Pharmacology (C-NCM106)
DRUG STUDY
DRUG NAME
a.) Metoclopramide
Generic Name: Metoclopramide
Brand Name: Metonia, Reglan
Appearance:
 Injection: 5mg/mL
 Oral Solutions: 5mg/mL
 Tablets: 5mg, 10mg
CLASSIFICATION MECHANISM OF ACTION
GI Stimulants/ Dopamine MOA: Stimulates motility of upper GI tract,
Antagonists increases lower esophageal sphincter
tone, and blocks dopamine receptors at
the chemoreceptor trigger zone
THERAPEUTICS
Indications:
To prevent or reduce:
 nausea and vomiting from
emetogenic cancer chemotherapy
 Postoperative nausea and
vomiting
 To facilitate small-bowel
intubation
 To aid in radiologic exam
 Delayed gastric emptying
secondary to diabetic
gastroparesis
 GERD
Contraindications:
 Patients hypersensitive to drug
and in those with
pheochromocytoma or other
catecholamine-releasing
paragangliomas, tardive
dyskinesia, or seizure disorders.
 Patients for whom stimulation of
GI motility might be dangerous
(with hemorrhage, obstruction,
or perforation)
EFFECTS
Side Effects: restless, drowsy, tired, lack
of energy, nausea, vomiting headache,
confusion, insomnia.
Adverse Effects: anxiety, drowsiness,
dystonic re actions, fatigue, lassitude,
restlessness, seizures, suicidal ideation,
akathisia, confusion, depression,
dizziness, extrapyramidal symptoms,
fever, hallucinations, headache, insomnia,
tardive dyskinesia, bradycardia,
supraventricular tachycardia,
hypotension, transient HTN, HF, bowel
disorders, diarrhea, nausea, incontinence,
urinary frequency, erectile dysfunction,
agranulocytosis, neutropenia, rash,
urticarial, loss of libido, prolactin
secretion, gynecomastia, amenorrhea.
NURSING CONSIDERATIONS
Assessment & Drug Effects:
 Monitor bowel sounds.
 Safety and effectiveness of drug
haven't been established for
therapy lasting longer than 12
weeks.
 Drug may cause tardive
dyskinesia, parkinsonian
symptoms, and motor rest-
lessness.
 Monitor patient for involuntary
movements of face, tongue, and
extremities, which may indicate
tardive dyskinesia or other
extrapyramidal adverse effects.
 Monitor patient for fever, CNS
symptoms, irregular pulse,
cardiac arrhythmias, or ab normal
BP, which may indicate NMS.
 Monitor patient for dizziness,
headache, or nervousness after
metoclopramide is stopped; these
may indicate withdrawal.
 Diphenhydramine or benztropine
may be used to counteract
extrapyramidal adverse effects
from high doses.
Patient & Family Education
 Instruct patient to take ODTs 30
minutes before food and at
bedtime and not to repeat dose if
inadvertently taken with food.
 Tell patient taking ODTs to open
blister pack with dry hands and
immediately place tablet on
tongue, let it melt completely, and
then swallow. (Taking it with
water isn't nec essary.) If tablet
breaks or crumbles, advise
patient to throw it away and take
a new tablet out of the blister
pack.
 Tell patient to avoid activities
that require alertness for 2 hours
after doses. Urge patient to report
persistent or serious adverse

DRUG NAME
b.) Loperamide
Generic Name: Loperamide
Brand Name: Imodium, Diatabs
Appearance:
 Capsule: 2mg
DRUG NAME
c.) Simethicone
Generic Name: Simethicone
Brand Name: Alka-seltzer, Anti-
Gas, Bicarsim Forte, Gas Aide,
Gas-X, Little Tummys, Mi-Acid
Gas Relief, Mylanta Gas
Maximum Strength, Mylicon,
Phazyme, SimePed
Appearance:
 Capsule: 125mg, 180mg,
250mg
CLASSIFFICATION MECHANISM OF ACTION
Antidiarrheal agents MOA: Loperamide acts by slowing
intestinal motility and by affecting water
and electrolyte movement through the
bowel. Loperamide inhibits peristaltic
activity by a direct effect on the circular
and longitudinal muscles of the intestinal
wall. It is a non-selective calcium channel
blocker and binds to opioid mu-receptors.
Evidence also suggests that at higher
concentrations it binds to calmodulin.
CLASSIFICATION MECHANISM OF ACTION
Miscellaneous GI Agents MOA: Simethicone is a surfactant that
decreases the surface tension of gas
bubbles in the gastrointestinal tract, more
easily allowing gas to exit the body.
THERAPEUTICS
Indications:
 For the control and symptomatic
relief of acute nonspecific
diarrhea and chronic diarrhea
associated with inflammatory
bowel disease.
 For reducing the volume of
discharge from ileostomies.
Contraindications:
 Patients with abdominal pain in
absence of diarrhea.
 Infants below 24 months old
 Patients with acute dysentery,
which is characterized by blood
in stools and high fever.
 Patients with acute ulcerative
colitis.
 Patients with bacterial
enterocolitis caused by invasive
organisms including Salmonella,
Shigella, and Campylobacter.
 Patients with
Pseudomembranous colitis
associated with the use of broad-
spectrum antibiotics.
THERAPEUTICS
Indications:
 To treat symptoms of too much
stomach acid such as stomach
upset, heartburn, and acid
indigestion.
 To relieve symptoms of extra gas
such as belching, bloating, and
feelings of pressure/discomfort in
the stomach or gut.
Contraindications:
 Patients with hypersensitivity to
EFFECTS
Side Effects: dizziness, drowsiness,
tiredness, constipation, skin rash, itching
Adverse Effects: severe constipation,
nausea, vomiting, abdominal pain,
uncomfortable fullness of stomach,
irregular heartbeat, severe dizziness,
fainting, rash, pruritus, urticaria,
angioedema, anaphylactic shock, dry
mouth, flatulence, dyspepsia, paralytic
ileus, megacolon, toxic megacolon,
urinary retention.
EFFERCTS
Side Effects: nausea, constipation,
diarrhea, headache.
Adverse Effects: dizziness, fainting,
black/tarry stools, slow/shallow
breathing, irregular heartbeat, mood
changes, deep sleep, pain with urination,
abdominal pain, rash, itching, swelling
(tongue, face, throat), severe dizziness.
reactions promptly.
 Teach patient signs and
symptoms of tar dive dyskinesia,
other extrapyramidal signs and
symptoms, and NMS.
 Advise patients to discontinue
drug and to seek immediate
medical attention if such signs
and symptoms occur.
 Advise patient not to drink
alcohol during therapy.
NURSING CONSIDERATION
 Patients should be advised to
check with their physician if their
diarrhea does not improve in 48
hours or if they note blood in
their stools, develop a fever or
develop abdominal distention.
 Tiredness, dizziness, or
drowsiness may occur in the
setting of diarrheal syndromes
treated with IMODIUM
(loperamide hcl). Therefore, it is
advisable to use caution when
driving a car or operating
machinery.
NURSING CONSIDERATIONS
 Assess patient for abdominal
pain, distention, and bowel
sounds prior to and periodically
throughout course of therapy.
Frequency of belching and
passage of flatus should also be
assessed.
 Explain to patient the importance
of diet and exercise in the
prevention of gas. Also explain
that this medication does not
prevent the formation of gas.
 simethicone or any component of
the inactive ingredients.
 Lactating patients
 Pregnant patients
 Patients with phenylketonuria
 Advise patient to notify health
care professional if symptoms are
persistent

 Tablet (Chewable):
125mg, 80mg


Oral
Liquid:

40mg/0.6mL

 Oral Suspension:
20mg/0.3mL

DRUG NAME CLASSIFICATION MECHANISM OF ACTION THERAPEUTICS EFFERCTS NURSING CONSIDERATIONS

c.) Esomeprazole
Generic Name: Esomeprazole
Brand Name: Nexium
Appearance:
 Capsules: 20mg, 40mg
 Tablets: 20mg
 Suspension: 2.5mg, 5mg,
10mg, 20mg, 40mg
 Injection: 20mg, 40mg
Antiulcer Drugs/ Proton Pump
Inhibitors
MOA: Esomeprazole exerts its stomach Indications:
acid-suppressing effects by preventing the  GERD; To heal erosive esophagitis
final step in gastric acid production by  Symptomatic GERD
covalently binding to sulfhydryl groups of  Erosive esophagitis due to acid
cysteines found on the (H+, K+)-ATPase mediated GERD
enzyme at the secretory surface of gastric  Shor-term treatment of GERD in
parietal cells. This effect leads to patients with history off erosive
inhibition of both basal and stimulated esophagitis who can’t take drug
gastric acid secretion, irrespective of the orally
stimulus. As the binding of esomeprazole  To reduce the risk of gastric
to the (H+, K+)-ATPase enzyme is ulcers in patients receiving
irreversible and new enzyme needs to be continuous NSAIDs therapy
expressed in order to resume acid  Long-term treatment of
secretion, esomeprazole's duration of pathologic hypersecretory
antisecretory effect that persists longer conditions
than 24 hours.  To eliminate Helicobacter Pylori
 Reduction of risk of rebleeding of
gastric or duodenal ulcers after
therapeutic endoscopy
Contraindications:
 Patients hypersensitive to drug or
components of esomeprazole or
omeprazole.
Side Effects: headache, flatulence,
indigestion, nausea, abdominal pain,
diarrhea, constipation, drowsiness,
itching, rash, nervousness.
Adverse Effects: headache, dizziness,
abdominal pain, constipation, diarrhea,
dry mouth, flatulence, nausea, vomiting,
pruritus, agranulocytosis, pancytopenia,
blurred vision, pancreatitis, stomatitis,
microscopic colitis, liver failure, hepatitis,
anaphylactic shock, GI candidiasis,
hypomagnesemia, muscular weakness,
muscle pain, bone fracture, hepatic
encephalopathy, taste disturbance,
aggression, agitation, depression,
hallucination, intestinal nephritis,
bronchospasm, hair loss, erythema
multifome, hyperhidrosis,
photosensitivity, toxic epidermal
necroysis
Patient & Family Education
Assessment & Drug Effects:
 Antacids can be used while taking
drug, unless otherwise directed
by prescriber.
 Monitor patient for rash or signs
and symptoms of
hypersensitivity.
 Monitor GI symptoms for
improvement or worsening.
Monitor LFTs, especially in
patients with preexisting hepatic
disease.
 Prolonged use may cause low
magnesium levels that require
magnesium supplementation and
possibly discontinuation of drug.
 Monitor magnesium level before
treatment and periodically during
treatment.
 Monitor patient for signs and
symptoms of low magnesium
level, such as abnormal HR or
heart rhythm, palpitations,
muscle de spasms, tremor, and
seizures. In children, abnormal
HR may present as fatigue, upset
stomach, dizziness, and light-
headedness.
 May increase risk of CDAD.
Evaluate for CDAD in patients
who develop diarrhea that
doesn't improve.
 Prolonged treatment (at least 3
years or more) may lead to
vitamin B12 malabsorption and
subsequent vitamin B12
deficiency, which is dose-related
and more severe in women and
those younger than age 30;
prevalence decreases after
discontinuation of therapy.
 Instruct patient to take drug
exactly as 17 prescribed.
 Tell patient to take drug at least 1
hour before a meal.
 Advice patient that antacids can
be used f while taking drug unless
otherwise directed by prescriber.
 Warn patient not to chew or
crush drugs pellets because this
inactivates the drug.
  Tell patient who has difficulty
swallowing capsule to mix
contents of capsule with 10
tablespoon of soft applesauce and
swallow immediately.
 Advice patient to store capsules
at room temperature in a tight
container.
 Tell patient to inform prescriber
of worsening signs and
symptoms, pain, or diarrhea that
doesn't improve.
 Instruct patient to alert
prescriber if rash or other signs
and symptoms of allergy occur.
 Warn patient to immediately
report symptoms of low
magnesium level, such as
involuntary muscle movements
or seizures.

DRUG NAME CLASSIFICATION MECHANISM OF ACTION THERAPEUTICS EFFERCTS NURSING CONSIDERATIONS

c.) Sucralfate GI Agents MOA: Sucralfate exerts its action locally
Generic Name: Sucralfate rather than systemically and its effect on
Brand Name: Carafate gastric acid is negligible with a low acid-
Appearance: neutralizing capacity (14—16 mEq/dose).
 Tablet: 1g Sucralfate reacts with hydrochloric acid in
the stomach to form an adherent, paste-
like substance capable of acting as an acid
buffer. Subsequently, sucralfate adheres
electrostatically to proteins on the surface
of an ulcer, such as albumin and
fibrinogen, forming insoluble, stable
complexes. These ulcer-bound complexes
act as a protective barrier at the ulcer site,
which facilitates recovery by shielding the
ulcer from the ulcerogenic properties of
pepsin, acid, and bile. Sucralfate
 Oral Suspension: predominantly binds to damaged GI
1g/10mL mucosa, although binding to normal
mucosa occurs to a minimal extent. This
agent also inhibits back-diffusion of
hydrogen ions, and adsorbs both pepsin
and bile acids. In vivo, recommended
doses of sucralfate inhibit pepsin activity
in gastric juice by 32%. Recent data
indicate that production of prostaglandin
E2 and gastric mucus may be increased.
Sucralfate also absorbs bile salts in vitro.
Indications:
Treatment of:
 Duodenal Ulcer
 Dyspepsia
 Epithelial wounds
 Chemotherapy-induced mucositis
 Radiation proctitis
Prevention of:
 Ulceration
 Stress ulcer prophylaxis in
ventilated patiens
 Behcet Disease
Contraindications:
 Patients with hypersensitivity to
sucralfate or any ingredients
contained in the drug.
 Patients with end-stage renal
disease
 Patients with uncontrolled
diabetes mellitus with
hyperglycemia
 Patients with impaired
swallowing or gag reflex
Side Effects: back pain, constipation,
diarrhea, dizziness, drowsiness,
insomnia, vertigo, abdominal pain, upset
stomach,
Adverse Effects: diarrhea, dizziness, dry
mouth, flatulence, headache, indigestion,
insomnia, nausea, vertigo, vomiting,
bezoars formation, GI discomfort, hives,
rash, itching, difficulty of breathing or
swallowing, swelling (face, throat,
tongue, lips), angioedema, aluminum
toxicity
Encourage the patient to:
 Tell the doctor and pharmacist if
you are allergic to sucralfate, any
other medications, or any of the
ingredients in sucralfate tablets
or liquid. Ask your pharmacist for
a list of the ingredients.
 Tell the doctor and pharmacist
what other prescription and
nonprescription medications,
vitamins, nutritional
supplements, and herbal products
you are taking or plan to take. Be
sure to mention anticoagulants
('blood thinners') such as
warfarin (Coumadin); cimetidine
(Tagamet); cinoxacin (Cinobac);
ciprofloxacin (Cipro); digoxin
(Lanoxin); enoxacin (Penetrex);
ketoconazole (Nizoral);
levofloxacin (Levaquin);
levothyroxine (Levothroid,
Levoxyl, Synthroid); lomefloxacin
(Maxaquin); nalidixic acid
(NegGram); norfloxacin
(Noroxin); ofloxacin (Floxin);
phenytoin (Dilantin, Phenytek);
quinidine; ranitidine (Zantac);
sparfloxacin (Zagam);
tetracycline; and theophylline
(Theo-24) If the patient is taking
 any of these medicines, take them
at least 2 hours before taking
sucralfate. The assigned doctor
also may need to change the
doses of the patient’s medications
or monitor you carefully for side
effects.
 Tell the patient who’s taking
antacids, to take them at least 30
minutes before or after sucralfate.


REFERENCES:
https://www.rxlist.com/imodium-drug.htm#side_effects
https://go.drugbank.com/drugs/DB00836
https://go.drugbank.com/drugs/DB09512https://www.webmd.com/drugs/2/drug-56526/antacid-simethicone-oral/details
https://www.webmd.com/drugs/2/drug-56526/antacid-simethicone-oral/details#:~:text=This%20medication%20can%20cause%20nausea,become%20severe%2C%20notify%20your%20doctor.
https://www.pdr.net/drug-summary/Gas-X-simethicone-2675
https://www.coursehero.com/file/23036643/Simethicone/
https://www.rxlist.com/consumer_esomeprazole_nexium/drugs-condition.htm
https://www.medicinenet.com/esomeprazole/article.htm#what_brand_names_are_available_for_esomeprazole4
https://www.mims.com/philippines/drug/info/sucralfate?mtype=generic
https://pubchem.ncbi.nlm.nih.gov/compound/Sucralfate#section=Mechanism-of-Action
https://www.rxlist.com/consumer_sucralfate__carafate/drugs-condition.htm
https://medlineplus.gov/druginfo/meds/a681049.html
https://www.ncbi.nlm.nih.gov/books/NBK551527/