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

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

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

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

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

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

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

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

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

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

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

14. Antiemetics Ondansetron Promethazine Scopolamine Dimenhydrinate

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

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

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

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

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

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

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

22. Laxatives Psyllium Docusate sodium Bisacodyl Magnesium hydroxide Senna
Lactulose
Methylcellulose
Castor oil

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

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

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

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

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

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

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

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

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

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

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

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

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