Gastrointestinal


Esomeprazole

Rapid Review

  • 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

Pearls

Video Credit: Drug Talk


Famotidine

Rapid Review

  • 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.

Pearls

Video Credit: NURSINGcom


Glucagon

Rapid Review

  • 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.

Pearls

Deep Dive

Video Credit: Lights Sirens Action EMS


Metoclopramide

Rapid Review

  • 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

Pearls

Video Credit: Eric Christianson


Octreotide

Rapid Review

  • Mechanism of Action: Octapeptide; mimics endogenous somatostatin to promote vascular smooth muscle contraction. Decreases splanchnic blood flow and inhibits gastrin, growth hormone, serotonin, and vasoactive intestinal peptide.
  • Indications: Bleeding esophageal varices, sulfonylurea overdose
  • Contraindications: Hypersensitivity, insulinoma
  • Dosage:
    • Variceal bleeding: 50 mcg IV bolus, followed by 50 mcg/hr infusion
    • Sulfonylurea toxicity: 50 mcg SQ q 6 hours prn
  • Half-life: 1.7 hours (IV)
  • Adverse Reactions: Bradycardia, arrhythmias, pancreatitis, nausea/vomiting

Pearls

Video Credit: Pharmacy Joe


Ondansetron

Rapid Review

  • 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

Pearls

Video Credit: Lights Sirens Action EMS

Brandon Simpson, PA-C
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  • Blog - 25 Feb 2021