Term
| Calcium carbonate (Tums®, Rolaids®) Aluminum hydroxide (Amphojel®) Magnesium hydroxide (Milk of Magnesia®)Aluminum and magnesium salts (Maalox®, Mylanta®) |
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Definition
Antacids
Decreases acidity in stomach by neutralizing acid; pH of stomach increases; Decreases injury to mucosal lining (renally eliminated)
AE - constipation- Calcium/Aluminum; diarrhea- magnesium |
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Term
| Cimetidine (Tagamet®, Tagamet HB®) - Ranitidine (Zantac®, Zantac 75®) |
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Definition
H2 blockers
Antagonizes H2 receptors in gut; Decreases acid production; Increases pH in stomach, decreases damage (renally eliminated; cimetidine - well known CYP enzyme inhibitor - lots of drug interactions
AE - cimetidine- antiandrogen
All- ^ risk for pneumonia; All can accumulate in renal/geriatric- H1 |
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Term
| Omeprazole (Prilosec®, Prilosec OTC®) |
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Definition
PPIs
Inhibits H+ / K+ ATPase in parietal cells Decreases acid production |
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Term
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Definition
Irreversible inhibition of the proton pump
blocks basal and stimulated acid release
a single dose can reduce acid up to 97% in 2 hours vs 65% with H2RA's
effects persist until new pump is created
partial recovery 3-5 days
full recovery- weeks |
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Term
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Definition
rebound acid hypersecretion when stopped
Increased risk for pneumonia
Increased risk for Clostridium difficile
long term -hypomagnesemia
long term- Fractures (Osteoporosis)
Link to dementia? |
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Term
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Definition
Anti-ulcer agent
Composed of aluminum hydroxide and sulfated sucrose. When ingested, creates a protective barrier/gel at active ulcer sites for up to 6 hours
AE - may decrease absorption of other drugs
constipation |
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Term
| Misoprostol (mye so PRAH stole) (Cytotec®) |
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Definition
Anti-ulcer agent
Prostaglandin analog- suppress stomach acid
promote secretion of bicarbonate and mucus
Indications - U.S. for NSAID induced ulcers
Offlabel- for nonNSAID related ulcers
AE - Pregnancy Category X
Contraindicated during pregnancy
Educate women about use, must have negative pregnancy test within 2 weeks, be on contraceptive |
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Term
| ondansetron – PO, IV ( 4-8 mg doses) |
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Definition
Serotonin Receptor Antagonists
antagonist at 5-HT3 receptors located in the CTZ as well as in the G.I. tract
Indications - CINV (chemotherapy induced N/V); N/V in pregnancy; radiation/anesthesia N/V; Post-Op N/V; toxins
AE - max dose of 16 mg (anything higher, QT prolongation) |
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Term
| promethazine (Phenergan®) – PO, PR, IM, IV ( 6.25-25 mg doses) |
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Definition
Dopamine Antagonist part 1/phenothiazines
1) antagonist at D2 receptors in the brain (CTZ); 2) Antagonism at H1 receptors (also some anticholinergic properties)
Indications - traditionally for antipsychotic purposes; CINV; toxins; surgery; chlorpromazine (hiccups)
AE - Extrapyramidal Symptoms
https://www.youtube.com/watch?v=n1CesjByFFw
BOXED WARNING: tissue injury- extravasation
BOXED WARNING: respiratory depression resulting in death
CNS depression, caution w/certain medications |
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Term
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Definition
Dopamine Antagonists Part 2
1) blocks dopamine AND serotonin receptors in the CTZ
2) enhances actions of acetycholine in the GI tract (resulting in increased motility)
Indications - "prokinetic;" supression of gastroesophageal reflux; diabetic gastroparesis; Post OP N/V; CINV; off label- hiccups
AE - BOXED WARNING
Extrapyramidal Symptoms
Specifically Tardive Dyskinesia
Not to be used in Bowel Obstruction, GI; perforation/hemorrhage; Cholinergic adverse effects- diarrhea |
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Term
| dronabinol (Marinol®) controlled substance |
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Definition
Cannabinoids
1) agonist at cannabinoid receptors in the brain
Indications - CINV; appetite stimulant (patients w/ AIDS and muscle wasting)
AE - sedation; euphoria |
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Term
| scopolamine patch (Transderm-Scop) |
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Definition
Anticholinergics
1) Block ACh receptors in the vestibular nuclei and reticular formation
Indications - motion sickness; Post op N/V
AE - dry mouth, dizziness, hallucinations, sedation, dilated pupils
Contraindications - Narrow Angle Glaucoma (must remove prior to MRI) |
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Term
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Definition
antihistamines
1) Weakly blocks ACh receptors from the inner ear to the vomiting center
2) Block H1 receptors from the inner ear to the vomiting center
Indications - motion sickness (scopolamine is superior); vertigo
AE - sedation; anticholinergic |
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Term
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Definition
doxylamine and pyridoxine (Diclegis)
ondansetron for hyperemesis gravidarum
Pregnancy Category B
Still being studied
ginger |
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Term
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Definition
Substance P/Neurokinin Antagonists
Aprepitant
for post Op N/V and CINV
Benzodiazepines- Lorazepam
For CINV
anticipatory nausea, amnesia
Glucocorticoids- full MOA is unknown
Dexamethasone and Methylprednisolone
For CINV |
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Term
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Definition
1.) Bone Marrow
Synthesis of erythryocytes
2) Erythropoietin
Stimulates bone marrow
3) iron, folic acid, B12 (cyanocobalamin)
building blocks for erythyrocytes |
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Term
| Different types of anemia |
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Definition
MIcrocytic anemia (small MCV)
many causes
Iron deficiency anemia most common
Normocytic Anemia
low H/H
Macrocytic anemias (large MCV)
many causes
megaloblastic anemias (DNA issue) most common
Vitamin B12 deficiency, folate deficiency |
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Term
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Definition
Iron Deficiency Anemia
Essential mineral in the body
Oxygen carrier in hemoglobin and myoglobin
Stored in the liver, spleen, and bone marrow
Iron deficiency results in anemia
Use iron to treat |
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Term
ferrous sulfate (Feosol)-325 mg tablet, contains 65 mg elemental iron
GOAL is 200 mg of elemental iron/day for IDA |
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Definition
oral iron
Iron Salt replenishment for the body when dietary is insufficient
Indications - prevention of iron deficiency anemia; treatment of iron deficiency anemia
AE - GI TRACT
nausea, heartburn, bloating, constipation (diarrhea)
liquid iron can STAIN teeth; both forms can "stain" a bowel movement- black stool normal |
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Term
| Oral iron AE and Drug/Drug |
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Definition
Drug/drug - iron likes to bind with other drugs
-avoid administering with oral antibiotics (fluoroquinolones and tetracyclines)
-Ascorbic Acid is acidic (increases absorption)
-Therefore co-administration with an Antacid such as Tums (calcium carbonate) will do what?
AE - Boxed Warning: Most common cause of pediatric poisoning deaths
As little as 15 tablets can lead to overdose
Children can appear asymptomatic
Severe N/V/D, GI bleeding |
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Term
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Definition
Parenteral iron
Iron Salt replenishment for the body when dietary is insufficient
Indications - treatment of iron deficiency anemia in CKD; exception (iron dextran) can be used w/o CKD; dependent on whether or not using HD, or ESAs
AE - BOXED WARNING: anaphylactic reactions during any dose!
Iron Dextran only product requiring a small TEST dose first |
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Term
| Epoetin Alfa (e POE e tin AL fa) (Epogen) |
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Definition
Erythropoesis Stimulating Agents (ESA's)
stimulates production of RBC's in the bone marrow. Natural hormone is produced by the kidneys
Ind - Anemia in CKD; Chemotherapy induced Anemia (requires REMS); few other uses
AE - Target Hgb used to be 12 g/dL, NOW its 11g/dL, HOLD if over; HYPERTENSION (most common); Heart Attack, Stroke, Heart Failure, thrombosis
Contra - Contraindications: drug allergy, uncontrolled hypertension, head and neck cancers, risk of thrombosis |
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Term
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Definition
CANCER:
ESAs shortened overall survival and/or increased the risk of tumor progression or recurrence in some clinical studies with certain cancers
CHRONIC KIDNEY DISEASE:
patients experienced greater risks of death, serious adverse cardiovascular reactions, and stroke when administered ESAs to target a hemoglobin level of greater than 11 g/dL
CARDIOVASCULAR:
Erythropoiesis-stimulating agents (ESAs) increase the risk of death, myocardial infarction (MI), stroke, venous thromboembolism, thrombosis of vascular access |
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Term
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Definition
Large MCV
Folate Deficiency
Pernicious Anemia
Treatment- The B Vitamins!
B9 (folic acid)
B12 (cyanocobalamin) |
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Term
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Definition
Water-soluble, B-complex vitamin (B9)
Essential for erythropoiesis
Primary uses
Folic acid deficiency
During pregnancy to prevent neural tube defects
Malabsorption syndromes are the most common cause of deficiency
Should not be used until actual cause of anemia is determined
May mask symptoms of pernicious anemia, which requires treatment other than folic acid
The folic acid supplementation will allow the RBCs to mature and have a normal MCV, but the B12 is still deficient ( can lead to neurologic damage) |
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Term
| Cyanocobalamin (Vitamin B12) |
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Definition
Used to treat pernicious anemia and other megaloblastic anemias
Deficiency can result in neurologic changes, and CNS lesions
Requires Intrinsic Factor for absorption
Can be given IM, SC, orally, intranasally
Low risk for toxicity |
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