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the medication in this section affect some aspect of the GI tract to treat or prevent:
nausea/vomiting motion sickness diarrhea constipation GERD (treat by increasing gastric motility)
medications include:
antiemetics laxatives antidiarrheals prokinetic agents medication for irritable bowel syndrome
antiemetics
select prototype medications: glucocorticoids: dexamethasone (decadron) substance P/neurokinin 1 antagonists: aprepitant (emend) serotonin antagonist: ondansetron (zofran), granisetron (kytril) dopamine antagonists: prochlorperazine ( compazine), metoxlopramide (reglan), promethazine (phenergan) cannabinoids: dronabinol (marinol) anticholinergics: scopolamine (transderm scop) antihistamine: dimenhydrinate (dramamine), hydroxizine (vistaril) benzodiazepines: lorazepam (ativan), diazepam (valium)
glucocorticoids: dexamethasone (decadron)
pharmacological action
the antiemetic mechanism is unknown
is usually combined with other antiemetics to treat chemotherapy induced nausea and vomiting CINV.
substance P/neurokinin 1 antagonists: aprepitant (emend)
pharmacological action
aprepirant inhibits substance P/neurokinin1 in the brain
for best results, it should be combined with a glucocorticoid or serotonin antagonist. extended duration of action makes it effective for immediate use and delayed response.
serotonin antagonist: ondansetron (zofran)
pharmacological actions
prevents emesis by blocking the serotonin receptors in the chemoreceptor trigger zone (CTZ), and antagonizing the serotonin receptors on the afferent vagal neurons that travel from the upper GI tract to the CTZ.
prevents sneaks related to chemotherapy, radiation therapy, and postoperative recovery.
dopamine antagonist: prochlorperazine (compazine). a sublet of phenothiazine.
pharmacological action
antiemetic effects of the medication result from blockade of dopamine receptors in the CTZ.
prevents emesis related to chemotherapy, opiods, and postoperative recovery.
cannabinoids: dronabinol (marinol)
pharmacological action
antiemetic mechanism of medication is unknown.
is used to control CINV and to increase appetite in clients who have aids.
scopolamine interferes with the transmission of nerve impulses traveling from the vestibular apparatus of the inner ear to the vomiting center VC in the brain.
scopolamine treats motion sickness.
muscarinic and histaminergic receptors in nerve pathways that connect the inner ear and VC are blocked by dimenhydrate.
dimenhydrinate treats motion sickness.
substance P/neurokinin antagonist: aprepitant
side effects
fatigue, diarrhea, dizziness, possible liver damage.
treat headache with non opioid analgesics. monitor stool pattern.
serotonin antagonist: ondansetron
side effects
headache, diarrhea, dizziness
treat headache with non opioid analgesics. monitor stool patterns.
dopamine antagonists: prochlorperazine
side effects
extrapyramidal symptoms
inform of possible side effects stop meds and notify if symptoms occur. administer anticholinergic medications such benadryl to treat symptoms.
hypotension
monitor clients receiving antihypertensive medications for low blood pressure.
sedation
inform client of potential for sedation. avoid activities that require alertness.
anticholinergic effects (dry mouth, urinary retention, constipation)
increase fluids exercise regularly chew hard candy or gum administer stimulant laxative such as senna (senokot) to counteract a decrease in bowel motility, or a stool softner such as docusate sodium (colase) to prevent constipation. advise to void every 4 hour, monitor I&O, and palpate lower abdomen every 4-6 hr to assess the bladder.
cannabinoids: dronabidol
side effects
potential for dissociation, dysphoria
avoid using in mental health disorders
hypotension, tachycardia
avoid using in clients with cardiovascular disorders
anticholinergics: scopolamine and antihistamines: dimenhydrinate
side effects
sedation
advise of potential sedation. avoid activities that require alertness.
anticholinergic effects (dry mouth, urinary retention, constipation)
same as for the ones before.
use dopamine antagonist cautiously, if at all, with:
children and older adults due to the increased risk for extrapyramidal side effects.
dopamine antagonist, antihistamines, and anticholinergic antiemetics should be used cautiously in clients with:
urinary retention or obstruction asthma narrow angle glaucoma
antiemetics
medication and food interactions
CNS depressants, such as opioids and alcohol can intensify CNS depression of antiemetics.
avoid activities that require mental alertness
concurrent use of antihypertensives can intensify hypotensive effects of antiemetics.
sit or lie down avoid sudden changes in movement
concurrent use of anticholinergic medication (antihistamines) can intensify anticholinergic effects of antiemetics.
teach how to reduce anticholinergic effects
antiemetics prevent or treat nausea and vomiting from various causes.
match the medication with the cause.
when a client is receiving a chemotherapy agent that causes severe nausea,___.
combining 3 antiemetics and administratering them prior to chemotherapy is more effective than treating nausea that is already occurring.
laxatives
select prototype medications: psyllium (metamucil) docusate sodium (colace) bisacodyl (dulcolax) magnesium hydroxide (milk of magnesia) other medication: senna (senokot), lactulose
bulk forming laxatives: psyllium
pharmacological action
bulk forming laxatives soften fecal mass and increase bulk, which is identical to the action of dietary fiber.
decrease diarrhea in clients with diverticulosis and irritable bowel syndrome IBS. control stool for clients with an ileostomy or colostomy. promote defecation in older adults with decrease in peristalsis due to age related changes in the GI tract.
surfactant laxatives: docusate sodium
pharmacological action
lower surface tension of the stool to allow penetration of water.
constipation related to pregnancy or opioid use. prevention of painfull elimination in clients with conditions such as cerebral aneurysm or post MI. decrease the risk of fecal impaction in immobile clients and promote defecation in older adults with decreased peristalsis due to age related changes in the GI tract.
stimulant laxatives: bisacodyl
therapeutic action
result in stimulation of intestinal peristasis.
client preparation prior to surgery or diagnostic tests such as a colonoscopy. short term treatment of constipation caused by high dose opioid use.
osmotic laxatives: magnesium hydroxide
pharmacological action
draw water into the intestine to increase the mass of stool, stretching musculature, which results in peristatsis.
low dose: prevent painful elimination (clients with episiotomy or hemorrhoids) high dose: client preparation prior to surgery or diagnostic tests such as a colonoscopy. rapid evacuation of the bowel after ingestion of poisons or following antielminthic therapy to rid the body of dead parasites.
laxatives
side effects
GI irritation
do not crush or chew enteric coated tablets.
rectal burning sensation, leading to proctitis
discourage clients from using bisacodyl suppositories on a regular basis.
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