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Histamine-2 receptor antagonists

Histamine-2 receptor antagonists. Cimetidine (Tagamet) Famotidine (Pepcid) Reduce the amount of gastric acid and also reduce the number of hydrogen ions in the stomach Used for gastric and duodenal ulcers, GERD, heartburn, acid indigestion. Complications.

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Histamine-2 receptor antagonists

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  1. Histamine-2 receptor antagonists • Cimetidine (Tagamet) • Famotidine (Pepcid) • Reduce the amount of gastric acid and also reduce the number of hydrogen ions in the stomach • Used for gastric and duodenal ulcers, GERD, heartburn, acid indigestion

  2. Complications • Decreased libido, gynecomastia, impotence • Lethargy, depression, confusion • Constipation, diarrhea, nausea • Dizziness, drowsiness • Older adults are more at risk for the CNS effects

  3. Interactions • Can increase levels of warfarin, phenytoin, theophylline, and lidocaine • Concurrent use of antacids can decrease the absorption and action www.PresentationPro.com

  4. Nursing administration • Advise pt. to eat small meals, eat in a relaxed environment and avoid foods that promote gastric acid secretion (caffeinated drinks, fried foods, etc.) • Encourage pt. to learn relaxation techniques to reduce stress • Avoid alcohol • Instruct pt. to notify provider of any occult bleeding, such as black tarry stools or blood in stools www.PresentationPro.com

  5. Proton pump inhibitors (PPIs) • Pantoprazole • Lansporazole • Esomeprazole • Block acid production in stomach and reduce gastric acid secretion by inhibiting the enzyme that produces gastric acid • Used for gastric and duodenal ulcers, erosive esophagitis, GERD www.PresentationPro.com

  6. Complications • Headache, diarrhea, nausea, vomiting • Pneumonia (long-term treatment) • Osteoporosis, fractures • Rebound acid hypersecretion • Hypomagnesemia • Contraindications • Pregnancy/lactation • Dysphagia, liver disease • Pts. at high risk for pneumonia www.PresentationPro.com

  7. Interactions and nursing administration • Can increase levels of digoxin and phenytoin • Decrease absorption of ketoconazole • Decrease absorption of antiretrovirals (HIV meds) • Can decrease beneficial effects of clopidogrel www.PresentationPro.com

  8. Nursing administration • Do not crush or break sustained-release capsules • Do not open capsules and sprinkle over food • Avoid alcohol and irritating foods and meds (NSAIDs) • Notify provider of any obvious or occult bleeding www.PresentationPro.com

  9. Mucosal protectant-sucralfate • Becomes a protective barrier in the stomach that adheres to an ulcer, protecting from further injury • Used for acute duodenal ulcers and maintenance of chronic ulcers • Gastric ulcers, GERD • Causes constipation www.PresentationPro.com

  10. Contraindications and interactions • Pregnancy • Hypersensitivity • Use cautiously in renal patients • Can interfere with the absorption of many meds if taken concurrently; give 1 hour before or after other meds • Antacids can interfere with the absorption of sucralfate www.PresentationPro.com

  11. Antacids • Aluminum hydroxide • Magnesium hydroxide • Calcium carbonate • Sodium bicarbonate • Neutralize gastric acid by producing neutral salts and inactivating pepsin • Used in peptic ulcer disease, GERD www.PresentationPro.com

  12. Complications • Constipation, diarrhea • Fluid retention • Hypophosphatemia, hypomagnesemia • Toxicity, hypermagnesemia • Use with caution in pts. With obstructions, or those who have perforations • Any pt. with abdominal pain needs a thorough workup to determine the source of the pain www.PresentationPro.com

  13. Nursing administration • Chew tablets (Tums) thoroughly • Shake liquid forms to distribute suspension • Take other meds 1 hour before or after taking antacids • Overuse can produce toxicity www.PresentationPro.com

  14. Antiemetics • Ondansetron • Promethazine • Scopolamine • Dimenhydrinate www.PresentationPro.com

  15. Ondansetron • Prevents emesis by blocking the serotonin receptors in the chemoreceptor trigger zone in the brain • Used for nausea/vomiting from chemotherapy, radiation and post-op • Given PO, IM or IV www.PresentationPro.com

  16. Promethazine, chlorpromazine • Block dopamine receptors in the CNS, producing antiemetic effects • Used for nausea caused by chemo, opioids or post-op • Given PO, IM or IV www.PresentationPro.com

  17. Scopolamine • Prevents nausea/vomiting by interfering with the transmission of nerve impulses traveling from the vestibular apparatus in the inner ear to the vomiting center in the brain • Used for motion sickness • Given transdermal, PO or sub-q www.PresentationPro.com

  18. Dimenhydrinate, diphenhydramine, meclizine • Antihistamines • Block receptors in nerve pathways that connect the inner ear and the vomiting center • Used for motion sickness • Given PO, IM or IV www.PresentationPro.com

  19. Metoclopramide • Blocks dopamine and serotonin receptors in the CNS to control nausea and vomiting • Also increases peristalsis • Used for post-op N/V, nausea from chemo • Also for management of diabetic gastroparesis www.PresentationPro.com

  20. Complications of metoclopramide • Extrapyramidal symptoms, sedation, diarrhea • Contraindicated in GI bleeding, seizure disorders; children and older adults, use with caution • Concurrent use of alcohol/other CNS depressants cause excess CNS depression www.PresentationPro.com

  21. Complications of antiemetics • Fatigue, drowsiness, dizziness, headache • Possible liver damage • Diarrhea • Prolonged QT interval • Hypotension • Sedation • Dry mouth, urinary retention, constipation www.PresentationPro.com

  22. Laxatives • Psyllium • Docusate sodium • Bisacodyl • Magnesium hydroxide • Senna • Lactulose • Methylcellulose • Castor oil www.PresentationPro.com

  23. Psyllium • Bulk-forming laxative • Softens fecal mass and increases bulk • Used to decrease diarrhea in pts. With IBS and diverticulosis, to control stool for pts. With ileostomy or colostomy, to promote defecation in older adults who have decreased peristalsis www.PresentationPro.com

  24. Docusate sodium • Lowers the surface tension of the stool to allow penetration of water • Used to relieve constipation due to pregnancy or opioid use • Prevent hard stools for hemorrhoid pts. • Prevent straining for aneurysm or cardiac pts. • Decrease risk of fecal impaction due to immobility www.PresentationPro.com

  25. Bisacodyl • Stimulates intestinal peristalsis • Used to prepare pts. For surgery or testing • High-dose opioid use resulting in constipation www.PresentationPro.com

  26. Magnesium hydroxide Draws water into the intestine to increase the mass of stool, stretching the colon and increasing peristalsis Prevents painful elimination Prepare pt. for testing www.PresentationPro.com

  27. Complications of laxatives • Gi irritation, painful cramping, rectal burning, sodium absorption and fluid retention, dehydration • Contraindications include fecal impaction, bowel obstruction, nausea, cramping or abdominal pain, ulcerative colitis and diverticulitis, pregnancy and lactation www.PresentationPro.com

  28. Laxatives • Milk and antacids can destroy the enteric coating on bisacodyl • Get a complete history of laxative use • Instruct pt. to increase fluids and exercise/activity www.PresentationPro.com

  29. Antidiarrheals • Diphenoxylate with atropine • Loperamide • Paregoric • Activate opioid receptors in the GI tract to de crease intestinal mobility and increase the absorption of sodium and fluids in the intestine www.PresentationPro.com

  30. Complications • With high doses of diphenoxylate, pts. can get opioid-like euphoria • Contraindicated in inflammatory bowel disorders, severe dehydration or electrolyte imbalances • Alcohol and other CNS depressants can cause excess sedation www.PresentationPro.com

  31. Nursing administration • Advise pt. to drink small amounts of clear liquids with electrolytes and not plain water as this can cause water intoxication, also to avoid caffeine • Severe cases of diarrhea may necessitate a hospital stay • For dehydrated pts. Monitor weight, electrolyte levels, I&O and vital signs www.PresentationPro.com

  32. Med for IBS-D: alosetron • Action: increases the firmness of stool and also decreases frequency of defecation • For female pts who have severe IBS-D • Can cause constipation; contraindicated in history of bowel obstruction • Phenobarbital can decrease levels • Results appear in 1-4 weeks www.PresentationPro.com

  33. Med for IBS-C: lubiprostone • Increases fluid secretion in the colon to promote intestinal motility • Used in IBS-C and chronic idiopathic constipation • Can cause diarrhea and nausea • Contraindicated in bowel obstruction • No significant interactions • Take with food to decrease nausea www.PresentationPro.com

  34. Vitamins and supplements • Iron (PO, IM) • Ferrous sulfate (PO) • Iron dextran (IV) • Replace deficient iron in anemic patient, promoting RBC formation www.PresentationPro.com

  35. Iron preparations • Complications: GI distress, teeth staining (liquid form), anaphylaxis, hypotension, toxicity • Contraindicated in allergy/hypersensitivity • Take on an empty stomach (the acids increase the absorption) • Vitamin C also increases absorption • Give liquid form through a straw www.PresentationPro.com

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