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Exam 3 Drugs - Drug review info for antiacids, anemia, anti-diarrheal, constipation, antiemetic,

Drug review info for antiacids, anemia, anti-diarrheal, constipation,...

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Pharmacology (NSG 251)

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Marian University

Academic year: 2023/2024

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Technische Universiteit Delft

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DRUG NAME

Medication(s): sulfamethoxazole-trimethoprim Mechanism:  One  Two  Three Uses:  One  Two  Three Interactions/Contraindications:  One  Two  Three Adverse Effects:  One  Two  Three Nursing Process:  One  Two  Three

ANTIACIDS: Gastro / Acid-Controlling

Mechanism:  Base (alkaline) mediated inhibition of the protein-digesting ability of pepsin  Increase in protective lining of the stomach  Increase tone of the lower esophageal (cardiac) sphincter which minimizes acid reflux o At low doses: Stimulate mucus production o At low doses: Stimulate prostaglandins o At low doses: stimulate bicarbonate Uses:  Symptomatic relief of stomach pain and reflux “heartburn” Interactions/contraindications:  Allergy  Renal failure: DO NOT USE ANY MAGNESIUM BASED PRODUCT  Caution: Electrolyte disturbances: hypercalcemia  Caution: bowel obstruction: magnesium  Interactions: common mechanisms o Adsorption and chelation: other drugs are bound to or chemically inactivated reducing or preventing their therapeutic effects o Increased stomach pH: increases absorption of basic drugs (benzodiazepines, sympathomimetics, valproic acid) and decreases absorption of acid drugs (allopurinol, thyroid hormones, digoxin, antihistamines, corticosteroids, digoxin, aspirin, isoniazid) o DO NOT GIVE WITH quinolone antibiotics: blocks antimicrobial effect Adverse effects:  Magnesium: diarrhea  Aluminum and calcium: constipation  Calcium: kidney stones  Systemic alkalosis with OVER USE of any antacid, especially sodium bicarbonate (baking soda)  Calcium can cause acid rebound  Chronic high dose calcium antacids can cause milk-alkali syndrome  Hypercalcemia, headache, nausea, and alkalosis  Aluminum antacids can lead to hypercalcemia and hypophosphatemia  Calcium antacids can cause gas and belching Nursing Process:  Conduct appropriate history and physical exam with focus of GI tract disorders, bowel pattern, GI related pain  Review current medications and review any available labs  Assess for HTN, heart failure, presence of edema: antacids are high in sodium  Long-term self-medication with antacids may be masking manifestation of a serious underlying condition (such as a bleeding ulcer, or cancer): encourage occasional use only, if continued use is necessary, advise patient to see their HCP after 2 weeks of use  Separate antacids by 2 hours from other meds  Pregnancy category A  Many antacids are high in sodium: read labels if the patient is on a sodium restriction  Calcium based antacids may also be used a source of calcium (as for osteoporosis treatment, prevention)  Liquid antacids must be shaken prior to dosing  Assess/report: prolonged constipation/diarrhea, increasing abdominal pain/distension, hematemesis or black tarry stools

PROTON PUMP INHIBITORS (PPIs) – Gastro / Acid-Controlling

Medication(s): omeprazole (several in class end in “prazole”) Mechanism:  Bind directly to the proton pump causing a total blockage of all hydrogen ion secretion from parietal cells  This stops 90% of acid secretion for 24 hours: this is achlorhydric (without acid) o Can lead to bacterial overgrowth o Can lead to intestinal metaplasia (a nonadaptive cellular/tissue change) o Can lead to hip fractures  Does not affect food absorption Uses:  First line therapy for esophagitis, GERD (poorly responsive to other treatments such as H 2 blockers), short term treatment of active gastric/duodenal ulcers, NSAID induced ulcers, and stress ulcer prophylaxis. Long term maintenance of healing of erosive esophagitis, and pathologic hypersecretory states Interactions/contraindications:  Allergy  Interaction: increase serum levels of diazepam and phenytoin  Interaction: increase risk of bleeding with warfarin  Interferes with absorption of digoxin, ampicillin, and iron  Slowed absorption when given with sucralfate  Food slows absorption Adverse effects:  Over prescribing of PPIs may be linked to GI tract infections due to loss of normal acid mediated microbial protection: FDA: BOX WARNING: Clostridioides (formerly Clostridium) difficile  Osteoporosis from inhibition of stomach acid necessary for calcium absorption, also PPIs may speed up bone demineralization: FDA: BOX WARNING: wrist, hip, and spine fractures, pneumonia, and magnesium depletion  Possible link between PPIs and dementia Nursing Process:  Complete appropriate history and physical exam, focusing on GI:  Ability to swallow (some capsules are LARGE)  Some capsules can be opened and given with small amount of applesauce: check prior to administration  Joints ROM, muscle strength, history of fractures without trauma  All PPIs can be used with antibiotics to treat H. pylori infection  Can be given orally or capsules opened/diluted in water and given per NG or PEG  NOTE: pantoprazole granules must be given through a NG tube larger than 16 French – clogging will occur with smaller tubes  Some PPIs come in IV formulation  Give on an empty stomach 30-60 minutes before meals to enhance absorption  For patients with GERD: teach to avoid black pepper, caffeine, alcohol, harsh spices, and extremes in food temperature

SUCRALFATE – Gastro / Acid-Controlling

Medication(s): sucralfate Mechanism: Mucosal protectant -- binds directly to surface of an ulcer (like a liquid bandage for the inside of the stomach wall)  In presence of stomach acid, sucralfate dissociates into aluminum salts (which enhance mucus and bicarbonate) and sulfated sucrose molecules that bind to proteins in the ulcer to limit the effects of pepsin (which can further erode ulcer)  Promotes ulcer healing Uses:  Treatment of active stress ulcers  Long term management of PUD  Esophageal erosion Interactions/contraindications:  Allergy  May interfere with absorption of other drugs: separate from other meds by 2 hours  Hypoglycemia may occur in the diabetic patient Adverse effects:  Nausea, constipation, and dry mouth Nursing Process:  Complete appropriate history and physical exam, focusing on GI  Local acting drug  Take on an empty stomach, separated from antacids by at least 30 minutes prior to or after the dose of sucralfate  Requires up to 4 doses per day  Teach patient importance of adhering to dose schedule  Take before meals and at bedtime  Monitor blood glucose response to sucralfate administration  For patients with difficulty swallowing (tablet is big) it can be given as a slurry  Place uncrushed tablet in plastic medicine cup and add 30 mL of warm water: the tablet will rapidly dissolve – then have patient drink it  Recent research and ED practice: sucralfate is being used to limit erosive esophagitis in children who swallow button batteries!

EPOETIN ALFA – Anemia

Medication(s): epoetin alpha Mechanism:  Biosynthetic form of the hormone erythropoietin Uses:  Treatment of anemia associated with chronic renal failure  Treatment of anemia associated with chemotherapy  Treatment of anemia associated with HAART therapy Interactions/Contraindications:  Allergy  Caution when given with uncontrolled hypertension  Caution when hemoglobin levels are above 10 g/dL (cancer patients) or above 11 g/dL (renal patients)  These drugs may increase tumor growth and increase risk of thrombosis (clots)  Frequently given with oral or IV iron Adverse Effects:  Hypertension  Fever, Headache  Pruritus, rash  Nausea/vomiting  Arthralgia  Injection site reaction  FDA: BOX WARNING: elevated hemoglobin levels above 11 g/dL: clots leading to MI, stroke, and death Nursing Process:  This medication is ineffective without adequate body iron stores and bone marrow function  Given by either subcutaneous injection or via IV  Teach/demo/return demo proper subcutaneous injection  Monitor CBC (especially hemoglobin)  Monitor blood pressure

FERROUS SULFATE – Anemia

Medication(s): ferrous sulfate Mechanism:  Elemental iron Uses:  Correct symptoms of iron deficiency anemia  Prevention of iron deficiency anemia Interactions/Contraindications:  Allergy  Hemochromatosis (iron overload)  Do not give to patients with ulcerative colitis, peptic ulcer disease, hemolytic anemia, cirrhosis, gastritis  INTERACTIONS: decreased iron absorption with antacids and calcium  INTERACTIONS: decrease absorption of antibiotics such as tetracycline and quinolones Adverse Effects:  Nausea, constipation, black tarry stools, diarrhea  Temporary discoloration of tooth enamel (liquid formulations) Nursing Process:  Complete a nutritional assessment  Assess for manifestations of iron deficiency anemia  For females between puberty and menopause: complete a history of menstrual cycles, assess for excessive or dysfunctional bleeding, pregnancy status  Monitor for iron toxicity  Vomiting, diarrhea, abdominal pain, drowsiness, tachypnea, hypotension, seizures, coma  Monitor serum iron levels, bilirubin, and levels of folate and B  Monitor RBC, hemoglobin, hematocrit, and reticulocyte counts  Give oral iron with an acidic beverage ascorbic acid (Vitamin C)  Take with food (avoid calcium products) if GI set occurs  Dilute liquid forms of iron, drink through a straw, bush teeth after use  Sit upright for 30 minutes after a dose to prevent esophageal irritation  Teach patient that iron will turn stools black in color  Encourage food sources of iron:  Meat (beef, chicken turkey, fish, veal, lamb, pork  Eggs  Beans (lima, navy, kidney, lima, soy, dried peas)  Spinach, turnips, kale, collard greens  Iron-enriched breads, noodles, and rice  Iron-fortified cereals

FOLIC ACID – Anemia

Medication(s): folic acid Mechanism:  Synthetic version of vitamin B 9  Important for erythropoiesis  Required for synthesis of DNA and RNA Uses:  Prevent and treat folic acid deficiency  Prevention of neural tube disorders: spina bifida and anencephaly Interactions/Contraindications:  Allergy  DO NOT give folic acid for anemia until the cause of the anemia is known, otherwise blood counts may normalize masking symptoms  NOTE: oral contraceptives, sulfonamides, methotrexate can all cause folic acid deficiency Adverse Effects:  Rare  Yellow discoloration of urine Nursing Process:  Encourage folic acid foods:  Spinach, kale, brussels sprouts, cabbage, broccoli, asparagus, beets  Beans and legumes  Oranges and orange juice  Whole grains  eggs  Pork, shellfish, liver  Fortified cereals  Take folic acid supplements/and encourage folic acid foods starting at least 1 month prior to becoming pregnant

VITAMIN B12 – Anemia

Medication(s): Vitamin B12 (cyanocobalamin) Mechanism:  Water soluble B vitamin  required coenzyme for metabolic pathways for fat and carbohydrate metabolism and protein synthesis  cell growth and replication  hematopoiesis  myelin synthesis: loss of myelin leads to slowing of impulse conduction leading to sensory and motor impairments. Eventual degeneration of the nerve occurs Uses:  Treatment of vitamin B 12 deficiency:  Pernicious anemia secondary to loss of intrinsic factor  From malabsorption, such as gastric bypass  Strict vegan diet and/or alcoholism Interactions/Contraindications:  Allergy  Hereditary optic nerve atrophy (Leber’s Disease)  INTERACTION: decrease oral B12 absorption when taken with anticonvulsants, aminoglycoside antibiotics, long-acting potassium preparations Adverse Effects:  B12 is nontoxic and LARGE doses must be consumed to produce adverse effects:  Thrombosis  Flushing  Optic nerve atrophy  Diarrhea  Pruritus, rash  hypokalemia Nursing Process:  Monitor serum blood levels  Oral forms of Vitamin B12 require presence of intrinsic factor  Give with food  Encourage food sources of B12:  Liver  Beef  lamb  Mackerel, cams, crab, tuna, oysters, octopus, trout, sardines, salmon  Milk  Swiss cheese  B12 fortified foods: cereal, yogurt, soy milk  Given by deep IM injection (to treat megaloblastic pernicious anemia)  Preferred route  Also comes in an intranasal gel and a sublingual tablet

PSYLLIUM – Constipation

Medication(s): psyllium Mechanism:  A natural bulk-forming laxative (dried seeds from the Plantago psyllium plant) which increases water absorption, bulks the stool, and stimulates passage of feces through the GI tract Uses:  Management of acute and chronic constipation  Irritable bowel syndrome  Diverticulitis Interactions/Contraindications:  Allergy  Do not use in patients with nausea, vomiting, or abdominal pain  GI strictures (narrowing of the GI lumen) Adverse Effects:  Few if any systemic effects, action limited to the GI tract  Impaction/blockage  Gas formation Nursing Process:  Available OTC  MUST be taken with ample water to prevent esophageal obstruction or fecal impaction  Approved and safe for long term use  Assess swallowing  If taking the powder version: mix with water (per directions) and drink immediately. Follow with an additional glass of water

PROBIOTICS – Anti-Diarrheal

Medication(s): Mechanism:  Intestinal flora modifiers  Most commonly: Lactobacillus organisms  Saccharomyces boulardii is used to treat Clostridioides difficile Uses:  Suppress growth of diarrhea-causing bacteria  Reestablish normal flora in the GI tract  Reduction in abdominal pain and cramping Interactions/Contraindications:  Allergy  Use cautiously severe illness and compromised immune systems Adverse Effects:  Infection Nursing Process:  Take exactly as directed  Encourage natural sources such as yogurt, fermented milk, miso, tempeh, and soy beverages  Self-medication with probiotics for prolonged diarrhea may delay diagnosis and treatment of an underlying disease or disorder

LACTULOSE– Constipation

Medication(s): lactulose Mechanism:  Hyperosmotic laxative increases water in the stool, promoting peristalsis and producing a watery BM  Lactulose is a synthetic derivative of lactose that cannot be digested or absorbed. Colon bacteria digest the bacteria creating acids which increase stool water content and defecation Uses:  Acidic environment reduces serum ammonia levels by converting ammonia to ammonium (water soluble) which is then excreted in the stool  Lactulose is used to control serum ammonia levels in patients with cirrhosis of the liver.  Protein converts to ammonia which is converted to Blood Urea Nitrogen (BUN) by the liver and excreted in the urine by the kidney. Patients with cirrhosis or hepatitis cannot make this conversion and ammonia levels rise causing hepatic encephalopathy. Manifestations of rising ammonia levels include anxiety, loss of balance/coordination/concentration, flapping hand tremor (asterixis), personality changes, muscle twitches, reduced alertness, altered sleep, slurred speech. If levels rise too high, hepatic coma and death follow Interactions/Contraindications:  Allergy  Contraindicated in persons on a low lactose diet Adverse Effects:  Abdominal bloating  Rectal irritation Nursing Process:  Older adults are less tolerant of this drug and other hyperosmotic laxatives

MAGNESIUM SALTS – Constipation

Medication(s): magnesium citrate, magnesium hydroxide (milk of magnesia MOM), fleet enema Mechanism:  Saline laxatives  Moves water into the stool, bulks the stools, promotes peristalsis and watery diarrhea Uses:  Relief of constipation  Bowel prep prior to a diagnostic procedure  Removal of unabsorbed poisons from the GI tract Interactions/Contraindications:  allergy  Renal insufficiency and renal failure  Abdominal pain, nausea, vomiting, obstruction, rectal bleeding Adverse Effects:  Magnesium toxicity (with renal insufficiency)  Cramping, diarrhea  Thirst  Electrolyte imbalances Nursing Process:  May cause dehydration  Do not give or take with renal impairment  Assess for electrolyte imbalance  Very potent: nurses often think of it as “dynamite in a bottle”  Magnesium citrate is more palatable chilled  Drink extra fluids

SCOPOLAMINE – Antiemetic / Antinausea

Medication(s): scopolamine Mechanism:  Anticholinergic (acetylcholine blockers) Uses:  Motion sickness  Post-operative Nausea and vomiting Interactions/Contraindications:  Allergy to scopolamine or atropine  Contraindicated in patients with narrow-angle glaucoma  INTERACTION: anticholinergics have added drying effect when given with antihistamines and antidepressants Adverse Effects:  Dizziness, drowsiness  Tachycardia  Blurred vision, dilated pupils  Difficult urination  Constipation  erythema Nursing Process:  Comes in oral, injectable, and transdermal formulas  Transdermal patch is placed on the mastoid process. Each patch is effective for 72 hours. Clean skin and dry prior to applying.  Wear gloves to apply and remove  Teach patient NOT TO TOUCH the patch with fingers (if the active drug is touched and the eyes rubbed: pupil dilation will occur)  Teach patient to apply in advance of activities that produce motion sickness  Teach patient to carefully remove patch, folding the patch with medication inside and then wash hands  Rotate placement right to left  Older adults may experience confusion, agitation, and hypotension  Teach to avoid tasks that require mental clarity or motor skills (due to sedative effect)

PROMETHAZINE – Antiemetic / Antinausea

Medication(s): promethazine Mechanism:  Antidopaminergic with antihistamine and anticholinergic properties Uses:  Intractable hiccups  Nausea and vomiting Interactions/Contraindications:  allergy  do NOT use in children under 2 yeas  INTERACTION: increased CNS depression when antidopaminergics are given with opioids, hypnotics, alcohol Adverse Effects:  Sedation is most common side effect  Orthostatic hypotension, tachycardia  Extrapyramidal symptoms  Tardive dyskinesia  Blurred vision, dry eyes  Urinary retention  Dry mouth, anorexia, constipation Nursing Process:  Preferred route is oral or IM, rectal, and IV use is not preferred but is commonly used  If giving IV: drug must be given via a vein only. Accidental arterial injection causes extensive tissue damage that may lead to amputation. Dilute in at least 10 mL and given via an infusing IV from the port farthest away from the patient  Assess IV access frequently; discontinue use is burning occurs  Assess hydration status carefully (turgor, tongue furrows) as may lead to excess drop in blood pressure  Assess ROM and muscle function: assess for abnormal involuntary muscle twitches that could be associated with extrapyramidal symptoms  Verify drug name carefully as a common sound alike drug  Teach patient to avoid use with other CNS depressants and alcohol and limit caffeine  Avoid driving or using machinery due to sedative effect

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