What are antiemetic drugs?
drugs for treatment of nausea and vomiting
What is nausea?
a feeling of sickness that may cause urge to vomit
What are the 5 neurotransmitters that affect the vomiting central of the brain?
dopamine, serotonin, histamine, acetylcholine, substance P
Serotonin receptor antagonists (5-HT3) have what suffix?
setron
What might substance P/neurokinin 1 antagonist cause?
neutropenia
Promethazine is what type of drug?
dopamine antagonists
When would you usually give serotonin antagonists?
before chemotherapy or after surgery
Patients receiving chemotherapy should not use what type of medications?
over the counter medications
aprepitant and fosaprepitant are what type of drug?
substance P/neurokinin antagonists
What is a side effect of substance P/ neurokinin antagonists?
decreased neutrophil count
A patient taking dopamine antagonists (phenothiazines) should do what at home?
ask for help when getting up or changing positions
Dopamine antagonists and Promotility drugs may cause what type of symptoms?
extrapyramidal symptoms
What are extrapyramidal symptoms?
Pseudoparkinsonism - shuffling, propulsive gait, masklike face, drooling
Akathisia - continuous restlessness and fidgeting
acute dystonia - facial grimacing, involuntary upward eye movement
tardive dyskinesia: smacking of lips, chewing motion, facial dyskinesia
Dronabinol is what type of drug?
cannabinoids
Cannabinoids should be reserved for what type of patients?
patients who continue to have nausea and vomiting who do not respond to other categories of antiemetics
When taking cannabinoids what should a patient avoid and why?
avoid alcohol, sedatives, or other CNS depressants because they may increase the risk
Metoclopramide (Reglan) is what type of drug?
promotility drugs
What is metoclopramide (Reglan) used for?
used to increase contraction of the upper GI tract to move contents more quickly through the tract
Promotility drugs may cause what?
suicidal ideation and orthostatic hypotension
What are recommendations you should give to a patient with peptic ulcer disease or GERD?
stop smoking, avoid alcohol and NSAIDs, eat smaller portions, don't eat within 3 hours of bedtime
What do antacids do?
neutralize stomach acid and increase gastric pH
What suffix do histamine 2 receptor antagonists have?
tidine
What do Histamine receptor antagonists do?
decrease production of stomach acid
What do proton pump inhibitors do?
block acid secreting pumps inside the stomach
What suffix do proton pump inhibitors have?
prozole
What do cryoprotective drugs do?
attach to the stomach ulcer to protect it from damage due to acid
What are the common ingredients in antacids?
aluminum, calcium and magnesium
Aluminum hydroxide and calcium carbonate may cause?
constipation
Magnesium hydroxide may cause?
diarrhea
What is magnesium hydroxide?
antacid and laxative
If a patient takes magnesium hydroxide what may it cause?
hypermagnesemia
What are side effects of hypermagnesemia?
weak muscles and bradycardia
When is the best time to take antacids?
between meals and at bedtime or one hour after meals and before bedtime
When should you take other medications when taking antacids?
one hour before or two hours after taking the antacid
What are side effects and adverse effects of Histamine H2 receptor antagonists?
sedation, change in mental status, and increase risk of pneumonia
Cimetidine can increase the levels of what other drugs?
warfarin, phenytoin, theophylline and lidocaine
What levels should you monitor if your patient is taking cimetidine?
INR and PT
What are side effects and adverse effects of proton pump inhibitors?
sedation, photosensitivity, increase risk of osteoporosis and fractures, and increase risk of pneumonia
What do laxative treat?
constipation
What should you recommend to your patient with constipation?
take 6-8 glasses of water everyday, high fiber diet, regular exercise
Why do you hesitate to give laxatives?
can cause burning sensation, abdominal pain, electrolyte imbalance, causes diarrhea, increases risk of intestinal rupture
Psyllium is what type of laxative?
bulk-forming laxative
Bulk-forming laxative can treat?
both constipation and diarrhea
Docusate sodium is what type of laxative?
surfactant laxative
What do surfactant laxatives do?
lower surface tension of the stool to allow penetration of water to make the stool softer
How do stimulant laxatives work?
stimulate the intestinal peristalsis and increase the amount of water and electrolytes within the intestinal lumen
Bisacodyl is what type of laxative?
stimulant laxative
Stimulant laxatives should not be taken with what?
milk, dairy products and calcium
If your patient has been taking Bisacodyl for a few days what blood level should you check?
potassium
What kind of patients should not take laxatives and why?
patients with congestive heart failure or high blood pressure due to the sodium it contains
You should give high dose of osmotic laxatives to what kind of patients?
patients preparing for surgery or diagnostic tests such as a colonoscopy and Barium Enema
What are contraindications for laxatives?
patients who have any abdominal condition such as bowel obstruction or fecal impaction
What should you give a patient with diarrhea?
water and electrolytes
How long should you give antidiarrheal for?
only for 1 or 2 days and no longer
Dicyclomine is what type of antidiarrheal?
anticholinergic
Diphenoxylate and loperamide are what type of antidiarrheal?
opioid agonists
Diphenoxylate is what type of substance?
controlled substance
What type of patients should never receive dicyclomine?
patients with history of glaucoma