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drugs for digestion
pharm final
| Question | Answer |
|---|---|
| 3 cells that produce acid in the stomach | chief cells, parietal cells, mucoid cells |
| How do chief cells produce stomach acid? | produce pepsionogen which converts to pepsin (protein) |
| What do parietal cells have | proton pumps and H2 (histamine) receptors |
| How much HCl is produced daily | 1 to 3 liters |
| pH of stomach | 2.5 to 3.5 |
| what happens to the production of stomach acid when the individual is anxious? | stomach produces more acid |
| 4 functions of parietal cells | breaks food; activates pepsinogen; kills microbes; secretes intrinsic factor |
| What is intrinsic factor necessary for? | B12 production |
| What do mucoid cells produce | thick mucous lining around stomach and bicarbonate |
| Health alterations in GI system | GERD, heartburn, belching, esophogitis |
| Age most affected by GERD | infants and over 40 years old; obesity |
| Life style changes to prevent GERD | elevating HOB; avoiding fatty or acidic foods; smaller meals at least 3 hours before sleep; eliminating tobacco and alcohol |
| What physiologic dysfunction causes GERD? | cardiac sphincter is loose and acid gets up into esophagus |
| What is one cause of asthma in adults | GERD; acid comes up; goes into lungs; coughing occurs |
| define peptic ulcer disease | erosion of GI mucosa |
| risk factors for peptic ulcer disease | smoking; caffine; family history; stress; drugs; H. pylori |
| drugs that can cause peptic ulcer disease | glucocorticoids, NSAIDs, aspirin |
| symptoms of peptic ulcer disease | gnawing or burning, upper abdominal pain, worse when stomach is empty (eating helps stomach pain) |
| why do NSAIDs cause peptic ulcer disease | destroy mucous membrane in stomach |
| How does H. pylori survive in stomach | has protective surrounding mucous that prevents stomach acid from damaging bacteria; then implants into stomach lining |
| relation of vagus nerve and acid production | vagus nerve helps produce more acid |
| What bacteria causes 85% of peptic ulcers | H. pylori |
| What does CLOtest detect? | determines if H. pylori is present |
| goals of pharmacotherapy for GI problems | relief, promote healing, prevent future occurrence |
| 3 drugs for GI problems | antacids; H2 receptor antagonists; proton pump inhibitor |
| Antacid dynamics | neutralize stomach acid |
| 4 minerals seen in antacids | magnesium; aluminum; calcium carbonate; bicarbonate |
| antacid prototype | aluminum hydroxide (Amphojel); calcium carbonate (Tums); magnesium hydroxide (MOM) sodium bicarbonate (Alka-Seltzer) |
| aluminum hydroxide (amphojel) | antacid |
| aluminum hydroxide (amphojel) side effect | constipation |
| calcium carbonate (tums) | antacid |
| calcium carbonate (Tums) side effect | constipation |
| magnesium hydroxide (MOM) | antacid |
| magnesium hydroxide (MOM) side effects | diarrhea |
| sodium bicarbonate (Alka-Seltzer) | antacid |
| sodium bicarbonate (Alka-Seltzer) side effects | metabolic alkalosis, hypernatremia, abdominal distention |
| Best choice of antacid | calcium carbonate (Tums) = naturally occurring |
| What is a very strong antacid | sodium bicarbonate (Alka-Seltzer) |
| calcium carbonate with magnesium hydroxide (Mylanta, Rolaids) | combination antacid |
| magnesium with aluminum (Maalox) | combination antacid |
| magnesium, aluminum, simethicone (Mylanta, Maalox Plus) | combination antacid |
| Calcium, magnesium plus famotidine (pepcid complete) | combination antacid |
| Clacium carbonate with magnesium hydroxide (Mylanta, Rolaids) side effects | hypercalcemia, renal calculi, metabolic alkalosis, constipation |
| Magnesium with aluminum (Maalox) side effect | hypermagnesemia |
| magnesium, aluminum, simethicone (Mylanta, Maalox Plus) side effects | hypermagnesemia |
| What OTC medication is simethicone in? | gas reliever Beno; gas-ex |
| Kinetics of antacids | po |
| When do antacids start working | 10-15 minutes |
| How long do antacids last | 2 hours |
| Nursing education for antacids | liquid better than tablet; don't give with milk or other medications |
| What nursing intervention should be performed when administering antacids in NG tube | check patency and flush tube (interacts with other medications) |
| Excessive use of antacids can cause | systemic problems, rebound acidity; phosphate depletion (osteoporosis) |
| use caution with antacids with what disorders | kidney, heart failure |
| common ending for H2 receptor antagonist | "tidines" |
| H2 receptor antagonist dynamics | occupy histamine 2 receptors; prevents acid secretion |
| H2 receptor antagonist prototype | ranitidine HCl (Zantac) |
| ranitidine Hcl (Zantac) | H2 receptor antagonist |
| H2 receptor antagonist kinetics | IV, po at bedtime |
| H2 receptor antagonist therapeutic uses | prevent or healing of ulcers |
| Side effects of H2 receptor antagonist cimetadine (Tagamet) | confusion, drowsiness, headache in elderly, fatigue, gynecomastia |
| Nursing education for H2 receptor antagonist | do not take with antacids, report any blood in stool |
| Why are H2 receptor antagonist not given with antacids | if taken together, one will undo the other |
| Long term use of H2 receptor antagonist causes what? | anemia; B12 and iron deficiency |
| Tongue condition seen with anemia | red tongue; atrophic glossitis |
| what chemicals in body contribute to proton pump | acetylcholine, gastrin, histamine |
| common ending for proton pump inhibitors | "prazole" |
| PPI dynamics | reduce acidity by binding histamine, potassium + ATPase (proton pump enzyme) |
| PPI prototype | emeprazole (Prilosec); pantoprazole (protonix) |
| emeprazole (prilosec) | PPI |
| pantoprazole (protonix) | PPI |
| Therapeutic uses for PPIs | erosive esophatitis, short term for ulcer, GERD |
| How long should PPIs be used | no more than 3 months |
| kinetics of PPI | po, prior to eating |
| CNS side effects of PPI | increase dizziness |
| GI side effects of PPI | diarrhea, abdominal pain, nausea, vomiting |
| Integumentary side effects of PPI | rash = urticaria |
| Side effects from long term use of PPI | increased gastric cacner; infections (pneumonia in elderly) c. diff infections |
| nursing education for PPI | give before meals; do not crush/break; avoid smoking/alcohol/spicy foods; eat food with probiotics (yogurt) |
| why do PPIs predispose patients to infections | acid in stomach kills of bacteria on food = PPI block acid production = cause infection |
| cytoprotective agent dynamics | coat ulcer surfaces (acid shield); protects ulcer when eating so stomach acid does not pour into ulcer |
| cytoprotective agent prototype | sucralfate (Carafate) |
| sucralfate (Carafate) | cytoprotective agent |
| therapeutic usage for cytoprotective agents | peptic ulcer disease |
| Kinetics for cytoprotective agents | po with water; before meals/bedtime; up to 6 hours |
| When should antacids be given if taken with cytoprotective agents | 30 minutes before cytoprotective agents or 1 hour after cytoprotective agents |
| misoprostol (Cytotec) | cytoprotective agent; can cause miscarriages or cervix to dilate |
| misoprostol (cytotec) dynamics | synthetic prostaglandin E1 to suppress gastric acid and heal gastric ulcers |
| misoprostol (cytotec) kinetics | po with or after meals |
| physiological conditions contributing to nausea/vomiting | infection; pain; anesthetic; migraine; trauma; inner ear; motion sickness; diabetes; pregnancy; food poisoning; drugs; chemotherapy |
| psychological conditions contributing to nausea/vomiting | nervousness, stress, unpleasant smells |
| selection of antiemetics depends on... | cause and severity of nausea and vomiting |
| herbal antiemetic | peppermint, ginger |
| anticholinergic: Antihistamine antiemetic therapeutics | motion sickness; nausea |
| anticholinergic: antihistamine prototype | diphenhydramine (Benadryl); Scopolamine (Transderm) |
| diphenhydramine (Benadryl) | anticholinergic: antihistamine |
| scopolamine (Transderm) | anticholinergic: antihistamine |
| side effects of anticholinergic: antihistamine | drowsiness, dry mouth |
| phenothiazine dynamics | blocking brain dopamine receptors, inhibit signal to vomiting center |
| phenothiazine prototype | prochlorperazine (compazine); promethazine (Phenergan) |
| prochlorperazine (comazine) | phenothiazine |
| promethazine (Phenergan) | phenothiazine |
| Kinetics of phenothiazine | po, rectal suppository |
| side effects of phenothiazine | dry eyes, dry mouth, drowsiness, constipation |
| SSRIs therapeutic uses | vomiting related to surgery, radiation therapy or chemotherapy |
| SSRIs prototype | ondansetron (Zofran) |
| benefit of ondansetron (Zofran) | does not cause drowiness |
| neurokinin receptor antagonist | antiemetic (po) |
| cannabinoid | antiemetic (product of marijuana) |
| aprepitant (Emed) | neurokinin receptor antagonist |
| Dronabinol (marinol) | cannabinoids |
| glucocorticoids | antiemetic |
| dexamethasone (Decadron) | clucocorticoids |
| benzodiazepine | antiemetic |
| lorazepam (Ativan) | benzodiazepine (IV) |
| when are patients given dronabinol (Marinol) | nausea/vomiting related to HIV or chemotherapy |
| nursing interventions for antiemetics | change position slowly; avoid driving or hazardous tasks |
| Client safety/nursing education for antiemetics | drowsiness (risk for fall); report vomiting of blood or severe abdominal pain; |
| nonpharmacological ways to reduce nausea | ice chips, cool cloth around neck |
| is constipation a disease or symptom | symptoms |
| causes of constipation | lack of exercise, dietary fiber, fluids, medications, foods, health problems, aging |
| medications causing constipation | opiods, anticholinergic, antihistamine, antacids, iron |
| foods causing constipation | white flour, dairy products, chocolate, bananas |
| health problems causing constipation | hypothyroidism, diabetes, irritable bowel |
| why does aging cause constipation | slower transit time |
| rationale for using Laxatives | prophylactic for surgery; prevent straining; cathartic |
| another name for straining | valsalva maneuver |
| effects of straining on body | increases BP, abdominal pressure, intraoccular pressure, intracranial pressure |
| define cathartic | cleanse bowel prior to procedures |
| dynamics of bulk forming laxatives | absorb water to fecal mass |
| Therapeutic uses for bulk forming laxatives | first choice for prevention and treatment of constipation |
| bulk forming laxative prototypes | psyllium mucilloid (Metamucil); methycellulose (Citrucil) |
| psyllium mucilloid (Metamucil) | bulk forming laxative |
| methycellulose (Citrucil) | bulk forming laxative |
| side effects of bulk forming laxatives | cramping |
| teaching for bulk forming laxatives | take with 1-2 glasses water; may take 24-48 hours to work |
| stool softeners/surfactant dynamics | more water and fat absorbed in stool |
| therapeutic uses for stool softeners/surfactant | persons at risk for constipation |
| stool softener/surfactant prototype | docusate (Colace) |
| docusate (Colace) | stool softener/ surfactant |
| side effects of stool softener/ surfactant | abdominal cramping, diarrhea |
| Caution for Colace | don't give colace to person on sodium restriction or abdominal pain |
| stimulant dynamics | irritate the bowel to increase peristalsis |
| stimulant prototype | bisacodyl (Dulcolax) |
| side effects of stimulants | abdominal cramping, fluid and electrolyte loss, laxative dependency if taken frequently |
| bisacodyl (Dulcolax) | stimulant |
| Educaiton for stimulants | enteric coating: no dairy products or coating will break down - gastric irritation |
| dynamics of saline/osmotic | not absorbed, pull water into fecal mass |
| saline/osmotic prototype | sodium biphosphate (Fleet enema); polyethylene glycol (Miralax) |
| sodium biphosphate (Fleet enema) | saline/osmotic |
| polyethylene glycol (Miralax) | saline/osmotic |
| isotonic prototype | polyethylene glycol (PEG) and electrolytes (GoLytely) powder mixture |
| polyethylene glycol (PEG) and electrolytes (GoLytely) powder mixture | isotonic |
| therapeutic uses for isotonics | bowel cleansing before colonoscopy |
| preparation for isotonic powder mixture | reconstitution (4 liters - 1 glass every 10 minutes) refirgerate |
| When does isotonic powder mixture start working | within 1 hour of starting |
| Diarrhea a disease or symptoms | symptom |
| Causes of diarrhea | infections, toxins and pathogens, medications |
| medications causing diarrhea | antibiotics, lactose |
| diarrhea contributes to what | fluid and electrolyte loss |
| Natural therapy for diarrhea | lactobacillus acidophilus (probiotic bacterium) |
| ABC diet for diarrhea | apples, banana, carrot (contain pectin) |
| BRAT diet for diarrhea | bananas, rice, applesauce, tea (toast) older diet |
| antidiarrheal: opioid dynamics | slow peristalsis |
| antidiarrheal: opioid prototype | codeine, diphenoxylate with atropine (Lomotil) |
| codeine | antidiarrheal: opioid |
| diphenoxylate with atropine (Lomotil) | antidiarrheal: opioid |
| OTC antidiarrheal: opioids | ioperamide (Imodium) - analogue of meperidine (demerol) |
| Schedule V antidiarrheal: opioid | diphenoxylate with atropine (Lomotil) |
| side effects of antidiarrheal: opioid | drowsiness, dry mouth, constipation, paralytic ileus |
| dynamics of bismuth salt (Pepto-Bismol) | bind and absorbs toxins |
| nursing education for diarrhea/constipation | monitor for electrolyte imbalance, fever, record frequncy of stools, presence of blood, ice or hard candy for dry mouth, avoid colas (high sugar), stop medicaiton when diarrhea stopped |
| Why should you avoid colas (high sugar) with diarrhea | contributes to more diarrhea |
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