Non-prescription antiemetic uses include mild infectious disease, pregnancy, and _____ _______.
motion sickness
Physiology of vomiting includes:
-CTZ =
-Vestibular apparatus =
-Cortex =
-Vagus nerve and GI tract
-CTZ = neurons in this area simulated by bloodstream contents
-Vestibular apparatus = cholinergically signals motion sickness
-Cortex = sensory input
-Vagus nerve and GI tract
Viceral Stimulation can cause vomiting
Caused by GI obstruction, motility disorders (gastroparesis), hernias, peritoneal and topical irritants, others: cardiac diseases, _________ diseases, and overeating
urologic
____ disorders such as vestibular disorders, increased ICP, infections like meningitis or psychogenic problems can cause nausea and vomiting
CNS
Irritation of the ___ can occur at initiation or withdrawal or drugs, or caused by systemic disorders
CTZ
Things that can cause you be nauseated or vomiting include psychogenic stimuli from cortex/limbic system (anticipatory/bulimia), motion sickness, GI disturbances, pregnancy, post-op vomiting, ______ poisoning involving CTZ
blood
The three sources of sensory input are: ______, proprioception, and vestibular apparatus
visual
Symptoms of motion sickness include headache, malaise, restlessness, drowsiness, and feelings of ________
warmth
Sign and symptoms of nausea and vomiting include: regurgitation and ______
retching
Treatment goals of nausea and vomiting include:
-identifying and correcting underlying cause
-recommend appropriate _____ for symptom relief
nonRx
Treatment options for adults per underlying conditions include:
Pregnancy -
Motion sickness -
Overeating -
Food poisoning -
Medication use -
Treatment options for adults per underlying conditions include:
Pregnancy - R&R, non-Rx, referral
Motion sickness - OTC, antihistamines
Overeating - antacids, H2RAs, bismuth containing, or phosphorylated carb bev
Food poisoning - oral rehydration
Medicati
Exclusion for Self-Treatment for nausea and vomiting in adults include:
-food poisoning lasting more than ___ hours
-severe abdominal pain
-fever
-diarrhea
-blood
-dark urine
-jaundice
-pregnancy
-head injury
-meningitis-like symtpoms
-caused by cancer, d
12/COPD
General treatment for children with nausea and vomiting:
Motion sickness -
Gastroenteritis -
Episodic or situational -
General treatment for children with nausea and vomiting:
Motion sickness - avoid triggers, OTC antihistamine
Gastroenteritis - oral rehydration, avoid antiemetic, restart feeding with formula/solids
Episodic or situational - phosphorylated carb solution
Exclusion for nausea and vomiting in children
-meningitis like symptoms
<_ months old or weight <_kg
-refusal to drink
-lack urination in past _-_ hours
-lethargic or sleepy
-vomiting each feeding
-projectile or continuous vomiting >_ hours
-colored vomit
6/8/8-12/8
NonRx therapy for nausea and vomiting in pregnancy include
-eating dry toast or crackers
-sips of liquid especially ______ or fruit juices
-eat _-_ small meals
-avoid overeating
-avoid greasy, spicy, acidic foods
carbonated/4-5
NonRx therapy for nausea and vomiting in motion sickness include _____________ wristbands
accupressure
Rx therapy for motion sickness is ___________ while food related nausea and vomiting includes: antacids, H2RAs, PPI, phosphorylated carbs, bismuth subsalicylate
antihistamines
Antihistamines work by reducing the stimulation the ________, but can cause drowsiness and anticholinergic side effects.
Do NOT give to patients with conditions who you shouldn't give anticholinergics
labyrinth
Antihistamines can have drug interactions with other CNS depressants and anticholinergic and sedative effects with ____
TCAs
Meclizine or bonine is not recommended for children <__ years old
12
Emetrol is a carbohydrate solution that contains sugars and ______ ____ which exerts an osmotic effect and slows GI motility and emptying. It is used for emesis associated with intestinal flu, food, or emotional upset.
phosphoric acid
Avoid Emetrol in __ or hereditary fructose intolerance
DM
Why is gatorade not the best oral rehydration solution?
high amounts of sugar makes the solution hypertonic, pulling water into the GI tract and exacerbates diarrhea
For special populations of nausea and vomiting recommend...
Pregnancy -
Children -
Elderly -
For special populations of nausea and vomiting recommend...
Pregnancy - use OTC emetics with MD
Children - Antacids and H2RA with MD support
Elderly - prone to dehydration, avoid antihistamines
NonRx antiemetics are only for preventing and controlling occasional, ___-_______ symptoms
self-limiting
Causes of primary idiopathic constipation include: normal-transit, slow-transit, and outlet ______
obstruction
Causes of secondary constipation include
-inadequate fiber or fluids
-inactivity
-pregnancy
-underlying disease like colon cancer, IBD, diabetic neuropathy and ___________
-medications
hypothyroidism
Drugs that can cause constipation include
-analgesics
-anticholinergics
-calcium or aluminum antacids
-iron supplements
-non-K+ sparing diuretics
-______ ______ ________
sodium polystyrene sulfonate
Signs and symptoms of constipation include: decreased frequency of bowel movements and _________ _________
abdominal discomfort
Treatment goals include reliving constipation, establishing good habits of diet and exercise, promote safe use of laxatives and avoid ____ of laxatives
overuse
Step-wise therapy for constipation starts with
-diet and lifestyle + bulk formers
-_____ or _________ laxatives
-stimulant laxatives
saline/hyper osmotic
Exclusions for self-treatment for constipation include
-abdominal pain, cramping
-unexplained farts
-fever, nausea, vomiting
-para or _____________
-______ laxative use
-unexplained change in bowel habits
-blood in stool
-symptoms recurring after lifestyl
quadriplegia/daily/2
NonRx constipation therapy is to
-increase fiber intake gradually starting with 2 servings daily and increase every 7-10 days for a recommended __-__ grams daily
-drink non caffeinated beverages 32-128oz daily
-increase exercise
20-35
Rx therapy for constipation includes bulk forming laxatives, hyperosmotics (saline/polymer), stimulants, stool softeners (emollients/______)
lubes
Bulk forming laxatives work by retaining water to help stimulate ______ and stool water content
They work within ___-___ hours
peristalsis/12-24
Adverse effects of bulk formers include: abdominal cramping, bloating, and ____.
CI include: fluid restriction, partial intestinal obstruction, fecal impaction, and difficulty swallowing
farts
Bulk laxatives include: psyllium, methylcellulose and _____ ___________
Calcium polycarbophil
Hyper-osmotic laxatives include: saline, lactulose, and ______ type.
polymer
Saline laxatives work by drawing water into the intestines.
__________ containing can cause illeus of GI, heart block, and renal failure. Sodium containing avoid in fluid restriction, CHF, cirrhosis.
Magnesium
Adverse effects of saline laxatives include: abdominal cramping, excessive diuresis, dehydration and _-_____ disturbances
e-lyte
Examples of saline laxatives include magnesium citrate, _____ _______, and dibasic sodium phosphate
magnesium hydroxide
Sodium phosphate solutions have a BBW to Rx-only products for ____.
Non-Rx products should not be used for bowel cleansing.
AKI
Polymer laxatives work because they are large in size which helps have an osmotic effect, they are _____ tolerated than salines, and adverse effects include bloating, cramping, farting. PEG 3350 is an example of a polymer laxatives
better
Stimulant laxatives work in _-__ hours. It stimulates peristalsis by irritating mucosa. Often used for rapid relief, bowel prep or OIC.
6-12
Adverse effects of stimulant laxatives are worse and include: severe cramping, fluid and e-lyte imbalances, and ______________.
malabsorption
Examples of stimulant laxatives include senna which can discolor urine and colon; ________ use chronically can cause pH problems, hypoCa2+, and malabsorption, glycerin suppositories, and castor oil which is only used for acute bowel evacuation
bisacodyl
Stool softeners can be emollients because the ______ surfactants help wet the poo. There are _____ adverse effects aside from mild cramps because it's not rally absorbed. Some significant drug interactions include increased absorption of digoxin, warfarin
anionic/minimal/mineral oil
Examples of stool stool softener emollients include: ________ in colace and kaopectate.
docusate
Stool softeners that work as lubricants like _____ ____ work by softening and coating. It is only indicated for the short term to prevent straining. It can cause a _______ ______ _______ or aspiration.
mineral oil/foreign body reactions
Special patient populations in constipation include
Elderly-
Pregnancy -
Elderly - sensitive to e-lyte and fluid shifts, important to becareful with saline laxatives and use tap water or bulk forming laxatives
Pregnancy -diet is preferred, mineral oil, castor oil, and osmotic agents all have problems
For constipation, most patients benefit from dietary and lifestyle medication. However, laxative therapy should be limited to short term or <_ week
1
Causes of diarrhea include infections, _______ poisoning or intolerance and medications
food
medications that can cause diarrhea include cefixime, amoxicillin/clavulanate, clindamycin, anticancer agents, mistoprostol, colchicine, and ______________
metoclopramide
Goals of diarrhea therapy include correcting fluid and e-lyte loss, reliving symptoms, treat and identify cause, and prevent acute morbidity and _______
mortality
To treat mild-moderate, uncomplicated diarrhea seeking symptomatic relief with _________ or correction of fluid and e-lytes with pedialyte
loperamide
Exclusions for Self Treatment include
-symptoms >__ hours
-kids <6 months, severely dehydrated, >6 months with high fever
-blood, pus, mucus in stool
-severe abdominal pain, vomiting
-risks like DM, CVD, CKD, IS, pregnancy, chronic
48
NonRx therapy for diarrhea includes
-fluid and electrolyte management
-dietary management
-preventive measures like isolation, hand washing, sterile technique, proper food handling, and caution when _______ to high risk areas
traveling
Loperamide works by binding to peripheral mu receptors to decrease GI motility and secretions. Adverse effects of loperamide include headache, drowsiness, and abdominal pain. it can cause _______ ___ including arrhythmias and death at higher than recommen
cardiovascular risks
Dose of loperamide is 4mg initially then 2mg after each stool for max of _mg/daily
8