NCLEX Medications Affecting Digestion and Nutrition (part 2)

You can find part 1 here – http://www.nclexreviewonline.com/nclex-medications-affecting-digestion-and-nutrition-part-1/

Prostaglandin E Analog

Expected Action:

ò acid secretion / ñ secretion of HCO₃^– and mucus / ñ submucosal vasodilation.

Example: misoprostol (Cytotec)

Therapeutic Uses: Long-term NSAID therapy, induce labor by causing cervical ripening.

Adverse Effects: Diarrhea and abdominal pain, Dysmenorrhea and spotting

Contraindications/Precautions:

Pregnancy (X), Potential to become pregnant

Antiemetics (Types)

Serotonin antagonists…………….. ondansetron (Zofran)
Dopamine antagonists prochlorperazine (Compazine)
Glucocorticoids……………. dexamethasone (Decadron)
Cannabinoids…………………………… dronabinol (Marinol)
Anticholinergics………. scopolamine (Transderm Scop)
Antihistamine…………….. dimenhydrinate (Dramamine)
- Others
Granisetron (Kytril)
Promethazine (Phenergan)
Metoclopramide (Reglan)
Hydroxyzine (Vistaril)
Aprepitant (Emend)

Antiemetics

(Action, Use, Effects, Interactions)

Agent – Action – Use

Ondansetron — V SER_R in CTZ & vagal nerve — Chemo, radiation, postop

Prochlorperazine — V DOP_R in CTZ — Chemo, opioids, postop

Dexamethasone – Unknown — Combo for chemotherapy

Dronabinol – Unknown — Chemotherapy (CINV)

Scopolamine — V impulses: inner ear VC — Motion sickness

Dimenhydrinate — V HIS_R MUS_R inner ear VC — Motion sickness

Agent —- Adverse Affect

Ondansetron — Headache, diarrhea, dizziness

Prochlorperazine — EPS (Tx ĉ Benadryl or Ativan), hypotension, sedation, and anticholinergic effects.

Dronabinol — Dissociation, dysphoria, hypotension, tachycardia

AntiCh, AntiHis — Sedation, anticholinergic effects

Interactions

CTZ = chemoreceptor trigger zone

CNS depressants / Antihypertensives / Anticholinergics Additive Effects

Watch for Antagonists ĉ urinary retention, asthma, and narrow-angle glaucoma

Combo therapy allows lower doses of each \ decreased side effects

Antidiarrheals

Expected Action:

Activate opioid receptors in GI to decrease motility and increase absorption of water & Na⁺

Example: diphenoxylate (Lomotil), Others: loperamide (Imodium), difenoxin (Motofen)

Adverse Effects: At recommended doses, diphenoxylate has no CNS effects, ñ diphenoxylate doses typical opioid responses

Contraindications/Precautions: Pregnancy (?) , increased risk of megacolon with inflammatory bowel disorders serious complications including perforated bowel.

Interactions: CNS depressants increased depressive effect

Education: Encourage use of electrolyte replacement drinks, Avoid plain water (no electrolytes) and caffeine (increased motility), Manage dehydration (weight, VS, I&O) – 0.45% NS may be prescribed

Prokinetic Agents

Expected Action: