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GI Pharm
| Question | Answer |
|---|---|
| PUD is most often caused by | heliobacter pylori |
| PUD pathogenesis: | imbalance between mucosal defensive factors and aggressive factors |
| Aggressive factors of PUD: | H pylori, NSAIDs (inhibit prostaglandins), Acid, Pepsin (enzymes break down proteins), smoking |
| Prostaglandins have been shown to: | inhibit gastric secretion, stimulate bicarbonate secretion, and increase gastric blood volume. |
| Stomach and duodenum defensive factors: | mucus, bicarbonate, blood flow, prostaglandins |
| Drugs used to treat PUD/GERD: | antisecretory agents (H2 blockers, PPIs), mucosal protectants, antacids |
| Action of H2 blockers & PPIs: | suppress acid secretion |
| Action of mucosal protectants: | form protective layer over gastric mucosa |
| Action of antacids: | react with gastric acids to form neutral salts |
| H. pilori treated with: | antibiotics |
| Histamine 2 receptor antagonists end in: | dine |
| histamine H1: | produces symptoms of allergy |
| histamine H2: | promotes secretion of gastric acid |
| H2 receptor antagonist treatment of stomach & duodenal ulcers duration: | 6-8 weeks |
| H2 receptor antagonist treatment of esophagitis duration: | 12 weeks |
| H2 RA Cimetidine (Tagamet)pharmacokinetics: | absorption decreased by antacids and sulcralfate, inhibits hepatic metabolism of many other drugs, 1/2 life: 2 hrs., use cautiously in renal impairment. |
| H2 RA Cimetidine (Tagamet)pharmacokinetics adverse effects: | well-tolerated in usual doses; CNS: confusion & depression (more in elderly); CV: DYSRHYTHMIAS, GI: constipation, diarrhea, nausea; Endo: gynocomastia; Hemat: AGRANULOSIS, APLASTIC ANEMIA; inc. risk for infection |
| H2 RA Cimetidine (Tagamet)pharmacokinetics nursing considerations: | avoid admin. of antacids w/in 1 hr of, give sucrafate 2 hrs after, monitor for adverse effects, monitor renal function, check for drug-drug interactions |
| Proton pump inhibitors end in: | azole |
| PPI's action: | bind to gastric proton pump to prevent the release of gastric acid |
| PPIs effective at relieving s/s of esophagitis in: | 1-2 weeks |
| PPIs gastric ulcer treatment duration: | 4-6 weeks |
| omeprazole (Prilosec) Pharmacokinetics: | PPIs broken down by gastric acid, so enteric coated; 95% protein binding, distribution extensive, crosses placenta, secreted in breast milk; metabolized in liver, 1/2 life 30min-1hr, extended release formula (DO NOT CRUSH) |
| omeprazole (Prilosec) Pharmacodynamics: Adverse effects | well-tolerated usual doses/duration; CNS: dizziness, drowsiness; GI: <abdominal pain>, constipation, diarrhea, gas, nausea; increased risk of C diff; decreases effectiveness of anti-platelet med. Plavix (so stint doesn't get clogged) |
| H2 blockers & PPIs: Patient teaching: | stop smoking (decreases effectiveness), increase fluid and fiber intake to min. constipation, avoid alcohol, NSAIDs, and foods that increase GI irritation, report s/s GI bleeding, report confusion/hallucinations |
| Take antacids _ hr apart from cimetidine. | 1 |
| Mucosal protectant: sucralfate (Carafate) action: | creates protective barrier for gastric muscose against acid and pepsin, does not decrease acid secretion or neutralize acids |
| Mucosal protectant: sucralfate (Carafate) nursing considerations: | must have pH of at least 4, flush NG tube before and after! |
| Mucosal protectant: sucralfate (Carafate) Pharmacokinetics: | administer PO (tablet or oral suspension); admin. 1 hr ac and at bedtime, minimal systemic absorption, 90% excreted in feces |
| Mucosal protectant: sucralfate (Carafate) Pharmacodynamics: Adverse effects: | none serious, constipation most significant |
| Mucosal protectant: sucralfate (Carafate): Drug interactions: | minimal; antacids, H2 blockers, and PPIs may decrease effectiveness by raising pH; may decrease absorption of digoxin, warfarin, phenytoin, theophylline, and fleuroquinolone antibiotics – admin. at least 2 hrs. apart |
| Antacid: Aluminum hydroxide (AlternaGel, Rolaids) | Low acid neutralizing capacity; slow onset of action, longer duration, most commonly given w/Mg++ because can cause constipation; may decrease phosphate levels |
| Antacid: Magnesium hydroxide (Milk of Magnesia) | rapid acting, long duration; high acid neutralizing cap.; antacid of choice except in renal impairment, Mg++ toxicity can occur - CNS depression, monitor BUN/creatinine/Mg++; can cause diarrhea (usually combined w/aluminum to decrease) |
| Antacid: Calcium carbonate (Tums): | rapid acting, long duration; high ANC; can cause acid rebound; can cause constipation, belching, gas; monitor Ca++ levels; DO NOT TAKE IN CHRONIC RENAL FAILURE |
| Maalox and Mylanta are combinations of... | aluminum and magnesium |
| Dulcolax, Senokot, and Ex-lax are what type of laxatives? | stumulant |
| Milk of Magnesia, Fleet Phospho-Soda are what type of laxatives? | osmotic |
| Bismuth subsalicylate (Pepto Bismol) is used to treat... | diarrhea |
| Zofran (like methadone and erethromycin) does what? | elongates QT interval |
| Antiemetic: Serotonin Receptor Antagonist: | odenestron (Zofran)-side effects: <headache>, dizziness, diarrhea |
Created by:
aek
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