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Chap. - 16


antacids, drugs to treat ulcers, antispasmodics, management of IBD, antidiarrheal agent, antiflatulents, laxatives/cathartics, & antiemetics categories of GI drugs based on action
act by partially neutralizing gastric hydrochloric acid & available in many OTC preparations for relief of indigestion, heartburn, & sour stomach antacids
antacids are also prescribed to help relieve pain & promote __ of gastric & duodenal ulcers healing
drug that reduces gastric acid secretion, or that acts to prevent/treat gastric or duodenal ulcers antiulcer agents
antacids may contain aluminum, __ __, or magnesium either individually or in combination calcium carbonate
is not recommended alone because of flatulence, metabolic alkalosis, & electrolyte imbalance w/prolonged use sodium bicarbonate
__ carbonate (Tums) may cause constipation calcium
__ alone can cause diarrhea magnesium
__ alone is constipating aluminum
combination antacids are frequently used to control the frequency & __ of bowel movements consistency
Maalox, Gelusil, Mylanta are examples of combination antacids
choice of specific antacids preparation depends on palatability, cost, adverse effects, __ __ __, sodium content, & patient's renal & cardiovascular function acid neutralizing capacity
side effects of frequent use of antacids with aluminum or calcium carbonate is constipation
side effects of frequent use of antacids can include __ __ & renal complications urinary calculi
__ is a side effect of frequent use of antacids w/aluminum osteoporosis
side effects of use of antacids with calcium carbonate & sodium bicarbonate include belching & flatulence
for patient's w/CHF, renal pathology/history of renal calculi, cirrhosis of liver or edema the use of antacids is contraindicated
antacids can cause dehydration or electrolyte imbalance
antacids used w/administration of other drugs, used concurrently, can alter effectiveness of other drugs
antacids should not be taken within 2 hours of most other drugs
antacids may __ __ of the drugs: tetracyclines, quinolones, isoniazid, & other anti-infectives; digoxin, indomethacin & iron; salicylates & thyroid hormones decrease effectiveness
antacids taken with diazepam will increase sedation
antacids taken with amphetamines & quinidine will increase cardiac irregularities
antacids taken with enteric-coated drugs may cause the medications to be released __ __ in the stomach prematurely
enteric-coated drugs should be taken in __ __ from antacids by two hours separate dose
patients taking meds in management of __ __ __ should be instructed regarding avoidance of constrictive clothing, treatment of obesity, avoiding recumbency after meals, & elevating head of the bed esophageal reflex disease
name of antacid w/calcium Tums
name of antacid w/magnesium Milk of Magnesia
name of antacid w/aluminum Amphojel
name of antacid w/combination of both magnesium & aluminum Maalox
H2 blockers reduce gastric acid secretion by acting as __ blockers histamine2
cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac) are all H2 blockers
H2 blockers are used __ for relief of acid indigestion and heartburn, GERD, & upper GI bleeding/esophagitis short-term
can include diarrhea, dizziness, rash, & headache side effects from H2 blockers
in patient's taking Tagamet there is an infrequent occurrence of __ __, which is reversible mild gynecomastia
H2 blocker side effects can include __ __ in older/debilitated adults, although rarely w/Pepcid mental confusion
in adults >50yrs: reduction of gastric juices w/anti-ulcers agents, on a regular basis for extended periods, can deplete __ __, which is necessary for B12 absorption intrinsic factor
can possibly lead to pernicious anemia, confusion, disorientation, & numbness of extremities; so a supplement may be required B12 deficiency
H2 blockers are __ for patients with impaired renal function, liver dysfunction, children or pregnant/nursing contraindicated
Tagamet & high doses of Zantac may cause __ __ __ in patients already taking Coumarin anticoagulants increased blood concentrations
Tagamet may cause increased blood concentrations in patients already taking phenytoin, propranolol, diazepam, lidocaine, & tricyclic antidepressants
Tagamet & high doses of Zantac may cause increased blood concentrations in patients already taking theophylline
antacids may interfere with absorption of __ & __; separate administration by at least one hour Tagamet & Zantac
H2 blocker with less drug interactions Pepcid
synthetic analog of prostaglandin E1; inhibits gastric acid secretion & protects mucosa from irritant effect of certain drugs (such as NSAIDs), especially in older adults & those w/history of gastric ulcers misoprostol (Cytotec)
misoprostol (Cytotec) in not FDA-approved for treatment of gastric/duodenal ulcers
diarrhea, nausea, & abdominal pain may occur early in treatment w/misoprostol (Cytotec) & is usually __; can be taken with food to minimize side effect self-limiting
begin misoprostol (Cytotec) therapy on 2nd-3rd day of next normal menstrual period in order to attempt prevention of menstrual irregularities
misoprostol (Cytotec) can cause __ __, possibly incomplete, w/potentially dangerous uterine bleeding, maternal, or fetal death spontaneous abortion
for women of child bearing age, pregnant woman, & children under 21yr misoprostol (Cytotec) is contraindicated
misoprostol (Cytotec) taken w/ antacids can decrease rate of absorption
antacids taken w/misoprostol (Cytotec) should be given at least 2h away & should not be a __ __, which exacerbates diarrhea magnesium type
gastric antisecretory agent; proton pump inhibitor (PPI); used for short-term(4-8wk) relief of GERD, confirmed gastric/duodenal ulcer, & erosive esophagitis & "heartburn" omeprazole (Prilosec)
omeprazole (Prilosec) is __ to the H2-receptor antagonists unrelated
lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix), & esomeprazole (Nexium) all belong to the category of proton pump inhibitors (PPIs)
H2-blockers will decrease __ effectiveness PPIs
will delay absorption of most PPIs sucralfate
diazepam, phenytoin, & warfarin will __ __ levels in patients taking PPIs increase serum
ampicillin, ketoconazole, & iron results in poor __ of PPIs bioavailability
Nexium, Prevacid, & Prilosec should be given on a(n) empty stomach
Aciphex & Protonix can be given __ __ to meals without regard
PPIs in SR form can be opened & sprinkled over applesauce or yogurt, given w/fruit juices & swallowed immediately, but should not be chewed, broken, or crushed
antiulcer agent that inhibits pepsin; therapuetic effects are from local rather than systemic activity sucralfate (Carafate)
sucralfate (Carafate) should be taken on empty stomach because reacts w/ __ __ in stomach to form paste that adheres to mucosa hydrochloric acid
side effects from sucralfate (Carafate) are __, but may include constipation occasionally rare
sucralfate (Carafate) can alter __ so other drugs should be given after 2h of administration absorption
antacids may decrease __ __ of sucralfate (Carafate), separate administration times by 30 minutes mucosal binding
patients w/ recurrent/refractory peptic ulcer disease, w/failure to heal w/in 12 weeks or w/frequent recurrences unrelated to NSAIDs may suffer from infection w/ Helicobacter pylori
Helicobacter pylori infections have been treated successfully w/ __ __ over 14 days multi-drug (3) regimens
Helicobacter pylori treatment containing amoxicillin w/clarithromycin & lansoprazole (Prevacid) Prevpac
Helicobacter pylori treatment containing tetracycline w/metronidazole & bismuth salicylate Helidac pack
Helidac pack contains antibacterial & antiprotozoal w/an antiemetic
Prevpac contains antibiotics & PPI
four pills in each __ of Helidac dose
Helidac: two pink tablets __ __ should be chewed and swallowed bismuth subsalicylate
Helidac: white tablet (metronidazole) and the orange and white capsule (tetracycline) should be swallowed whole
Helidac: Be sure to drink at least 8 ounces of fluid with each dose—and especially at bedtime—to prevent irritation
consists of all four Helidac pills which are taken 4 times each day for 14 days one dose
Helidac regimen should include an __ __ such as cimetidine, famotidine, or ranitidine acid blocker
Prevpac packet consists of a __ __ which should be taken 10-14 days daily dose
each Prevpac packet contains the __ & __ doses of this medication morning & evening
PREVPAC pink and black capsule Prevacid
PREVPAC yellow tablet clarithromycin
PREVPAC two capsules of same coloring amoxicillin
each PREVPAC dose should be taken twice per day before eating
PREVPAC pills __ __ swallowed whole must be
have chemical structures similar to those of aspirin & exhibit anti-inflammatory activity in the GI tract; used in management of Crohn's & ulcerative colitis mesalamine (Asacol, Rowasa) & sulfasalazine (Azulfidine)
mesalamine (Asacol, Rowasa) & sulfasalazine (Azulfidine) are __ designed to reach ileum & colon, bypassing stomach & upper intestines salicylates
mesalamine (Asacol, Rowasa) & sulfasalazine (Azulfidine) are safe for __ use and well tolerated in most patients long-term
intolerance to sulfasalazine can be minimized by taking the __ product enteric-coated
sulfasalazine can cause anaphylaxis or asthma attacks in those allergic to sulfonamides
caution: those allergic to __ for Rowasa enema sulfites
sulfasalazine should be administered with __ for those with hepatic impairment caution
sulfasalazine interactions w/warfarin increase risk of hemorrhage
sulfasalazine interactions w/methotrexate increase bone marrow suppression
sulfasalazine interactions w/cyclosporin will cause decreased efficacy
sulfasalazine interactions w/oral diabetic agents can lead to hypoglycemia
used to treat moderate-severe forms of IBD in patients who a inadequately controlled w/salicylates glucocorticoids
prednisone, prednisolone, & hydrocortisone enemas are glucocorticoids used to treat moderate-severe IBD
oral glucocorticoids do not require direct contact w/__ __ __ to be effective inflamed intestinal tissue
act in various ways to reduce number of loose stools antidiarrhea agents
act as adsorbents & protectants to achieve a drying effect kaolin & pectin preparations
kaolin & pectin preparation Kapectolin
transient __ is a side effect of kaolin & pectin preparations constipation
kaolin & pectin preparations can cause impaired absorption is taken with Digoxin
kaolin & pectin preparations are contraindicated for infants & older adults, as well as those with bowel obstruction
laxative works on intestinal wall increasing amount of fluid & electrolytes within intestinal lumen & causes release of prostaglandins, increasing peristalsis stimulant laxatives
laxative helps water & lipids combine w/stool resulting in softer fecal mass stool softeners
laxative coats surface of stool & intestine w/film, decreasing water reabsorption, allowing stool to pass through intestine emollients
laxative combines w/water in intestine to forms emollient gel/viscous solution resulting in peristalsis bulk-forming laxative
laxative combines w/water in intestine to forms emollient gel/viscous solution resulting in peristalsis bisacodyl (Dulcolax)
laxative coats surface of stool & intestine w/film, decreasing water reabsorption, allowing stool to pass through intestine mineral oil (Kondremul, Fleet)
laxative helps water & lipids combine w/stool resulting in softer fecal mass docusate sodium (Colace, Dialose, Surfak)
laxative combines w/water in intestine to forms emollient gel/viscous solution resulting in peristalsis psyllium (Metamucil, Konsyl-D, Fiberall, etc.)