🫁 Exam 7
Respiratory, eye and ear, then the gastrointestinal drugs.
Modules 12–13 · 50 questions · 32 drugs · 17 concepts
Modules 12 & 13 — the questions
Which medications are recommended for the treatment of mild to moderate asthma (Hint: steps 1 & 2)?⭐ HIGH YIELD
Step 1 (intermittent): a short-acting beta-2 agonist, albuterol, as needed. Step 2 (mild persistent): a daily LOW-DOSE INHALED CORTICOSTEROID is the preferred controller plus PRN albuterol; the 2020 update also allows PRN concomitant ICS with the SABA. Alternatives at Step 2 are a leukotriene receptor antagonist (montelukast), cromolyn, nedocromil, or theophylline.
- An inhaled corticosteroid is the preferred controller at every persistent step. The alternatives listed are genuinely less effective.
- Persistent asthma means symptoms more than 2 days a week or nighttime awakenings more than twice a month. Needing the rescue inhaler more than 2 days a week means step up.
- Montelukast carries a boxed warning for neuropsychiatric events. Teach families to report mood changes, agitation, and suicidal thinking.
- Theophylline has a narrow therapeutic index: monitor levels and watch for nausea, tachycardia, and seizures. It is rarely used now.
- Inhaled corticosteroid technique: use a spacer and RINSE THE MOUTH after every dose to prevent oral candidiasis. If both inhalers are due, give the BRONCHODILATOR first, wait, then the corticosteroid.
Rescue is albuterol. Control is a steroid inhaler. Needing rescue more than twice a week means control is failing.
Compare the adverse effects of 1st generation and 2nd generation antihistamines.⭐ HIGH YIELD
First generation crosses the blood-brain barrier, so it causes heavy SEDATION plus ANTICHOLINERGIC effects. Second generation barely crosses, so it is non-sedating or minimally sedating with few anticholinergic effects, making it the safer choice for daily use and for older adults.
- First-generation drugs still have real uses: acute allergic reactions, motion sickness, vertigo, nausea, and as sleep aids. There the sedation is the point.
- Both block H1 receptors. NEITHER is the treatment for anaphylaxis; epinephrine is.
- Teach: no alcohol or other CNS depressants, and no driving on first-generation agents.
- Avoid first-generation agents in narrow-angle glaucoma, BPH, and dementia.
| 1st generation | 2nd generation |
|---|
| Diphenhydramine, chlorpheniramine, hydroxyzine, promethazine, meclizine | Loratadine, cetirizine, fexofenadine, levocetirizine, desloratadine |
| Crosses the blood-brain barrier readily | Poorly crosses the blood-brain barrier |
| Strong sedation, drowsiness, impaired driving; paradoxical excitation in children and older adults | Non-sedating to minimally sedating (cetirizine is the most sedating of this group) |
| Anticholinergic: dry mouth, blurred vision, urinary retention, constipation, tachycardia, confusion | Few or no anticholinergic effects |
| Short-acting, often every 4 to 6 hours | Long-acting, usually once daily |
| On the Beers list: avoid in older adults | Preferred in older adults; adjust for renal function |
1st gen puts you to sleep AND dries you out. 2nd gen just treats the allergy.
What are the treatment options for a dry cough?⭐ HIGH YIELD
For a dry, nonproductive cough: dextromethorphan (the OTC antitussive) is first-line, codeine or hydrocodone for severe cough, benzonatate (numbs airway stretch receptors), and honey as an effective non-drug option in anyone over 1 year old.
- Dextromethorphan: avoid with SSRIs, MAOIs, and other serotonergic drugs because of serotonin syndrome. It has abuse potential at high doses.
- Codeine and hydrocodone antitussives: sedation, constipation, respiratory depression. Contraindicated in children under 12 and in nursing mothers.
- Benzonatate must be SWALLOWED WHOLE. Chewing or sucking it numbs the mouth and throat and can cause choking and laryngospasm; it is lethal if a young child ingests it.
- NEVER give honey to an infant under 1 year: infant botulism.
- Suppress only a DRY cough. A productive cough should be helped with an expectorant (guaifenesin) and fluids, not suppressed. Look for the cause: ACE inhibitors cause a persistent dry cough, and the fix is switching to an ARB.
Dry cough, suppress it. Wet cough, loosen it. Never honey under one.
Describe the process for administering eye drops.⭐ HIGH YIELD
Wash hands, tilt the head back, pull the LOWER LID down to make a pocket, drop the medication into the conjunctival sac (never onto the cornea and never touching the eye with the tip), have the patient close the eye gently, then apply pressure to the inner canthus for 30 to 60 seconds to prevent systemic absorption.
- Before: check the label, expiration date, and which eye (OD right, OS left, OU both). Inspect the solution and tip for cloudiness or discoloration.
- Set the cap on a clean surface tip-side up, and never let the dropper touch the eye, lashes, or any surface. Stabilize the dominant hand by resting it on the patient's forehead or on the back of the non-dominant hand.
- Wait 5 MINUTES between different eye drops, give drops before ointments, and remove contact lenses first (reinsert after about 15 minutes).
- Punctal occlusion matters most with beta blocker drops such as timolol, where systemic absorption causes bradycardia and bronchospasm.
- Blot excess solution with a tissue, wiping from the inner to the outer canthus.
Lower lid pocket, never the cornea. Then press the inner corner, because that is the drain to the bloodstream.
Describe the process for administering ear drops.⭐ HIGH YIELD
Wash hands, warm the drops to room temperature (cold drops cause vertigo and pain), position the patient with the affected ear UP, straighten the canal: ADULTS pull the pinna UP AND BACK, CHILDREN under 3 pull DOWN AND BACK. Instill along the side of the canal, pump the tragus, and keep the ear up for 2 to 5 minutes.
- Never warm drops in a microwave. Hold the bottle in your hands or in warm water for a few minutes.
- Do not let the dropper touch the ear and do not occlude the canal completely with the dropper tip.
- A loose cotton ball may be placed at the outermost canal for a few minutes if ordered, but never packed in.
- If the tympanic membrane is perforated or tubes are in place, only specific sterile preparations (fluoroquinolone otic drops) may be used.
- Eye drops CAN be used in the ear in a pinch, but ear drops must NEVER go in the eye: otic preparations are not sterile.
Adults UP and back (adults are grown up). Kids DOWN and back (kids are little).
Every drug on the list
💉 Acetylcysteine
Mucolytic; antidote—acetaminophen, Amino acid l-cysteine
What it is for
Mucolytic (thins mucus in chronic bronchitis, cystic fibrosis); antidote for acetaminophen overdose.
How it works
Breaks disulfide bonds in mucus → decreases viscosity.
Watch for
Bronchospasm, nausea, unpleasant odor.
Teaching
- Use nebulizer; may cause rotten egg smell; rinse mouth after use.
- That foul odor and smell may be unpleasant
- To clear airway for inhalation
- To report vomiting because dose may need to be repeated
🔗 Full card in the drug guide
💉 Albuterol
Bronchodilator, Adrenergic β2-agonist, sympathomimetic, bronchodilator
What it is for
Acute bronchospasm in asthma/COPD. Immediate relief of acute exacerbation of asthma.
How it works
Short-acting β2 agonist → bronchodilation.
Watch for
Tremor, tachycardia, nervousness.
Teaching
- Use as rescue inhaler; report chest pain or palpitations.
- To use exactly as prescribed; to take missed dose when remembered, alter dosing schedule; not to use OTC medications; that excess stimulation may occur, to use this produ …
- About use of inhaler: review package insert with patient; use demonstration, return demonstration; shake, prime before first use and when not used for >2 wk; release 4 te …
- To avoid getting aerosol in eyes (blurring of vision may result) or use near flames or sources of heat
🔗 Full card in the drug guide
💉 Beclomethasone
Antiasthmatic, Corticosteroid
What it is for
Long-term control of asthma.
How it works
Inhaled corticosteroid → reduces swelling and airway inflammation.
Watch for
Oral candidiasis, hoarseness.
Teaching
- Rinse mouth after use; not for acute attacks.
- To take as prescribed, not to double or skip doses, not to use for acute asthma
- To gargle/rinse mouth after each use to prevent oral fungal infections
- To notify prescriber if therapeutic response decreases; dosage adjustment may be needed
🔗 Full card in the drug guide
💉 CodeineHIGH ALERTBLACK BOX
Opiate analgesic, antitussive, Opiate, phenathrene derivative
What it is for
Antitussive for severe dry (nonproductive) cough.
How it works
Opioid acts on cough center in medulla.
Watch for
Sedation, constipation, respiratory depression.
Teaching
- Avoid driving; risk of dependence; take with food.
- To report any symptoms of CNS changes, allergic reactions
- That physical dependency may result after extended periods, product should be used short term
- To change position slowly; orthostatic hypotension may occur
Antidote / reversal: 1
🔗 Full card in the drug guide
Cromolyn
Cromolyn sodium is a MAST CELL STABILIZER used to PREVENT asthma and allergic symptoms by stopping mast cells from releasing histamine. It is not a rescue drug and will not help an attack already in progress.
- Onset takes 2 to 4 weeks of regular use. Teach the patient to keep using it even when they feel fine.
- Available as an inhaled or nebulized solution (asthma), a nasal spray (allergic rhinitis), and ophthalmic drops (allergic conjunctivitis).
- Also used prophylactically 15 to 20 minutes before exercise or a known allergen exposure.
- Very safe drug. Main effects are throat irritation, cough, and a bad taste. Rinse the mouth after use.
- It is an alternative (not preferred) controller at Step 2 asthma; inhaled corticosteroids work better.
Cromolyn CALMS the mast cell before it fires. Prevention only, never in a crisis.
💉 Dextromethorphan
Antitussive, Non-opioid cough suppressant
What it is for
Non-opioid antitussive for dry cough.
How it works
Suppresses cough reflex in medulla.
Watch for
Sedation, dizziness; abuse potential.
Teaching
- Avoid alcohol; do not exceed dose.
- For a dry cough only. Suppressing a productive cough keeps secretions in the lungs, which is exactly wrong in pneumonia or COPD.
- Never with an MAOI, and be careful with SSRIs — serotonin syndrome is the real risk here.
- Check the label of every combination cold product; many already contain it, and many also contain acetaminophen, which is easy to double up on by accident.
🔗 Full card in the drug guide
💉 Diphenhydramine
Antihistamine (first generation, nonselective), Ethanolamine derivative, H1-receptor antag
What it is for
Allergic rhinitis, urticaria, insomnia.
How it works
1st-gen H1 blocker.
Watch for
Sedation, anticholinergic effects.
Teaching
- Avoid driving; caution in elderly.
- About all aspects of product use; to notify prescriber of confusion, sedation, hypotension
- To avoid driving, other hazardous activity if drowsiness occurs
- That photosensitivity may occur, use sunscreen, protective clothing
🔗 Full card in the drug guide
💉 Fexofenadine
Antihistamine—2nd generation, Piperidine, peripherally selective
What it is for
Allergic rhinitis.
How it works
2nd-gen H1 blocker.
Watch for
Minimal sedation, headache.
Teaching
- Start taking within 4 days before allergy season
🔗 Full card in the drug guide
💉 Fluticasone
Steroidal anti-inflammatory, antiasthmatic, Corticosteroid
What it is for
Allergic rhinitis, asthma control.
How it works
Corticosteroid → reduces inflammation.
Watch for
Nasal irritation, oral candidiasis (inhaled). Epitaxis, nasal ulceration, cough, headache
Teaching
- Rinse mouth; use regularly.
- To use bronchodilator 1st, before using inhalation, if taking both
- Not to use for acute asthmatic attack; acute asthma may require oral corticosteroids
- To avoid smoking, smoke-filled rooms, those with URIs, those not immunized against chickenpox or measles
🔗 Full card in the drug guide
💉 Guaifenesin
Expectorant
What it is for
Expectorant for productive cough.
How it works
Increases respiratory tract secretions → easier mucus clearance. Expectorant
Watch for
Nausea, dizziness.
Teaching
- Drink plenty of fluids.
- To avoid driving, other hazardous activities if drowsiness occurs (rare)
- To avoid smoking, smoke-filled room, perfumes, dust, environmental pollutants, cleansers
- To consult health care provider if cough lasts >7 days
🔗 Full card in the drug guide
💉 Ipratropium
Anticholinergic, bronchodilator, Synthetic quaternary ammonium compound
What it is for
COPD, sometimes asthma.
How it works
Anticholinergic → bronchodilation.
Watch for
tachycardia, constipation, dry mouth
Teaching
- Drink water
- That compliance is necessary with number of inhalations/24 hr or overdose may occur; about spacer device for geriatric patients; that max therapeutic effects may take 2-3 …
- How to use equipment properly and take medication as directed; to take missed doses as soon as remembered unless almost time for the next dose; to space remaining doses e …
- That rinsing mouth after use of the inhaler, good oral hygiene, and sugarless gum or candy may minimize dry mouth; to notify health care professional if stomatitis occurs …
🔗 Full card in the drug guide
💉 MontelukastBLACK BOX
Bronchodilator, Leukotriene receptor antagonist, cysteinyl
What it is for
Asthma prophylaxis, allergic rhinitis. Persistent asthma or copd
How it works
Leukotriene receptor antagonist → reduces inflammation.
Watch for
Headache, rare neuropsychiatric effects. Suicidal idation
Teaching
- Take in evening; not for acute attacks.
- To check OTC medications, stimulation; to avoid alcohol
- To avoid hazardous activities; dizziness may occur
- If aspirin sensitivity is known, not to take NSAIDs while taking this product
🔗 Full card in the drug guide
💉 OmalizumabBLACK BOX
Antiasthmatic, Monoclonal antibody
What it is for
Severe allergic asthma.
How it works
Monoclonal antibody binds IgE → prevents allergic cascade.
Watch for
Injection site reaction, anaphylaxis.
Teaching
- Administer in clinic; monitor for allergic reaction.
- That improvement will not be immediate
- Not to stop taking or decrease current asthma medications unless instructed by prescriber
- To avoid live virus vaccines while taking this product
🔗 Full card in the drug guide
Phenylephrine stimulant⭐ HIGH YIELD
Phenylephrine is a pure ALPHA-1 AGONIST. Intranasally or orally it is a decongestant (vasoconstricts nasal mucosa); IV it is a vasopressor that raises blood pressure; as ophthalmic drops it dilates the pupil for eye exams.
- Because it is alpha-only, it raises blood pressure without directly stimulating the heart, so it can cause REFLEX BRADYCARDIA.
- Adverse effects: hypertension, headache, palpitations, restlessness, urinary retention, and rebound congestion.
- Rhinitis medicamentosa: nasal sprays used longer than 3 DAYS cause rebound congestion. Teach the 3-day limit.
- Caution or avoid in uncontrolled hypertension, coronary disease, narrow-angle glaucoma, BPH, hyperthyroidism, and with MAOIs (hypertensive crisis).
- Oral phenylephrine is poorly absorbed, and the FDA has concluded it is not effective as an oral decongestant.
PhenylEPHRINE is pure alpha: squeeze the vessels. Dry nose, high BP, big pupil, and a reflexively slow heart rate.
Pseudoephedrine Stimulant⭐ HIGH YIELD
Pseudoephedrine is an oral SYMPATHOMIMETIC decongestant. It stimulates alpha-1 receptors to vasoconstrict swollen nasal mucosa, with some beta stimulation, relieving nasal and sinus congestion.
- CNS and cardiac stimulation: insomnia, nervousness, tremor, palpitations, tachycardia, and INCREASED BLOOD PRESSURE.
- Avoid in hypertension, coronary artery disease, arrhythmias, hyperthyroidism, diabetes (it raises glucose), BPH, narrow-angle glaucoma, and with MAOIs.
- Teach: take the last dose several hours before bedtime to avoid insomnia, and never exceed the label dose.
- Sold behind the pharmacy counter with ID and quantity limits because it is a methamphetamine precursor.
- Combination cold products often contain acetaminophen. Add up the total daily acetaminophen (max 4 g/day, less with liver disease or alcohol use).
PseudoEPHEDRINE dries the nose, wires the patient, and raises the pressure.
💉 TheophyllineHIGH ALERT
Bronchodilator, Xanthine derivative
What it is for
Asthma/COPD (alternative).
How it works
Methylxanthine → bronchodilation via PDE inhibition.
Watch for
Nausea, arrhythmias, seizures (narrow therapeutic index). Palpitations and restlessness
Teaching
- Avoid caffeine; monitor serum levels. Eye/Ear Medications:
- Narrow therapeutic window, roughly 10 to 20 mcg/mL. Levels get drawn and they matter.
- The first signs of toxicity are nausea, vomiting, restlessness and a fast heart. Seizures and arrhythmias come later. Report the early ones.
- Caffeine stacks on top of it — cut back on coffee, tea, cola and chocolate.
🔗 Full card in the drug guide
💉 Amoxicillin
Antiinfective, antiulcer, Aminopenicillin
What it is for
Bacterial ear infections (otitis media), sometimes eye infections.
How it works
Beta-lactam antibiotic; inhibits bacterial cell wall synthesis.
Watch for
GI upset, diarrhea, allergic reactions (rash, anaphylaxis).
Teaching
- That capsules may be opened, contents taken with fluids; that chewable form is available; to take as prescribed, not to double dose
- All aspects of product therapy: to complete entire course of medication to ensure organism death; that culture may be taken after completed course of medication
- To report sore throat, fever, fatigue, diarrhea (superinfection or agranulocytopenia), blood in stool, abdominal pain (pseudomembranous colitis)
- That product must be taken in equal intervals around the clock to maintain blood levels; to take without regard to food, that capsules may be opened, contents taken with …
🔗 Full card in the drug guide
Brimonidine
Brimonidine is an ALPHA-2 ADRENERGIC AGONIST eye drop for open-angle glaucoma and ocular hypertension. It lowers intraocular pressure by both decreasing aqueous humor production and increasing outflow. A topical gel form also treats rosacea redness.
- Local effects: burning and stinging, ocular redness, dry mouth, blurred vision, foreign-body sensation, and allergic conjunctivitis.
- Systemic absorption causes hypotension, bradycardia, drowsiness, and fatigue. Apply punctal occlusion for 1 to 2 minutes after instilling.
- CONTRAINDICATED in infants and children under 2 and with MAOIs: it can cause profound CNS depression and apnea.
- Remove soft contact lenses before instilling because of benzalkonium chloride, and wait 15 minutes to reinsert.
- Separate different eye drops by 5 minutes.
Brimonidine puts alpha-2 brakes on aqueous production. Press the inner corner or the whole body gets sleepy.
💉 Dorzolamide
Antiglaucoma, Carbonic anhydrase inhibitor
What it is for
Glaucoma, ocular hypertension. Indicated for chronic open-angle glaucoma
How it works
Carbonic anhydrase inhibitor → decreases aqueous humor production
Watch for
Bitter taste, eye discomfort, possible sulfonamide allergy.
🔗 Full card in the drug guide
💉 Latanoprost
Antiglaucoma agent, Rho kinase inhibitor/prostaglandin F2 alpha analogue
What it is for
Glaucoma, ocular hypertension.
How it works
Prostaglandin analog → Reduces IOP by increasing aqueous humor outflow
Watch for
Iris pigmentation (brown discoloration), eyelash growth, eye irritation. Eyelash and eyelid skin may become pigmented
🔗 Full card in the drug guide
Pilocarpine
Pilocarpine is a direct-acting CHOLINERGIC (muscarinic) agonist. As eye drops it causes MIOSIS and ciliary muscle contraction, opening the trabecular meshwork so aqueous humor drains: used for glaucoma, especially acute angle-closure. Orally it treats dry mouth (xerostomia) from Sjogren syndrome or head and neck radiation.
- Expect blurred vision, difficulty seeing in the dark, and brow ache or headache from ciliary spasm. Teach caution driving at night.
- Systemic cholinergic effects: sweating, salivation, nausea, cramping, diarrhea, bradycardia, bronchospasm. Use punctal occlusion.
- Caution or avoid in asthma and COPD (bronchoconstriction), bradycardia, peptic ulcer disease, and iritis.
- Atropine is the antidote for excessive cholinergic effect.
- Contrast with atropine drops: pilocarpine CONSTRICTS the pupil, atropine DILATES it.
PILOcarpine makes the pupil PIN-point and drains the eye.
💉 Timolol
Antiglaucoma agent, antihypertensive, Nonselective beta-blocker
What it is for
Glaucoma, ocular hypertension.
How it works
Non-selective beta-blocker → decreases aqueous humor production.
Watch for
Bradycardia, bronchospasm (systemic absorption), eye irritation. Teaching points: Takes 2-4 weeks to reach therapeutic effect. Monitor HR. Glaucoma drugs are lifelong and work by reducing IOP. Module 11: Gastrointestinal Medications What are the recommended treatment options for peptic ulcer disease caused by H. pylori infection? (Hint: triple therapy) Proton Pump Inhibitor (PPI) Omeprazole Antibiotic 1 Clarithromycin Antibiotic 2 Amoxicillin or Metronidazole What are the different classifications of laxatives? Give examples of medications in each class. CLASS GENERIC NAME BULK FORMING Psyllium LUBRICATING Mineral Oil OSMOTIC Lactulose STIMULANT Senna STOOL SOFTENER Docusate sodium Drug Monographs: Know the indications, mechanism of action (if mentioned in the lecture), contraindications, adverse effects, and client teaching points for each medication.
Teaching
- Eye drops are absorbed systemically. Press on the inner corner of the eye (punctal occlusion) for about a minute after instilling — that is what keeps it out of the bloodstream.
- Nonselective, so it hits beta-2 in the lungs. A person with asthma can bronchospasm from eye drops.
- For ORAL timolol: apical pulse for a full minute, hold and call if under 60. With the drops there is no standard hold parameter, but still check pulse and breathing — the systemic absorption is real.
- It masks hypoglycemia in diabetes — sweating still happens, but the racing heart and tremor do not.
Antidote / reversal: 1
🔗 Full card in the drug guide
Aluminum Hydroxide GERD
Aluminum hydroxide is an ANTACID that directly neutralizes stomach acid already present, giving fast but short-lived relief of heartburn, GERD, and indigestion. It also binds phosphate, so it is used as a phosphate binder in chronic kidney disease.
- Signature side effect is CONSTIPATION. That is why it is combined with magnesium hydroxide, which causes diarrhea, so the two balance each other (Maalox, Mylanta).
- Give antacids about 1 hour AFTER meals and at bedtime for the longest acid-neutralizing effect.
- Big interaction problem: separate from other oral drugs by 1 to 2 hours. It binds tetracyclines, fluoroquinolones, iron, levothyroxine, digoxin, and phenytoin and blocks their absorption.
- Long-term or high dose: hypophosphatemia, aluminum accumulation in renal failure, constipation and impaction.
- Antacids relieve symptoms only. They do not heal ulcers or treat the cause; PPIs and H2 blockers do that.
ALuminum means A Lot of constipation. Mag means must go (diarrhea). Together they cancel out.
💉 Aprepitant
Antiemetic, Substance P/neurokinin antagonist
What it is for
Prevents chemotherapy-induced nausea/vomiting.
How it works
NK1 receptor antagonist → blocks substance P.
Watch for
Fatigue, diarrhea, hiccups.
Teaching
- Take as prescribed before chemo; may interact with warfarin and oral contraceptives.
- To take only as prescribed; to take first dose 1 hr prior to chemotherapy or within 3 hr of surgery to prevent nausea, vomiting
- To report all medications and herbals to prescriber before taking this medication
- That those patients also taking warfarin should have clotting monitored closely during 2-wk period after administration of aprepitant
🔗 Full card in the drug guide
💉 Dexamethasone
Corticosteroid, synthetic, Glucocorticoid, long acting
What it is for
Anti-inflammatory; adjunct for chemo-induced nausea.
How it works
Corticosteroid → reduces inflammation and prostaglandin synthesis.
Watch for
Hyperglycemia, immunosuppression, mood changes. osteoporosis
Teaching
- Do not stop abruptly; monitor blood sugar; report infection signs.
- To carry medical alert ID as corticosteroid user at all times
- To contact prescriber if surgery, trauma, stress occurs because dose may need to be adjusted
- To notify prescriber if therapeutic response decreases because dosage adjustment may be needed
🔗 Full card in the drug guide
💉 Dimenhydrinate
Antiemetic, antihistamine, anticholinergic, H1-receptor antagonist, ethanolamine derivativ
What it is for
Motion sickness, nausea. Vomiting, dizziness, vertigo
How it works
H1 antihistamine → blocks vestibular stimulation.
Watch for
Sedation, dry mouth, urinary retention.
Teaching
- Avoid driving; increase fluids; caution in elderly.
🔗 Full card in the drug guide
Diphenoxylate/Atropine Loperamide is similar⭐ HIGH YIELD
Diphenoxylate with atropine (Lomotil) is an opioid-derived ANTIDIARRHEAL that slows GI motility so more water is absorbed. The small dose of atropine is added purely to DISCOURAGE ABUSE by causing unpleasant anticholinergic effects at high doses. Loperamide (Imodium) acts on the same gut opioid receptors but does not cross into the CNS at normal doses.
- Do NOT use either drug in infectious diarrhea with fever or bloody stools (C. difficile, Shigella, E. coli O157). Trapping the pathogen risks toxic megacolon and sepsis.
- Lomotil is contraindicated in children under 2 and in ulcerative colitis flares or toxic megacolon.
- LOPERAMIDE AT HIGH DOSES CAUSES QT PROLONGATION, TORSADES DE POINTES, AND CARDIAC ARREST. It is abused for opioid effect; never exceed label dosing.
- Both cause drowsiness, so no driving.
- The real priority in diarrhea is fluid and electrolyte replacement, not just stopping the stool.
| Diphenoxylate/atropine (Lomotil) | Loperamide (Imodium) |
|---|
| Prescription; Schedule V controlled substance | Over the counter; not scheduled |
| Atropine added as an abuse deterrent | No added deterrent |
| Can cause CNS effects: sedation, euphoria, respiratory depression in overdose | Minimal CNS penetration at label doses |
| Anticholinergic effects: dry mouth, blurred vision, urinary retention, tachycardia | Mainly constipation, cramping, and dizziness |
Lomotil is an opioid with a booby trap (atropine). Loperamide is the OTC cousin: safe at label dose, deadly to the heart above it.
Dronabinol
Dronabinol (Marinol) is synthetic THC used for chemotherapy-induced nausea and vomiting that has not responded to other antiemetics, and for APPETITE STIMULATION in AIDS-related anorexia with weight loss.
- It is a Schedule III controlled substance. CNS effects: dizziness, drowsiness, euphoria or dysphoria, confusion, anxiety, paranoia, and hallucinations, all worse in older adults. Fall precautions and no driving.
- Cardiovascular: tachycardia and orthostatic hypotension. Teach the patient to rise slowly.
- Additive sedation with alcohol, opioids, benzodiazepines, and other CNS depressants.
- Avoid in psychiatric illness (psychosis, mania), substance use disorder, and pregnancy. Use caution in cardiac disease.
- Give before meals when used for appetite, and supervise the first doses because the response is unpredictable.
Dronabinol is legal THC in a capsule: eat more, vomit less, feel strange.
Famotidine GERD⭐ HIGH YIELD
Famotidine is an H2 RECEPTOR ANTAGONIST. It blocks histamine at the gastric parietal cell so less acid is SECRETED. Used for GERD, peptic ulcer disease, stress ulcer prophylaxis, and Zollinger-Ellison syndrome.
- Take at bedtime for nocturnal acid, or about 30 minutes before a trigger meal.
- Reduce the dose in renal impairment. Famotidine is renally cleared, and confusion or delirium can occur in older or renal patients.
- Cimetidine, the older H2 blocker, inhibits CYP450 and causes gynecomastia; famotidine does neither, which is why famotidine is preferred.
- Separate from antacids by about 1 hour. It can mask the symptoms of gastric cancer.
| H2 blocker (famotidine) | PPI (omeprazole) |
|---|
| Blocks the histamine-2 receptor on the parietal cell | Irreversibly blocks the H+/K+ ATPase proton pump, the final common step |
| Faster relief, about 1 hour; moderate acid suppression | Slower to start, days for full effect; much stronger acid suppression |
| Good for intermittent or nighttime symptoms; tolerance can develop | Better for healing erosive esophagitis and ulcers |
| Fewer long-term risks | Long-term: fracture, C. difficile, pneumonia, low B12 and magnesium |
The '-tidines' turn down the faucet. The '-prazoles' shut off the pump.
💉 Lactulose
Laxative; ammonia detoxicant (hyperosmotic), Lactose synthetic derivative
What it is for
Constipation; hepatic encephalopathy. Draws water into stool making it easier to pass.
How it works
Osmotic laxative; reduces ammonia absorption.
Watch for
Diarrhea, electrolyte imbalance.
Teaching
- Expect loose stools; maintain hydration; monitor mental status.
- Not to use as a laxative long term, to use as prescribed
- To dilute with water or fruit juice to counteract sweet taste
- To store in cool environment; not to freeze
🔗 Full card in the drug guide
💉 LorazepamHIGH ALERTBLACK BOX
Sedative, hypnotic; antianxiety, Benzodiazepine, short acting
What it is for
Anxiety; adjunct for nausea. Chemotherapy-induced nausea, vomiting
How it works
Benzodiazepine → enhances GABA.
Watch for
Sedation, dependence.
Teaching
- Avoid alcohol; do not stop abruptly; short-term use only.
- That product may be taken with food
- Not to take more than prescribed amount; may be habit forming
- To avoid OTC preparations (cough, cold, hay fever) unless approved by prescriber
Antidote / reversal: 1
🔗 Full card in the drug guide
💉 MetoclopramideBLACK BOX
Cholinergic, antiemetic, GI stimulant, Central dopamine receptor antagonist
What it is for
Nausea, gastroparesis. Nausea due to chemo vomiting, GERD, hyperemesis in pregnancy
How it works
Dopamine antagonist → increases GI motility. GI stimulant
Watch for
EPS, tardive dyskinesia.
Teaching
- Report involuntary movements; avoid long-term use.
- To avoid driving, other hazardous activities until stabilized on product
- To avoid alcohol, other CNS depressants that will enhance sedating properties of this product
🔗 Full card in the drug guide
💉 MisoprostolBLACK BOX
Gastric mucosa protectant, antiulcer, Prostaglandin E1 analog
What it is for
Prevent NSAID-induced ulcers. Protect from peptic ulcer disease
How it works
Prostaglandin analog → increases mucus, decreases gastric acids, stimulates uterus
Watch for
Diarrhea, abdominal pain.
Teaching
- Take with food; use contraception; avoid in pregnancy.
🔗 Full card in the drug guide
Omeprazole GERD. Is a Protein Pump Inhibitor⭐ HIGH YIELD
Omeprazole is a PROTON pump inhibitor (proton, not protein). It irreversibly blocks the H+/K+ ATPase pump in gastric parietal cells, the final common step of acid secretion. Used for GERD, erosive esophagitis, peptic ulcer disease, H. pylori regimens, and Zollinger-Ellison syndrome.
- Take 30 to 60 MINUTES BEFORE the first meal of the day. The pump has to be active for the drug to bind it.
- Swallow delayed-release capsules WHOLE. Do not crush or chew. Capsules may be opened onto applesauce only if the label allows.
- Full effect takes several days, so it is not an on-demand rescue for heartburn.
- Long-term risks: C. difficile infection, pneumonia, hip and spine fractures, hypomagnesemia, B12 and iron deficiency, and rebound acid hypersecretion if stopped abruptly. On the Beers list beyond 8 weeks without a clear indication.
- CYP2C19 inhibitor: it reduces activation of CLOPIDOGREL, so use pantoprazole instead when clopidogrel is needed. It also decreases absorption of drugs that need acid, such as ketoconazole, iron, and atazanavir.
'-prazole' means PUMP off. Take it BEFORE breakfast or you are wasting the dose.
💉 Ondansetron
Antiemetic, 5-HT3 antagonist
What it is for
Nausea/vomiting (chemo, postop).,
How it works
Prevents nausea, vomiting by blocking serotonin peripherally, centrally, and in the small intestine
Watch for
Headache, constipation, QT prolongation.
Teaching
- Report palpitations; monitor bowel habits.
- To report diarrhea, constipation, rash, changes in respirations, discomfort at insertion site, serotonin symptoms, EPS symptoms
- That headache requiring analgesic is common
- Drink with whole glass of water (PO)
🔗 Full card in the drug guide
💉 Orlistat
Weight-control agent, Lipase inhibitor
What it is for
Obesity.
How it works
Lipase inhibitor → reduces fat absorption.
Watch for
Oily stools, flatulence, vitamin deficiency. steatorrhea
Teaching
- Take with low-fat meals; supplement fat-soluble vitamins.
🔗 Full card in the drug guide
💉 Pancrelipase
Digestant, Pancreatic enzyme—bovine/porcine
What it is for
Pancreatic enzyme replacement. Cystic fibrosis
How it works
Aids digestion of fats, proteins, carbs.
Watch for
GI upset, hyperuricemia.
Teaching
- Take with meals; do not crush; monitor stools.
- To notify prescriber of allergic reactions, abdominal pain, cramping, or blood in urine
- To always take with food; not to crush, chew del rel product, caps
- To store at room temperature, away from moisture
🔗 Full card in the drug guide
💉 PhentermineHIGH ALERT
What it is for
Short-term obesity treatment.
How it works
Sympathomimetic → appetite suppressant.
Watch for
Insomnia, hypertension, tachycardia. palpitations
Teaching
- Take in morning; avoid caffeine; short-term use only.
🔗 Full card in the drug guide
Probiotics
Probiotics are live beneficial bacteria and yeasts (Lactobacillus, Bifidobacterium, Saccharomyces boulardii) taken to restore normal gut flora, most commonly to prevent or shorten antibiotic-associated diarrhea, and for irritable bowel symptoms.
- Separate from oral antibiotics by about 2 hours so the antibiotic does not kill the probiotic.
- CONTRAINDICATED or high risk in severely immunocompromised, critically ill, and central-line patients: risk of bacteremia or fungemia, especially with S. boulardii.
- Also use caution with short gut, damaged GI mucosa, and in premature infants.
- Common effects: gas, bloating, and mild cramping in the first few days.
- Refrigerate products that require it and check the CFU count and expiration. Supplements are not FDA-regulated for potency.
Probiotics rebuild the gut garden, but never plant live bugs in an immunocompromised patient.
Psyllium⭐ HIGH YIELD
Psyllium (Metamucil) is a BULK-FORMING LAXATIVE: soluble fiber that absorbs water, swells, and creates a soft bulky stool that stimulates peristalsis. Used for chronic constipation, IBS, diverticulosis, and to modestly lower LDL cholesterol.
- MUST be taken with a full 8 oz glass of water plus adequate fluids all day. Without fluid it can cause esophageal or intestinal OBSTRUCTION and impaction.
- Contraindicated in bowel obstruction, fecal impaction, dysphagia, and GI strictures or narrowing.
- Onset is 12 to 72 hours. This is the safest laxative for long-term use but useless for immediate relief.
- Separate from other oral medications by at least 2 hours. It binds and reduces absorption of digoxin, warfarin, salicylates, and carbamazepine.
- Start low and increase slowly to limit gas and bloating. It may lower blood glucose in diabetics.
Bulk-forming means fiber plus fluid. Fiber without water is a plug, not a laxative.
💉 Scopolamine
Cholinergic blocker, Belladonna alkaloid
What it is for
Motion sickness. Drying secretions in palliative clients
How it works
Anticholinergic → blocks muscarinic receptors.
Watch for
Dry mouth, blurred vision, urinary retention. Anticholinergic side effects
Teaching
- Apply patch behind ear; replace every 3 days; wash hands after handling.
🔗 Full card in the drug guide
💉 Senna
Laxative, Stimulant laxative
What it is for
Constipation.
How it works
Stimulant laxative → increases peristalsis.
Watch for
Cramping, electrolyte imbalance, dependency.
Teaching
- Short-term use only; report severe pain.
- Give at bedtime — it works in about 6 to 12 hours, so it acts in the morning.
- This is the laxative that goes WITH an opioid. Opioids slow the gut; a stool softener alone often is not enough.
- Not for daily long-term use. The bowel stops working on its own.
🔗 Full card in the drug guide
💉 Sucralfate
Protectant, antiulcer, Aluminum hydroxide, sulfated sucrose
What it is for
PUD.
How it works
Forms protective barrier over ulcer.
Watch for
Constipation.
Teaching
- Take on empty stomach; separate from other meds by 2 hrs.
- To take on empty stomach
- To take full course of therapy; not to use for >8 wk; to avoid smoking
- To avoid antacids, milk, alkaline water within 1 hr of this product
🔗 Full card in the drug guide
💉 Sulfasalazine
GI antiinflammatory, antirheumatic (DMARD), Sulfonamide
What it is for
Ulcerative colitis, rheumatoid arthritis.
How it works
Anti-inflammatory in colon.
Watch for
Nausea, rash, bone marrow suppression. SJS, GI upset, photosensitivity
Teaching
- Monitor CBC; take with food; report sore throat or fever.
- To take each oral dose with full glass of water to prevent crystalluria
- That contact lenses, urine, skin may be yellow-orange
- To avoid sunlight or use sunscreen to prevent burns
🔗 Full card in the drug guide
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Where this came from. Drug cards are pulled from your own drug guide, which was fact-checked against FDA labeling. The concept answers were written for this guide from your course textbook,
Pharmacology (WTCS, 2e), so they should match your lectures. Check anything that contradicts what your instructor said — they write the exam.