Gastrointestinal

  • Esomeprazole
  • Famotidine
  • Glucagon
  • Metoclopramide
  • Ondansetron

Esomeprazole

  • Mechanism of Action: Proton pump inhibitor; suppresses secretion of gastric acid
  • Indications: Upper GI bleed (given prior to endoscopy), GERD, peptic ulcer disease
  • Contraindications
  • Dosage: 80 mg IV bolus for acute GI bleed; 20-40 mg PO daily for GERD/PUD
  • Onset: Less than 1 hour
  • Duration: Peak concentrations within 1-4 hours
  • Adverse Reactions: Headache, diarrhea, nausea, constipation
  • Special Considerations: None
Video Credit: Drug Talk

*Deep Dive: Esomeprazole (Drugs.com)



Famotidine

  • Mechanism of Action: Histamine-2 antagonist;  
  • Indications: GERD, PUD
  • Contraindications: Allergy to drug/class; Use caution in renal impairment
  • Dosage: Generally 20 mg BID x 2-4 weeks (depending on disease/severity)
  • Onset: Less than 1 hour
  • Duration: Peaked effect at 1-3 hours; duration is 10-12 hours
  • Adverse Reactions
  • Special Considerations: May sometimes be given for allergic reactions to provide additional relief of hives.
Video Credit: NURSINGcom

*Deep Dive: Famotidine (Drugs.com)



Glucagon

  • Mechanism of Action: Anti-hypoglycemic agent; increases plasma glucose levels by initiating degradation of hepatic stores of glycogen into glucose.
  • Indications: Severe hypoglycemia, beta-blocker/calcium-channel blocker overdose.
  • Contraindications: Allergy to drug/class, pheochromocytoma, insulinoma
  • Dosage: For hypoglycemia: 1 mg IV/SQ/IM. For beta-blocker/Ca channel blocker toxicity: 3-10 mg IV loading dose followed by 1-10mg/hour IV continuous infusion.
  • Onset: Immediate
  • Duration: 60-90 minutes (IV); unknown for IM/SQ
  • Adverse Reactions: Hypotension, nausea/vomiting, hypokalemia
  • Special Considerations: Requires glycogen stores in the liver in order to work for hypoglycemia.
Video Credit: Lights Sirens Action EMS

*Deep Dive: Glucagon (Pubmed)



Metoclopramide

  • Mechanism of Action: Antiemetic; dopamine antagonist. Also stimulates upper GI tract motility.
  • Indications: Vomiting prevention/treatment, treatment of chronic GI motility disorders (diabetic gastroparesis)
  • Contraindications: Allergy to drug/class, pheochromocytoma, seizure disorder, GI bleeding/obstruction
  • Dosage: 10 mg IV q 6 hours prn
  • Onset: 1-3 minutes (IV)
  • Duration: 1-2 hours
  • Adverse Reactions: Extrapyramidal symptoms, dystonia, parkinsonism, drowsiness, fatigue
  • Special Considerations: None
Video Credit: Eric Christianson

*Deep dive: Rate of Metoclopramide Infusion Affects the Severity and Incidence of Akathisia (Emergency Medicine Journal)



Ondansetron

  • Mechanism of Action: Antiemetic; antagonizes serotonin 5-HTC receptors to reduce nausea
  • Indications: Nausea/vomiting
  • Contraindications: Allergy to drug, sertontine syndrome, long QT syndrome
  • Dosage: 4-8 mg q4-6 hours. Max 24 mg/day
  • Onset: 30 minutes
  • Duration: Half life of approximately 3-7 hours
  • Adverse Reactions: QT prolongation, bronchospasm, headache, fatigue
  • Special Considerations: Tends to be more effective if given prior to vomiting
Video Credit: Lights Sirens Action EMS

*Deep Dive: Antiemetic Use for Nausea and Vomiting in Adult Emergency Department Patients: A Randomized Controlled Trial Comparing Ondansetron, Metoclopramide, and Placebo (Annals of Emergency Medicine)


Brandon Simpson, PA-C
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