Meds Affecting Digestion and Nutrition

(General Key Points)

N203 ATI (Unit 0) Digestion and Nutrition !

 GI tract is the route of administration and the target of action GI effects are common (abdominal pain, constipation, nausea) When peptic ulcers are caused by H. pylori, non-antibiotics promote healing but only antibiotics will cure the disease. Drug therapy for peptic ulcers is directed at controlling symptoms, facilitating healing, lowering risk for complications, and pre enting relapse !re ention of emesis is more effecti e than treating it.

"ista#ine2 ("2) $ece%tor Agonists

N203 ATI (Unit 0) Digestion and Nutrition !

Proto: ranitidine ("antec) # Others$ cimetidine (%agamet),

ni&atidine ('(id), famotidine (!epcid) )electi ely block *+ receptors in parietal cells to suppress gastric acid secretion ,%- for heartburn, sour stomach, and indigestion Therapeutic Uses: Gastric.peptic ulcers . G/0D . hypersecretory conditions ("ollinger syndrome) In con1unction with antibiotics to treat ulcers caused by *. pylori. Adverse Effects: libido . impotence -2) effects (lethargy, depression, confusion) - fre3uent in elderly 4 renal or li er dysfunction. Contraindications/Precautions: 5 (6) risk of bacterial coloni&ation of stomach and respiratory tract
Expected Action:

Warfarin, phenytoin 7 metaboli&ing en&ymes inhibited by cimetidine le els -oncurrent use of antacids absorption *+-receptor antagonists )top drinking, stop smoking, eat smaller, more fre3uent meals Education: 0anitidine can be taken without regard to food
Interactions$

Proton Pu#% In&i'itor

N203 ATI (Unit 0) Digestion and Nutrition !

Proto: omepra&ole (!rilosec) # Others$ pantopra&ole (!rotoni(), Expected Action:

lansopra&ole (!re acid), esomepra&ole (2e(ium)

gastric acid secretion by irre ersible inhibition of en&yme that produces it. 0educe basal and stimulated acid production
Therapeutic Uses: Adverse Effects:

Gastric.peptic ulcers . G/0D . hypersecretory conditions ("ollinger syndrome) Insignificant 4 short-term treatment

5 (-) risk pneumonia d.t p* promoting bacterial coloni&ation

Contraindications/Precautions: Interactions: Education:

Delayed absorption of 'mpicillin, digo(in, iron, ketocona&ole if concurrent I8 pantoprazole may cause thrombophlebitis, headache, or diarrhea.

(ucralfate

N203 ATI (Unit 0) Digestion and Nutrition !

Expected Action:

Proto: )ucralfate (-arafate)

'cidic conditions 9 sucralfate to iscous gel that adheres to and protects ulcers.
Therapeutic Uses:

'cute duodenal ulcers 2o systemic effects

In estigational use for gastric ulcers and G/0D

Adverse Effects:

' oid constipation by : ;<== cc and fiber

Contraindications/Precautions: Interactions:

5 (6)

Antacids interfere with absorption of sucralfate. %ake on empty stomach, >( per day

absorption of phenytoin, digo(in, warfarin, ciproflo(acin

Education:

Antacids

N203 ATI (Unit 0) Digestion and Nutrition !

Expected Action:

Proto: 'l(,*)? gel ('mpho1el), Others$ 'l-,?, @g(,*)+ (@ilk of @agnesia), 2a*-,?

2eutrali&e gastric acid and inacti ate pepsin @ucosal protection through stimulation of prostaglandin production !eptic ulcer disease and G/0D Therapeutic Uses: Adverse Effects: 'l.-a compounds constipation, @g compounds diarrhea 2aA-containing fluid retention 'l(,*)?hypophosphatemia @g+A compounds to(icity with renal impairment. Contraindications/Precautions: 5 (-) GI perforation or obstruction Interactions: 'luminum-compounds bind to warfarin, tetracycline and their absorption -hew tablets thoroughly then take with B o& water or milk Education: Cre3uency of administration makes compliance difficult

Prostaglandin ) Analog

N203 ATI (Unit 0) Digestion and Nutrition !

Expected Action:

Proto: misoprostol (-ytotec)

acid secretion . secretion of *-,?- and mucus . submucosal asodilation.

Therapeutic Uses:

Dong-term 2)'ID therapy

Induce labor by causing cer ical ripening.

Adverse Effects:

Diarrhea and abdominal pain Dysmenorrhea and spotting

Contraindications/Precautions:

5 (E) !otential to become pregnant

Antie#etics
(Ty%es)

N203 ATI (Unit 0) Digestion and Nutrition !

 )erotonin antagonists........................................................ondansetron ("ofran) Dopamine antagonists........................................prochlorpera&ine (-ompa&ine) Glucocorticoids de(amethasone (Decadron) -annabinoids 'ntihistamine dronabinol (@arinol) dimenhydrinate (Dramamine) Others Granisetron (Fytril) !rometha&ine (!henergan) @etoclopramide (0eglan) *ydro(y&ine (8istaril) 'prepitant (/mend) 'nticholinergics scopolamine (%ransderm )cop)

Antie#etics
(Action* Use* )ffects* Interactions)

N203 ATI (Unit 0) Digestion and Nutrition !

Agent:

Action

Use

,ndansetron !rochlorpera&ine De(amethasone Dronabinol )copolamine Dimenhydrinate

Agent

)/00 in -%" G agal ner e D,!0 in -%" 8- I Hnknown omiting center Hnknown impulses$ inner ear 8 *I)0 @H)0 inner ear 8-

-hemo, radiation, postop -hemo, opioids, postop -ombo for chemotherapy -hemotherapy (-I28) @otion sickness @otion sickness

Adverse Effect

*eadache, diarrhea, di&&iness /!) (%( 4 Benadryl or Ativan), hypotension, sedation, and !rochlorpera&ine anticholinergic effects. Dronabinol Dissociation, dysphoria, hypotension, tachycardia 'nti-h, 'nti*is )edation, anticholinergic effects Interactions CTZ = chemoreceptor trigger one -2) depressants . 'ntihypertensi es . 'nticholinergics 'dditi e /ffects 'ntagonists 4 urinary retention, asthma, and narrow-angle glaucoma -ombo therapy allows lower doses of each side effects

,ndansetron

+a,ati-es

N203 ATI (Unit 0) Digestion and Nutrition !

Agent:

Action

Use

6ulk-forming JpsylliumK )urfactant JdocusateK )timulant JbisacodylK ,smotic J@g(,*) ?K

Agent

)often mass, bulk 7 same as dietary fiber. *+, content peristalsis, *+, absorption ( colon, intestine) intestine *+, mass stretching peristalsis GI irritation

diarrhea, control stool, promote defecation ,pioids, pain, straining, risk impaction, promote defecation -olonoscopy prep, short-term %( d.t opioid use -hemotherapy (-I28)

Adverse Effect

0ectal burningproctitis ( regular use of bisacodyl suppository) 'ccumulate to(ic le els of magnesium ( in renal dysfunction) 'ccumulation$ in heart disease and hypertension Interactions @ilk G antacids destroy enteric coating Cecal impaction . bowel obstruction . ulcerati e colitis . di erticulitis !romote fiber foods and : ;.< D daily

'll 'll @g+A salts 2aA salts

Antidiarr&eals

N203 ATI (Unit 0) Digestion and Nutrition !

Expected Action:

Proto: dipheno(ylate (Domotil) Others$ loperamide (Imodium), difeno(in (@otofen)

'cti ate opioid receptors in GI to motility and absorption of G 2aA

Adverse Effects:

't recommended doses, diphenoxylate has no -2) effects

diphenoxylate doses typical opioid responses

Contraindications/Precautions:

5 (L)

risk of megacolon with inflammatory bowel disorders serious complications including perforated bowel.
Interactions: Education:

-2) depressants depressi e effect /ncourage use of electrolyte replacement drinks

' oid plain water (no electrolytes) and caffeine ( motility) @anage dehydration (weight, 8), IG,) 7 =.><M 2) may be prescribed

Pro.inetic Agents

N203 ATI (Unit 0) Digestion and Nutrition !

Expected Action:

Proto: metoclopramide (0eglan)

dopamine and serotonin receptors in -%" emesis 'ugments action of acetylcholine to upper GI motility
Therapeutic Uses:

!ostop and chemo-induced nausea and omiting Diabetic gastroparesis Diarrhea

G/0D
Adverse Effects:

)edation

/!)$ 0estlessness, spasms of face G neck. @inimi&e /!) with ben&odia&epine like lorazepam (Ativan).

Contraindications/Precautions:

5 (L) )ei&ure disorder ( sei&ure risk)

GI perforation or bleeding, bowel obstruction, and hemorrhage

Fids and older adults due to risk of /!)

Interactions:

-oncurrent /t,* or -2) depressant$ sei&ure . sedation risks Dose N ;= mg dilute in <= mD D<W or 0ingerOsP Infuse o er ;<m

pioids and anticholiner!ics effects of metoclopramide.

Education: