 PPI Medications take about 2 weeks to become effective, Pt maybe given and antacid 

in the meantime for the effects to become evident.

 H2 antagonists when taken with antacids will become INACTIVATED!

 Renal failure Pt that need to be on an antacid benefit from taking something like 

(tums, Maalox smoothies) because these antacids are composed of calcium carbonate 

which renal failure Pt typically need extra calcium. 

 To the contrary renal failure Pt must AVOID at all cost aluminum and magnesiumbased antacids such as (Gelusil, Mylanta, Gaviscon, Maalox advanced versions)

 Metoclopramide and ondansetron will NOT be given to Pt who have Parkinson’s 

because it can increase EPS symptoms. 

 Beware of laxative abuse! Elderly patients have less frequent bowl movements and 

look for electrolyte imbalances (Na, K, Ca)

 Renal failure patients or dialysis Pt NEVER get a fleet enema because they contain 

phosphate which is harmful to the kidneys.

 Do NOT give laxatives if an obstruction is suspected. Listen to bowl quadrants to 

detect the lack of bowl sounds.

 While treating diarrhea with something like an opioid, this is going to enhance other 

medication effects by reducing the rate at which they leave the body. Like 

(barbiturates, alcohol, opioids and sedatives) 

 Take note of the anti-diarrheal Lomotil (diphenoxylate / atropine) atropine is an 

anticholinergic and must NOT be given to Pt with glaucoma. 

 A key point to remember in regards to the liver is that if the liver is damaged or 

compromised in anyway. It is going to impact the metabolization of other 

medications. Possibly increasing their active life in the body which then puts Pt at 

risk of harm from the inability for the medications to be metabolized correctly.

 TEST QUESTION – in regards to the liver and signs and symptoms of liver failure. It

is typically jaundice or elevated liver enzymes from a lab report. 

 PPI usage can cause osteoporosis 

 PPI usage longer than 7-14 should be consulted with your MD.

 PPI suffix “azole”

 H2 black suffix “itidine”

 Promethazine (antihistamine) (nausea and vomiting) may cause EPS, hypotension, 

CNS depression and is an anticholinergic. 

 K ions are followed by magnesium and phosphorus. Which in turn causes calcium 

loss. So renal Pt need to have increased calcium and they need to avoid ingesting food

or medications that will increase their potassium levels.

 Anti-emetics have anticholinergic effects 

 Pancreatitis – EVERYTHING MUST BE NPO! Pt will be in extreme pain, even the 

smell of food can cause the production and release of digestive enzymes from the 

pancreas.

 More often than not a PPI is used for GERDS and a H2 is used for an ulcer. 

 PPI before your first meal and on an empty stomach.