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GI Pharm

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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