe liver dysfunction and severe skin rashes.

Provide meticulous mouth oral care

Rule out pregnancy and advise women to use contraceptive measures to prevent pregnancy.

GIT DRUGS

Drugs affecting GI secretions There are five types of drugs that affect gastric acid secretions and are useful for the treatment of peptic ulcer. Histamine (H2) receptor antagonist/blockers Antacids Proton pump inhibitors Mucosal protectants Prostaglandin analogs

There are five types of drugs that affect gastric acid secretions and are useful for the treatment of peptic ulcer.

Histamine (H2) receptor antagonist/blockers

Antacids

Proton pump inhibitors

Mucosal protectants

Prostaglandin analogs

Drugs affecting secretions: anti ulcer Misoprostol Prostaglandin analog Sucralfate Mucosal protectants Omeprazole Proton pump inhibitors AlOH and MgOH Antacids Cimetidine Histamine (H2) receptor antagonist/blockers Prototype Anti-ulcer drugs

General indication of the drugs affecting gastric acid secretion Peptic ulcer Gastritis Patient on NPO to prevent stress ulcer

Peptic ulcer

Gastritis

Patient on NPO to prevent stress ulcer

General time of administration of the drugs affecting gastric acid secretion Misoprostol WITH MEALS Prostaglandin analog Sucralfate BEFORE MEALS Mucosal protectants Omeprazole BEFORE MEALS Proton pump inhibitors AlOH and MgOH Usually after meals Antacids Cimetidine With FOOD or ONE hour after ANTACID Histamine (H2) receptor antagonist/blockers Prototype Best time to give Anti-ulcer drugs

Pharmacology of Anti-ulcer drugs Inhibit Proton Pump in parietal cell decreasing secretion and acidity Proton pump inhibitors- “ Prazoles” Omeprazole, pantoprazole Block Histamine receptor causing decreased secretion and acidity H2-Blockers- “ tidine ” Cimetidine , Ranitidine Neutralize Gastric ACIDITY Antacids- AlOH, MgOH Mechanism of Action Drug

Pharmacology of Anti-ulcer drugs Prostaglandin Analogue, causes secretion of MUCUS Misoprostol (Cytotec) Coats the mucosal lining Sucralfate (Carafate) Blocks VAGUS nerve, decreases secretion Anti-cholinergic- Prophanteline Bromide Mechanism of Action Drug

Pharmacodynamics Histamine (H2) receptor blockers These drugs BLOCK the release of hydrochloric acid in the stomach in response to gastrin

Histamine (H2) receptor blockers

These drugs BLOCK the release of hydrochloric acid in the stomach in response to gastrin

Drugs affecting GI secretions Antacids These drugs interact with the gastric acids at the chemical level to neutralize them

Antacids

These drugs interact with the gastric acids at the chemical level to neutralize them

Drugs affecting GI secretions Proton pump inhibitors These drugs suppress the secretion of hydrochloric acid into the lumen of the stomach

Proton pump inhibitors

These drugs suppress the secretion of hydrochloric acid into the lumen of the stomach

Drugs affecting GI secretions Mucosal protectants These are agents that coat any injured area in the stomach to prevent further injury from acid

Mucosal protectants

These are agents that coat any injured area in the stomach to prevent further injury from acid

Drugs affecting GI secretions Prostaglandin analogs These are agents that inhibit the secretion of gastrin and increase the secretion of mucus lining of the stomach, providing a buffer.

Prostaglandin analogs

These are agents that inhibit the secretion of gastrin and

increase the secretion of mucus lining of the stomach, providing a buffer.

The H2 Blockers- “tidines” Prototype: Cimetidine 1. Ranitidine 2. Famotidine 3. Nizatidine

Prototype: Cimetidine

1. Ranitidine

2. Famotidine

3. Nizatidine

The H2 Blockers- “tidines” Pharmacodynamics: Drug Action The H2 blockers are antagonists at the receptors in the parietal cells of the stomach. The blockage results to inhibition of the hormone gastrin. There will be decreased production of gastric acid from the parietal cells. Also, the chief cells will secrete less pepsinogen.

Pharmacodynamics: Drug Action

The H2 blockers are antagonists at the receptors in the parietal cells of the stomach.

The blockage results to inhibition of the hormone gastrin.

There will be decreased production of gastric acid from the parietal cells.

Also, the chief cells will secrete less pepsinogen.

The H2 Blockers- “tidines” Therapeutic use of the H2 blockers Short-term treatment of active duodenal ulcer or benign gastric ulcer Treatment of hypersecretory conditions like the Zollinger-Ellison syndrome Prevention of stress-induced ulcers and acute GI bleeding Treatment of erosive GERD (reflux disease) Relief of Symptoms of heart burn and acid indigestion

Therapeutic use of the H2 blockers

Short-term treatment of active duodenal ulcer or benign gastric ulcer

Treatment of hypersecretory conditions like the Zollinger-Ellison syndrome

Prevention of stress-induced ulcers and acute GI bleeding

Treatment of erosive GERD (reflux disease)

Relief of Symptoms of heart burn and acid indigestion

The H2 Blockers- “tidines” Precautions and Contraindications Any known allergy is a clear contraindication to the use of the agents. Conditions such as pregnancy, lactation, renal dysfunction and hepatic dysfunction should warrant cautious use. Nizatidine can be used in hepatic dysfunction.

Precautions and Contraindications

Any known allergy is a clear contraindication to the use of the agents. Conditions such as pregnancy, lactation, renal dysfunction and hepatic dysfunction should warrant cautious use.

Nizatidine can be used in hepatic dysfunction.

The H2 Blockers- “tidines” Pharmocodynamics- Side effects and adverse effects GIT= diarrhea or constipation CNS= Dizziness, headache, drowsiness, confusion and hallucinations Cardio= arrhythmias, HYPOTENSION (related to H2 receptor blockage in the heart) Cimetidine= TREMORS, Gynecomastia and impotence in males

Pharmocodynamics- Side effects and adverse effects

GIT= diarrhea or constipation

CNS= Dizziness, headache, drowsiness, confusion and hallucinations

Cardio= arrhythmias, HYPOTENSION (related to H2 receptor blockage in the heart)

Cimetidine= TREMORS, Gynecomastia and impotence in males

The H2 Blockers- “tidines” Drug-drug Interactions Cimetidine, Famotidine, Ranitidine are metabolized in the liver- they can cause slowing of excretion of other drugs leading to their increased concentration.

Drug-drug Interactions

Cimetidine, Famotidine, Ranitidine are metabolized in the liver- they can cause slowing of excretion of other drugs leading to their increased concentration.

The H2 Blockers- “tidines” Drug-drug Interactions These drugs can interact with CIMETIDINE anticoagulants, phenytoin, alcohol, antidepressants.

Drug-drug Interactions

These drugs can interact with CIMETIDINE anticoagulants, phenytoin, alcohol, antidepressants.

The H2 Blockers- “tidines” Nursing considerations: Administer the drug WITH meals at BEDTIME to ensure therapeutic level One hour after Antacids Stress the importance of the continued use for the length of time prescribed

Nursing considerations:

Administer the drug WITH meals at BEDTIME to ensure therapeutic level

One hour after Antacids

Stress the importance of the continued use for the length of time prescribed

The H2 Blockers- “tidines” Nursing considerations: Monitor the cardiovascular status especially if the drugs are given IV Warn patient of the potential problems of increased drug concentration if the H2 blockers are used with other drugs or OTC drugs. Advise consultation first!

Nursing considerations:

Monitor the cardiovascular status especially if the drugs are given IV

Warn patient of the potential problems of increased drug concentration if the H2 blockers are used with other drugs or OTC drugs. Advise consultation first!

The H2 Blockers- “tidines” Nursing considerations: Provide comfort measures like analgesics for headache, assistance with ambulation and safety measures Warn the patients taking cimetidine that drowsiness may pose a hazard if driving or operating delicate machines.

Nursing considerations:

Provide comfort measures like analgesics for headache, assistance with ambulation and safety measures

Warn the patients taking cimetidine that drowsiness may pose a hazard if driving or operating delicate machines.

The H2 Blockers- “tidines” Nursing considerations: Provide health teaching as to the dose, frequency, comfort measures to initiate when side-effects are intolerable Evaluate the effectiveness: Relief of symptoms of ulcer, heart burn and GERD

Nursing considerations:

Provide health teaching as to the dose, frequency, comfort measures to initiate when side-effects are intolerable

Evaluate the effectiveness:

Relief of symptoms of ulcer, heart burn and GERD

The Antacids These are drugs or inorganic chemicals that have been used for years to neutralize acid in the stomach. The following are the common antacids that can be bought OTC: Aluminum salts (hydroxide) Calcium salts (carbonate) Magnesium salts (milk of magnesia) Sodium bicarbonate Magaldrate (aluminum and magnesium combination)

These are drugs or inorganic chemicals that have been used for years to neutralize acid in the stomach. The following are the common antacids that can be bought OTC:

Aluminum salts (hydroxide)

Calcium salts (carbonate)

Magnesium salts (milk of magnesia)

Sodium bicarbonate

Magaldrate (aluminum and magnesium combination)

The Antacids Pharmacodynamics: drug action These agents act to neutralize the acidic pH in the stomach. They do not affect the rate of gastric acid secretion.

Pharmacodynamics: drug action

These agents act to neutralize the acidic pH in the stomach.

They do not affect the rate of gastric acid secretion.

The Antacids Pharmacodynamics: drug action The administration of antacid may cause an acid rebound. Neutralizing the stomach content to an alkaline level stimulates gastrin production to cause an increase in acid production and return the stomach to its normal acidic state.

Pharmacodynamics: drug action

The administration of antacid may cause an acid rebound.

Neutralizing the stomach content to an alkaline level stimulates gastrin production to cause an increase in acid production and return the stomach to its normal acidic state.

The Antacids Therapeutic Indications Symptomatic relief of upset stomach associated with hyperacidity Hyperacidic conditions like peptic ulcer, gastritis, esophagitis and hiatal hernia Special use of AMPHOGEL (aluminum hydroxide): to BIND phosphate

Therapeutic Indications

Symptomatic relief of upset stomach associated with hyperacidity

Hyperacidic conditions like peptic ulcer, gastritis, esophagitis and hiatal hernia

Special use of AMPHOGEL (aluminum hydroxide): to BIND phosphate

The Antacids Precautions of Antacid Use Known allergy is a clear contraindication. Caution should be instituted if used in electrolyte imbalances, GI obstruction and renal dysfunction. Sodium bicarbonate is rarely used because of potential systemic absorption

Precautions of Antacid Use

Known allergy is a clear contraindication. Caution should be instituted if used in electrolyte imbalances, GI obstruction and renal dysfunction.

Sodium bicarbonate is rarely used because of potential systemic absorption

The Antacids Pharmacokinetics These agents are taken orally and act locally in the stomach

Pharmacokinetics

These agents are taken orally and act locally in the stomach

The Antacids Pharmacodynamics: Effects of drugs GIT= rebound acidity; alkalosis may occur. Calcium salts may lead to hypercalcemia Magnesium salts can cause DIARRHEA Aluminum salts may cause CONSTIPATION and hypophosphatemia by binding with phosphates in the GIT. 2. Fluid retention due to the high sodium content of the antacids.

Pharmacodynamics: Effects of drugs

GIT= rebound acidity; alkalosis may occur.

Calcium salts may lead to hypercalcemia

Magnesium salts can cause DIARRHEA

Aluminum salts may cause CONSTIPATION and hypophosphatemia by binding with phosphates in the GIT.

2. Fluid retention due to the high sodium content of the antacids.

The Antacids Nursing Considerations: Administer the antacids apart from any other medications by ONE hour before or TWO hours after- to ensure adequate absorption of the other medications Tell the patient to CHEW the tablet thoroughly before swallowing. Follow it with one glass of water Regularly monitor for manifestations of acid-base imbalances as well as electrolyte imbalances

Nursing Considerations:

Administer the antacids apart from any other medications by ONE hour before or TWO hours after- to ensure adequate absorption of the other medications

Tell the patient to CHEW the tablet thoroughly before swallowing. Follow it with one glass of water

Regularly monitor for manifestations of acid-base imbalances as well as electrolyte imbalances

The Antacids Nursing Considerations: Provide comfort measures to alleviate constipation associated with aluminum and diarrhea associated with magnesium salts. Monitor for the side-effects, effectiveness of the comfort measures, patient’s response to the medication and the effectiveness of the health teachings

Nursing Considerations:

Provide comfort measures to alleviate constipation associated with aluminum and diarrhea associated with magnesium salts.

Monitor for the side-effects, effectiveness of the comfort measures, patient’s response to the medication and the effectiveness of the health teachings

The Antacids Nursing Considerations: Evaluate for effectiveness: Decreased symptoms of ulcer and pyrosis Decreased Phosphate level (amphogel)

Nursing Considerations:

Evaluate for effectiveness:

Decreased symptoms of ulcer and pyrosis

Decreased Phosphate level (amphogel)

The PPI These are the newer agents for ulcer treatment The “prazoles” Prototype: Ome prazole Laniso prazole Esome prazole Panto prazole

These are the newer agents for ulcer treatment

The “prazoles”

Prototype: Ome prazole

Laniso prazole

Esome prazole

Panto prazole

The PPI Pharmacodynamics: drug action They act at specific secretory surface receptors to prevent the final step of acid production and thus decrease the level of acid in the stomach. The “pump” in the parietal cell is the H-K ATPase enzyme system on the secretory surface of the gastric parietal cells

Pharmacodynamics: drug action

They act at specific secretory surface receptors to prevent the final step of acid production and thus decrease the level of acid in the stomach.

The “pump” in the parietal cell is the H-K ATPase enzyme system on the secretory surface of the gastric parietal cells

The PPI Clinical use of the PPIs Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis and benign gastric ulcer. Long-term- maintenance therapy for healing of erosive disorders.

Clinical use of the PPIs

Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis and benign gastric ulcer.

Long-term- maintenance therapy for healing of erosive disorders.

The PPI Clinical use of the PPIs. Precautions with the use of the PPIs Known allergy is a clear contraindication. Caution if patient is pregnant

Clinical use of the PPIs.

Precautions with the use of the PPIs

Known allergy is a clear contraindication. Caution if patient is pregnant

The PPI Pharmacodynamics: Adverse effects CNS- dizziness , headache, asthenia (loss of strength), vertigo , insomnia, apathy GIT- diarrhea, abdominal pain, nausea, vomiting, dry mouth and tongue atrophy Respi- cough, stuffy nose, hoarseness and epistaxis.

Pharmacodynamics: Adverse effects

CNS- dizziness , headache, asthenia (loss of strength), vertigo , insomnia, apathy

GIT- diarrhea, abdominal pain, nausea, vomiting, dry mouth and tongue atrophy

Respi- cough, stuffy nose, hoarseness and epistaxis.

The PPI Nursing considerations: Administer the drug BEFORE meals. Ensure that patient does not open, chew or crush the drug. Provide safety measures if CNS dysfunction happens. Arrange for a medical follow-up if symptoms are NOT resolved after 4-8 weeks of therapy.

Nursing considerations:

Administer the drug BEFORE meals. Ensure that patient does not open, chew or crush the drug.

Provide safety measures if CNS dysfunction happens.

Arrange for a medical follow-up if symptoms are NOT resolved after 4-8 weeks of therapy.

The PPI Nursing considerations: Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems. Monitor patient response to the drug, the effectiveness of the teaching plan and the measures to employ

Nursing considerations:

Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems.

Monitor patient response to the drug, the effectiveness of the teaching plan and the measures to employ

The PPI Nursing considerations: Evaluate for effectiveness of the drug Healing of peptic ulcer Decreased symptoms of ulcer

Nursing considerations:

Evaluate for effectiveness of the drug

Healing of peptic ulcer

Decreased symptoms of ulcer

The Mucosal Protectant Sucralfate This is given to protect the eroded ulcer sites in the GIT from further damage by acid and digestive enzymes

Sucralfate

This is given to protect the eroded ulcer sites in the GIT from further damage by acid and digestive enzymes

Sucralfate Pharmacodynamics: Action of drug It forms an ulcer-adherent complex at duodenal ulcer sites, protecting the sites against acid, pepsin and bile. This action prevents further breakdown of proteins in the area and promotes healing.

Pharmacodynamics: Action of drug

It forms an ulcer-adherent complex at duodenal ulcer sites, protecting the sites against acid, pepsin and bile.

This action prevents further breakdown of proteins in the area and promotes healing.

Sucralfate Clinical use of sucralfate Short and long term management of duodenal ulcer. NSAIDs induced gastritis Prevention of stress ulcer Treatment of oral and esophageal ulcers due to radiation, chemotherapy or sclerotherapy.

Clinical use of sucralfate

Short and long term management of duodenal ulcer.

NSAIDs induced gastritis

Prevention of stress ulcer

Treatment of oral and esophageal ulcers due to radiation, chemotherapy or sclerotherapy.

Sucralfate Precautions on the use of Sucralfate This agent should NOT be given to any person with known allergy to the drug, and to those patients with renal failure/dialysis because of build-up of aluminum may occur if used with aluminum containing products.

Precautions on the use of Sucralfate

This agent should NOT be given to any person with known allergy to the drug, and to those patients with renal failure/dialysis because of build-up of aluminum may occur if used with aluminum containing products.

The Mucosal Protectant Pharmacodynamics: Side-effects & adverse reactions Primarily GIT= CONSTIPATION, occasionally diarrhea, nausea, indigestion, gastric discomfort, and dry mouth may also occur CNS= dizziness, drowsiness, vertigo Others= rash and back pain

Pharmacodynamics: Side-effects & adverse reactions

Primarily GIT= CONSTIPATION, occasionally diarrhea, nausea, indigestion, gastric discomfort, and dry mouth may also occur

CNS= dizziness, drowsiness, vertigo

Others= rash and back pain

The Mucosal Protectant Drug-drug interactions If used with aluminum salts= high risk of accumulation of aluminum and toxicity . If used with phenytoin, fluoroquinolones and penicillamines- decreased levels of these drugs when taken with sucralfate

Drug-drug interactions

If used with aluminum salts= high risk of accumulation of aluminum and toxicity .

If used with phenytoin, fluoroquinolones and penicillamines- decreased levels of these drugs when taken with sucralfate

The Mucosal Protectant Nursing Considerations Administer drug ON AN EMPTY stomach , 1 hour before meals , or 2 hour after meals and at BEDTIME Monitor for side-effects like constipation and GI upset Encourage intake of high-fiber foods and increased fluid intake Administer antacids BETWEEN doses of sucralfate, NOT WITHIN 30 minutes of sucralfate dose

Nursing Considerations

Administer drug ON AN EMPTY stomach , 1 hour before meals , or 2 hour after meals and at BEDTIME

Monitor for side-effects like constipation and GI upset

Encourage intake of high-fiber foods and increased fluid intake

Administer antacids BETWEEN doses of sucralfate, NOT WITHIN 30 minutes of sucralfate dose

The Mucosal Protectant Nursing Considerations Provide comfort measures if CNS effects occur Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems. Monitor patient response to the drug, the effectiveness of the teaching plan and the measures employed

Nursing Considerations

Provide comfort measures if CNS effects occur

Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems.

Monitor patient response to the drug, the effectiveness of the teaching plan and the measures employed

The Mucosal Protectant Nursing Considerations Evaluate effectiveness of therapy Healing of ulcer No formation of ulcer

Nursing Considerations

Evaluate effectiveness of therapy

Healing of ulcer

No formation of ulcer

Prostaglandin analogue Misoprostol This agent is a synthetic prostaglandin E1 analog that is employed to protect the lining of the mucosa of the stomach

Misoprostol

This agent is a synthetic prostaglandin E1 analog that is employed to protect the lining of the mucosa of the stomach

Prostaglandin analogue Misoprostol: Pharmacodynamics Being a prostaglandin analog, it inhibits gastric acid secretion to some degree It INCREASES mucus production in the stomach lining.

Misoprostol: Pharmacodynamics

Being a prostaglandin analog, it inhibits gastric acid secretion to some degree

It INCREASES mucus production in the stomach lining.

Prostaglandin analogue Misoprostol: Clinical use NSAIDs-induced gastric ulcers Duodenal ulcers unresponsive to H2 antagonists.

Misoprostol: Clinical use

NSAIDs-induced gastric ulcers

Duodenal ulcers unresponsive to H2 antagonists.

Prostaglandin analogue Precautions of Misoprostol Use This drug is CONTRAINDICATED during pregnancy because it is an abortifacient. Women should be advised to have a negative pregnancy test within 2 weeks of beginning therapy and should begin the drug on the second or third day of the next menstrual cycle. They should be instructed in the use of contraceptives during therapy.

Precautions of Misoprostol Use

This drug is CONTRAINDICATED during pregnancy because it is an abortifacient.

Women should be advised to have a negative pregnancy test within 2 weeks of beginning therapy and should begin the drug on the second or third day of the next menstrual cycle.

They should be instructed in the use of contraceptives during therapy.

Prostaglandin analogue Pharmacodynamic effects: drug reactions GIT= Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia GU effects= miscarriages, excessive uterine CRAMPING and bleeding , spotting, hypermenorrhea and menstrual disorders.

Pharmacodynamic effects: drug reactions

GIT= Nausea, diarrhea, abdominal pain, flatulence, vomiting, dyspepsia

GU effects= miscarriages, excessive uterine CRAMPING and bleeding , spotting, hypermenorrhea and menstrual disorders.

Prostaglandin analogue Nursing Considerations Administer to patients at risk for NSAIDs-induced ulcers during the full course of NSAIDs therapy Administer four times daily with meals and at bedtime Obtain pregnancy test within 2 weeks of beginning therapy. Begin the therapy on second or third day of menstrual period to ensure that the woman is not pregnant

Nursing Considerations

Administer to patients at risk for NSAIDs-induced ulcers during the full course of NSAIDs therapy

Administer four times daily with meals and at bedtime

Obtain pregnancy test within 2 weeks of beginning therapy. Begin the therapy on second or third day of menstrual period to ensure that the woman is not pregnant

Prostaglandin analogue Nursing Considerations Provide patient with both written and oral information regarding the associated risks of pregnancy Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems. Monitor patient response to the drug, the effectiveness of the teaching plan and the measures to employ

Nursing Considerations

Provide patient with both written and oral information regarding the associated risks of pregnancy

Provide health teaching as to drug name, dosages and frequency, safety measures to handle common problems.

Monitor patient response to the drug, the effectiveness of the teaching plan and the measures to employ

laxatives

Laxatives Lubricating the intestinal material to promote passage through the GIT Docusate Lubricants Increased fluid content of the fecal material causing stimulation of the local reflex Lactulose Mechanical (bulk) stimulants Direct stimulation of the GIT nerves Irritant laxatives Bisacodyl (Dulcolax) Chemical stimulants Action Prototype Type

Laxatives Generally used to INCREASE the passage of the colonic contents The general classifications is as follows: 1. Chemical stimulants 2. Mechanical stimulants 3. Lubricants

Generally used to INCREASE the passage of the colonic contents

The general classifications is as follows:

1. Chemical stimulants

2. Mechanical stimulants

3. Lubricants

Therapeutic Indications of the Laxatives SHORT term relief of Constipation Prevention of straining in conditions like CHF, post-MI, post partum, post-op Preparation for diagnostic examination Removal of poison or toxins Adjunct in anti-helminthic therapy

SHORT term relief of Constipation

Prevention of straining in conditions like CHF, post-MI, post partum, post-op

Preparation for diagnostic examination

Removal of poison or toxins

Adjunct in anti-helminthic therapy

Contraindications in Laxative use ACUTE abdominal disorders Appendicitis Diverticulitis Ulcerative colitis

ACUTE abdominal disorders

Appendicitis

Diverticulitis

Ulcerative colitis

Chemical Stimulant Cathartics Prototype: Bisacodyl Irritant laxatives: 1. Castor oil 2. Senna 3. Cascara 4. Phenolphthalein

Prototype: Bisacodyl

Irritant laxatives:

1. Castor oil

2. Senna

3. Cascara

4. Phenolphthalein

Chemical Stimulant Cathartics Pharmacodynamics These agents DIRECTLY stimulate the nerve plexus in the intestinal wall The result is INCREASED movement or motility of the colon

Pharmacodynamics

These agents DIRECTLY stimulate the nerve plexus in the intestinal wall

The result is INCREASED movement or motility of the colon

Mechanical Stimulant Cathartics Prototype: LACTULOSE (Cephulac) Bulk-forming laxatives 1. Magnesium (citrate, hydroxide, sulfate) 2. Psyllium 3. Polycarbophil

Prototype: LACTULOSE (Cephulac)

Bulk-forming laxatives

1. Magnesium (citrate, hydroxide, sulfate)

2. Psyllium

3. Polycarbophil

Mechanical Stimulant Cathartics Pharmacodynamics These agents are rapid-acting laxatives that INCREASE the GI motility by Increasing the fluids in the colonic material Stimulating the local stretch receptors Activating local defection reflex

Pharmacodynamics

These agents are rapid-acting laxatives that INCREASE the GI motility by

Increasing the fluids in the colonic material

Stimulating the local stretch receptors

Activating local defection reflex

Lubricants Prototype: Docusate 1. Glycerin 2. Mineral oil

Prototype: Docusate

1. Glycerin

2. Mineral oil

Lubricants Pharmacodynamics Docusate increases the admixture of fat and water producing a softer stool Glycerin Mineral oil forms a slippery coat on the colonic contents

Pharmacodynamics

Docusate increases the admixture of fat and water producing a softer stool

Glycerin

Mineral oil forms a slippery coat on the colonic contents

Pharmacokinetics: Common Side-effects of the Laxatives Diarrhea Abdominal cramping Nausea Fluid and electrolyte imbalance Sympathetic reactions- sweating, palpitations, flushing and fainting CATHARTIC dependence

Diarrhea

Abdominal cramping

Nausea

Fluid and electrolyte imbalance

Sympathetic reactions- sweating, palpitations, flushing and fainting

CATHARTIC dependence

The Nursing Process and Laxative ASSESSMENT Nursing History- elicit allergy to any laxatives, elicit history of conditions like diverticulitis and ulcerative colitis Physical Examination- abdominal assessment Laboratory Test: fecalysis, electrolyte levels

ASSESSMENT

Nursing History- elicit allergy to any laxatives, elicit history of conditions like diverticulitis and ulcerative colitis

Physical Examination- abdominal assessment

Laboratory Test: fecalysis, electrolyte levels

The Nursing Process and Laxative NURSING DIAGNOSIS Alteration in bowel pattern Alteration in comfort: pain Knowledge deficit

NURSING DIAGNOSIS

Alteration in bowel pattern

Alteration in comfort: pain

Knowledge deficit

The Nursing Process and Laxative IMPLEMENTATION Emphasize that it is use on a SHORT term basis Provide comfort and safety measures like ready access to the bathroom, side-rails Administer with a full glass of water

IMPLEMENTATION

Emphasize that it is use on a SHORT term basis

Provide comfort and safety measures like ready access to the bathroom, side-rails

Administer with a full glass of water

The Nursing Process and Laxative IMPLEMENTATION 4. Encourage fluid intake, high fiber diet and daily exercise 5. DO NOT administer if acute abdominal condition like appendicitis is present 6. Advise to change position slowly an avoid hazardous activities because of potential dizziness

IMPLEMENTATION

4. Encourage fluid intake, high fiber diet and daily exercise

5. DO NOT administer if acute abdominal condition like appendicitis is present

6. Advise to change position slowly an avoid hazardous activities because of potential dizziness

The Nursing Process and Laxative EVALUATION of drug effectiveness Evaluate relief of GI symptoms, absence of staining and increased evacuation of GI tract For Lactulose: decreased ammonia

EVALUATION of drug effectiveness

Evaluate relief of GI symptoms, absence of staining and increased evacuation of GI tract

For Lactulose: decreased ammonia

The Anti-diarrheals These are agents used to calm the irritation of the GIT for the symptomatic relief of diarrhea General Classifications 1. Local anti-motility 2. Local reflex inhibition 3. Central action on the CNS

These are agents used to calm the irritation of the GIT for the symptomatic relief of diarrhea

General Classifications

1. Local anti-motility

2. Local reflex inhibition

3. Central action on the CNS

The Anti-diarrheals Stops GIT spasm by CNS action Opium derivatives (paregoric) Central acting agent Directly inhibits the intestinal muscle activity to SLOW peristalsis Loperamide Local anti-motility Locally coats the lining of the GIT to soothe irritation that may stimulate the reflex Bismuth subsalicylate Local reflex inhibitor Action Prototype Type

Clinical Indications of drug use Relief of symptoms of acute and chronic diarrhea Reduction of fecal volume discharges from ileostomies Prevention and treatment of traveler's diarrhea

Relief of symptoms of acute and chronic diarrhea

Reduction of fecal volume discharges from ileostomies

Prevention and treatment of traveler's diarrhea

Contraindications of anti-diarrheal Use Poisoning Drug allergy GI obstruction Acute abdominal conditions

Poisoning

Drug allergy

GI obstruction

Acute abdominal conditions

Pharmacokinetics: Side effects Constipation Nausea, vomiting Abdominal distention and discomfort TOXIC MEGACOLON

Constipation

Nausea, vomiting

Abdominal distention and discomfort

TOXIC MEGACOLON

Nursing process and anti-diarrheals ASSESSMENT Nursing History – Elicit history of drug allergy, conditions like poisoning, GI obstruction and acute abdominal conditions Physical Examination- Abdominal examination Laboratory test- electrolyte levels

ASSESSMENT

Nursing History – Elicit history of drug allergy, conditions like poisoning, GI obstruction and acute abdominal conditions

Physical Examination- Abdominal examination

Laboratory test- electrolyte levels

Nursing process and anti-diarrheals NURSING DIAGNOSIS Alteration in bowel pattern Alteration in comfort: pain

NURSING DIAGNOSIS

Alteration in bowel pattern

Alteration in comfort: pain

Nursing process and anti-diarrheals IMPLEMENTATION Monitor patient response within 48 hours. Discontinue drug use if no effect Provide comfort measures for pain Provide teaching

IMPLEMENTATION

Monitor patient response within 48 hours. Discontinue drug use if no effect

Provide comfort measures for pain

Provide teaching

Nursing process and anti-diarrheals EVALUATION Monitor effectiveness of drug- RELIEF of diarrhea Monitor adverse effects, effectiveness of pain measures and effectiveness of teaching plan

EVALUATION

Monitor effectiveness of drug- RELIEF of diarrhea

Monitor adverse effects, effectiveness of pain measures and effectiveness of teaching plan

Emetics and Anti-emetics Emetic Agent Syrup of Ipecac Anti-emetics 1. Phenothiazines 2. Non-phenothiazines 3. Anticholinergics/Antihistamines 4. Serotonin receptor Blockers 5. Miscellaneous

Emetic Agent

Syrup of Ipecac

Anti-emetics

1. Phenothiazines

2. Non-phenothiazines

3. Anticholinergics/Antihistamines

4. Serotonin receptor Blockers

5. Miscellaneous

EMETIC Prototype: Ipecac Syrup

Prototype: Ipecac Syrup

EMETIC Pharmacodynamics Ipecac syrup irritates the GI mucosa locally, resulting to stimulation of the vomiting center It acts within 20 minutes

Pharmacodynamics

Ipecac syrup irritates the GI mucosa locally, resulting to stimulation of the vomiting center

It acts within 20 minutes

EMETIC Clinical Use of ipecac To induce vomiting as a treatment for drug overdose and certain poisonings

Clinical Use of ipecac

To induce vomiting as a treatment for drug overdose and certain poisonings

EMETIC Contraindications of Ipecac use Ingestion of CORROSIVE chemicals Ingestion of petroleum products Unconscious and convulsing patient

Contraindications of Ipecac use

Ingestion of CORROSIVE chemicals

Ingestion of petroleum products

Unconscious and convulsing patient

EMETIC Pharmacokinetics: side effects of Ipecac Nausea Diarrhea GI upset Mild CNS depression CARDIOTOXICITY if large amounts are absorbed in the body

Pharmacokinetics: side effects of Ipecac

Nausea

Diarrhea

GI upset

Mild CNS depression

CARDIOTOXICITY if large amounts are absorbed in the body

Nursing process and the EMETIC ASSESSMENT Nursing History- elicit the exact nature of poisoning Physical Examination- CNS status and abdominal exam

ASSESSMENT

Nursing History- elicit the exact nature of poisoning

Physical Examination- CNS status and abdominal exam

Nursing process and the EMETIC IMPLEMENTATION Administer to conscious patient only Administer ipecac as soon as possible Administer with a large amount of water Vomiting should occur within 20 minutes of the first dose. Repeat the dose and expect vomiting to occur with 20 minutes

IMPLEMENTATION

Administer to conscious patient only

Administer ipecac as soon as possible

Administer with a large amount of water

Vomiting should occur within 20 minutes of the first dose. Repeat the dose and expect vomiting to occur with 20 minutes

Nursing process and the EMETIC IMPLEMENTATION 5. Provide comfort measures like ready access to bathroom, assistance with ambulation 6. Offer support

IMPLEMENTATION

5. Provide comfort measures like ready access to bathroom, assistance with ambulation

6. Offer support

Nursing process and the EMETIC EVALUATION Evaluate patient response within 20 minutes of drug ingestion Monitor for adverse effects Evaluate effectiveness of comfort measures and teaching plan

EVALUATION

Evaluate patient response within 20 minutes of drug ingestion

Monitor for adverse effects

Evaluate effectiveness of comfort measures and teaching plan

ANTI-EMETICS These are agents used to manage nausea and vomiting They act either locally or centrally

These are agents used to manage nausea and vomiting

They act either locally or centrally

ANTIEMETICS Dronabinol, hydroxyzine Miscellaneous “ setron”- dolasetron Serotonin Receptor blockers Meclizine, buclizine Anticholinergics and Antihistaminics Metoclopramide Non-phenothiazines Prochlorperazine, promethazine Phenothiazines Common examples Anti-emetic types

ANTIEMETICS Act in the CNS , either in the medulla or in the cortex Miscellaneous Centrally and locally inhibits the serotonin receptors Serotonin receptor blockers Block the transmission of the impulses to the medulla Anticholinergics Reduces the responsiveness of the nerve cell in the medulla Non-phenothiazine Centrally block the vomiting center in the medulla Phenothiazines Pharmacodynamics Types

ANTIEMETICS N/V associated with chemotherapy Miscellaneous N/V associated with chemotherapy Serotonin-receptor Blockers N/V associated with motion sickness Anticholinergics N/V associated with chemical stimulation Non-phenothiazine N/V associated with anesthesia, intractable hiccups Phenothiazines Clinical Use Types

ANTIEMETICS Contraindications 1. Severe CNS depression 2. Severe liver dysfunction

Contraindications

1. Severe CNS depression

2. Severe liver dysfunction

ANTIEMETICS Pharmacokinetics: Side-effects 1. PHOTHOSENSITIVITY 2. Drowsiness, dizziness, weakness and tremors and DEHYDRATON 3. Phenothiazines= autonomic anti-cholinergic effects like dry mouth, nasal congestion and urinary retention

Pharmacokinetics: Side-effects

1. PHOTHOSENSITIVITY

2. Drowsiness, dizziness, weakness and tremors and DEHYDRATON

3. Phenothiazines= autonomic anti-cholinergic effects like dry mouth, nasal congestion and urinary retention

Nursing Process and the ANTIEMETICS ASSESSMENT Nursing History- elicit allergy, impaired hepatic function and CNS depression Physical Examination- CNS status and abdominal examination Laboratory test- Liver function studies

ASSESSMENT

Nursing History- elicit allergy, impaired hepatic function and CNS depression

Physical Examination- CNS status and abdominal examination

Laboratory test- Liver function studies

Nursing Process and the ANTIEMETICS NURSING DIAGNOSIS Alteration in comfort: pain High risk for injury Knowledge deficit

NURSING DIAGNOSIS

Alteration in comfort: pain

High risk for injury

Knowledge deficit

Nursing Process and the ANTIEMETICS IMPLEMENTATION Assess patient’s intake of other drugs that may cause dangerous drug interaction Emphasize that this is given on a short term basis

IMPLEMENTATION

Assess patient’s

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