1. Ondansetron Action: these block serotonin receptors in the central nervous system and gastrointestinal tract. As such, they can be used to treat post-operative and cytotoxic drug nausea & vomiting. Routes: Oral, IV, IM Dosage: 4 8 mg Side effects: Headache, constipation, and dizziness are the most commonly reported side effects associated with its use.

Anti-emetics

2.Domperidone Action: this blocks the action of dopamine. It has strong affinities for the dopamine receptors, which are found in the chemoreceptor trigger zone, located just outside the blood brain barrier, which - among others - regulates nausea and vomiting. Routes: Oral. Dosage: 10mg Side effects: Headache, dizziness, dry mouth, nervousness, flushing, or irritability

3.Metoclopramide Action: is a potent dopamine receptor antagonist used for its antiemetic properties. Thus it is primarily used to treat nausea and vomiting, and to facilitate gastric emptying in patients with gastroparesis. Routes: Oral, IV. Dosage: 10mg 20mg Side effects: restlessness, drowsiness, dizziness, lassitude, and or dystonic reactions.

NURSING INTERVENTIONS: Monitor vital signs. If vomiting is severe, dehydration may occur. Monitor for sign and symptoms of dehydration. Monitor bowel sounds for hypoactivity or hyperactivity. Provide mouth care after vomiting. Encourage the client to maintain oral hygiene. Administer medication by mouth as prescribed usually 30 minutes before meals and at bedtime.

Client Teaching: Instruct the client to store drug in tight, light resistant container. Instruct the client to avoid over-the-counter preparations. Instruct the client not to consume alcohol while taking antiemetics. Advise pregnant women to avoid antiemetics during the first trimester.

Common antacids: 1.Aluminium hydroxide (Amphojel, AlternaGEL) 2.Magnesium hydroxide (Phillips Milk of Magnesia) 3.Aluminum hydroxide with magnesium hydroxide (Maalox, Mylanta) 4.Calcium carbonate. Action Antacids perform a neutralization reaction, i.e. they buffer gastric acid, raising the pH to reduce acidity in the stomach. Routes: Oral.

Antacid

Side effects Carbonate: regular high doses may cause alkalosis, kidney stones. gastric distension. Aluminum hydroxide: hypophosphatemia and osteomalacia. constipation. Magnesium hydroxide: has laxative properties. Magnesium may accumulate in patients with renal failure leading to hypermagnesemia.

NURSING INTERVENTIONS: Avoid administering antacids with other oral drugs, because antacids can delay their absorption. An antacid should definitely not be given with tetracycline, digoxin or quinidine because it binds with and inactivates most of the drug. Antacids should be given 1-2 hours after other medications. Shake suspension well before administering; follow with water. Monitor electrolytes and urinary pH, calcium, and phosphate levels

Client teaching: Instruct the client to report pain, coughing, or vomiting of blood. Encourage the client to drink 2 oz of water after antacid to ensure that the drug reaches the stomach. Advise the client to take the antacid 1 to 3 hours after meals and at bedtime. Do not take antacid at mealtime; they slow gastric emptying time. Advise the client to notify the health care provider if constipation or diarrhea occurs.

Advise the client to avoid taking antacid with milk or foods high in Vitamin D Alert the client to consult with the health care provider before taking self prescribed antacids for a longer than 2 weeks. Laxatives (or purgatives) are foods, compounds, or drugs taken to induce bowel movements or to loosen the stool, most often taken to treat constipation 1.Bulk-producing agents

Laxatives (or purgatives) )

Site of Action: Small and large intestine Onset of Action: 12 - 72 hours Examples: psyllium husk (Metamucil), methylcellulose (Citrucel),, dietary fiber, apples Action: Bulking agents or roughage, these include dietary fiber. Bulk-producing agents cause the stool to be bulkier and to retain more water, as well as forming an emollient gel, making it easier for peristaltic action to move it along. They should be taken with plenty of water. Bulk-producing agents have the gentlest of effects among laxatives and can be taken just for maintaining regular bowel movements.

2.Stool softeners / Surfactants Site of Action: Small and large intestine Onset of Action: 12 - 72 hours Examples: docusate (Colace, Diocto) Action: These cause water and fats to penetrate the stool, making it easier to move along. Many of these quickly produce a tolerance effect and so become ineffective with prolonged use. They can be used for patients with occasional constipation or those with anorectal conditions for whom passage of a firm stool is painful.

3.Lubricants / Emollient Site of Action: Colon Onset of Action: 6 - 8 hours Action: These simply make the stool slippery, so that it slides through the intestine more easily. An example is mineral oil, which also retards colonic absorption of water, softening the stool. Mineral oil may decrease the absorption of fatsoluble vitamins and minerals. Side effects: nausea, vomiting, diarrhea, and abdominal cramping

4.Hydrating agents (osmotic) These cause the intestines to hold more water within, softening the stool. There are two principal types, saline and hyperosmotic. a) Saline Site of Action: Small and large intestine Onset of Action: 0.5 - 6 hours Examples: magnesium citrate, magnesium hydroxide (Milk of magnesia), magnesium sulfate (which is Epsom salt). Action: Saline laxatives attract and retain water in the intestinal lumen, increasing intraluminal pressure and thus softening the stool.

Side effects: drowsiness, weakness, paralysis, hypotension, flush and respiratory depression. b) Hyperosmotic agents Site of Action: Colon Onset of Action: 0.5 - 3 hours Examples: Glycerin suppositories, Sorbitol, Lactulose Action:Lactulose works by the osmotic effect, which retains water in the colon, lowering the pH and increasing colonic peristalsis.. Glycerin suppositories work mostly by hyperosmotic action, but also the sodium stearate in the preparation causes local irritation to the colon.

Side effects: nausea, vomiting, flatulence, diarrhea, abdominal cramps. 5.Stimulant / Irritant Site of Action: Colon Onset of Action: 6 - 10 hours- Dulcolax 2 - 6 hours-Castor oil (Small intestine) 15 min - 1 hour- Dulcolax suppository These stimulate peristaltic action and can be dangerous under certain circumstances. Long term use can lead to 'cathartic colon'. Stimulant laxatives act on the intestinal mucosa, or nerve plexus; they also alter water and electrolyte secretion.

They are the most severe among laxatives and should be used only in extreme conditions. Castor oil may be preferred when more complete evacuation is required. NURSING INTERVENTION: Monitor fluid intake and output. Note signs and symptoms of fluid and electrolyte imbalances that may result from watery stools. Habitual use of laxative can cause fluid volume deficit and electrolyte losses. In addition,it can cause a loss of urge to

Monitor bowel sounds. Identify the cause of constipation. Client teaching: Instruct the client to mix drug with water immediately before use. Instruct the client not to swallow the drug in dry form. Instruct the client to increase water intake, drink at least 8 glasses of fluids per day, if not contraindicated, which will decrease hard,dry stools.

Advise the client to avoid overuse of laxatives, which can lead to fluid and electrolyte imbalances and drug dependence. Instruct client not to chew tablets; swallow them whole. Advise the client to store suppositories at