Gastrointestinal

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

Deep Dive

• Esomeprazole (Drugs.com)

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

Deep Dive

• Famotidine (Drugs.com)

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

• Glucagon (Pubmed)

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

Deep Dive

• Rate of Metoclopramide Infusion Affects the Severity and Incidence of Akathisia (Emergency Medicine Journal)

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

Deep Dive

• Octreotide (PubMed)

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

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)