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Stack #1533256
Drugs for peptic ulcer disease
| Question | Answer |
|---|---|
| What does indirect stimuli activate? | CTZ (chemoreceptor trigger zone) which activates the vomit center |
| How does activation of CTZ occur? | 2 Ways: 1) signals from stomach and sm. intestine (along vagal afferents) 2) by the direct action of emetic compounds that are carried to CTZ in the blood |
| What are examples of Emetogenic compounds? | anticancer drugs, opioids, ipecac |
| What are serotonin receptor antagonists? | Most effective for suppressing nausea and vomit caused by Cisplatin and other anti- cancer drugs |
| What does Ondansertron (Zofran) block? | blocks 3 Serotonin receptors (5-HT3) in CTZ and neurons in the upper Gi tract |
| what are the side effects of (Zofran) Ondansertron? | CNS- headache GI- constipation/diarrhea NEURO- Dizziness |
| By what route is Ondansertron (Zofran) given? | IV or Oral -- rapid onset |
| If going home with an order for Zofran(Ondanstertron) what would be the route it is to be given in? | PO - every 2-3 hours PRN |
| What are the serotonin antagonists used for? | Chemotherapy, radiation, postoperative |
| what do Dopamine antagonists (Phenothiazides) block? | block dopamine receptors in the CTZ |
| what are dopamine receptors used for? | chemotherapy, postoperative, general |
| what are the aggressive factors of PUD | H-pylori, NSAIDS, Acid, Pepsin, Smoking |
| What are the defensive factors of PUD? | Mucus, Bi carbonate, blood flow, prostaglandins |
| What is the action of Metoclopramide (reglan) | Supresses emesis by blocking serotonin/dopamine and increases Gi motility by enhancing actions of acetylcholine |
| Why can't you take Cytotec (misoprostol) if you are pregnant? | pregnancy cat. X, used as an abortant to induce labor |
| what are the side effects of misoprostol (cytotec)? | Diarrhea, abdominal pain, dysmenorrhea |
| what is the action of Cytotec( misoprostol)? | vasodilates to promote blood flow, promotes secretion of bi carbonate which suppresses gastric acid |
| what is cytotec used for? | ulcers caused by long term use of NSAIDS |
| what decreases absorption of misoprostol (cytotec)? | antacids |
| what effects does cytotec (misoprostol) promote? | secretions if bi carbonate, mucus |
| what does cytotec suppress? | suppresses gastric acid secretions |
| what are direct acting stimuli? | cerebral cortex signals, sensory organ signals, vestibular apparatus (inner ear) |
| what are cerebral cortex signals? | anticipation and/or fear |
| vestibular apparatus signals | motion center, ear infection |
| sensory organ signals? | upsetting sights, bad odors, pain |
| what are antimetic drugs? | drugs that decrease nausea, reduce the urge to vomit |
| what are the receptors for emetic response? | serotonin, dopamine, glucocorticoids, histamine, muscarinic sholinergics, substance p, neurokinin |
| what do antacids do? | neutralize stomach acid |
| how is an antacid absorbed and eliminated? | absorbed through the GI tract and eliminated in the feces |
| what are the side effects of taking antacids? | constipation, diarrhea, they are sodium loading |
| because antacids are sodium loading, who cannot take them? | heart failure patients and renal failure patients |
| can antacids be taken in combination with other drugs? | yes, but absorption of some drugs can be reduced, so take them 2 hours apart |
| which antacid causes diarrhea? | milk of Mag |
| types of antacids? | sodium bicarbonate, milk of mag, calcium carbonate, aluminum hydroxide |
| when and how should you take antacids for them to be effective? | 7x/day, 1 hr before - 3 hrs after each meal and before bed |
| what do anti ulcer drugs do? | they destroy h-pylori, restore the balance between acid and pepsin and the GI mucosal defense |
| what are major causes of peptic ulcers? | h.pylori, NSAIDS, Zollinger--Ellison syndrome, smoking, 20-50% genetic |
| which causes of PUD cause Hypersecretion/ hypersecretory state which inpairs healing? | smoking, and Zollinger-Ellison syndrome |
| what is H pylori? | G- bacteria and a major cause of peptic ulcers and gastritis |
| What is the Proton pump? | an integral membrane protein that is capable of moving protons across a membrane, creates ATPase enzyme |
| what are PPI's used for | active suodenal ulcers, short term treatment of gastric ulcers, erosive esophagitis, symptomatic GERD, peptic ulccers in combo with antibiotics, Zollinger Ellison syndrome |
| what does the Proton pump inhibitors (PPI) inhibit? | inhibition of enzyme IRREVERSABLE, 5 -7 days until excreted |
| when do you give PPI's? | 30 minutes before meals, works immediately |
| where are PPI's metabolized? | by the liver |
| where are PPI's excreted? | in the urine, within 3-5 days |
| where are PPi's dissolved? | in the sm. intestines |
| how are PPI's chosen? | based on cost |
| can you crush or chew PPI's? | no |
| what is the length of therapy for Pantoprazole (protonix)? | 8 weeks |
| how are H2RA receptors metabolized? | metabolized by the liver and excreted in the urine |
| can Tagamet cross the blood brain barrier? | yes, confusion, hallucinations, excitation(in the elderly) |
| how do you treat with antimicrobial drugs? | use 2 antimicrobial drugs + a PPI for 14 days then use PPI for 6 more weeks to reduce acid |
| how are systemic antibiotics used? | indicated for destroying H pylori, and to reduce risk of duodenal ulcer |
| how do systemic antibiotics act on the body? | act by treating H pylori infection, usually combined with an H2 receptor antagonist or a PPI to decrease stomach acid and promote healing |
| how do systemic antibiotics circulate? | absorbed through GI tract and distributed widely and excreted in the urine |
| can you take protonix with food? | can be taken with or without food |
| what are the side effects of giving protonix? | diarrhea, headache, dizziness, pneumonia, abdominal discomfort, nausea |
| what are the side effects of giving protonix via the IV route? | abdominal discomfort and nausea |
| how long does it take for Prilosec to work? | short term - 4-8 weeks to heal but has long lasting effects |
| how much of the drug Prilosec reaches systemic circulation? | 50% |
| do all PPI's work the same way? | yes |
| what are the side effects of omeprazole? | pneumonia, hip fracture, osteoporosis, gastric tumor risk |
| how is omeprazole given? | given PO --DO NOT CRUSH/CHEW |
| what are the side effects of (tagamet)Cimetidine? | Gynecomastia (man boobs), confusion, headache, hallucinations, excitation, pneumonia, black tarry stools |
| how do you give (tagamet) Cimetidine? | PO/IV |
| what are the side effects of giving (Tagamet)cimetidine by IV route? | hypotension, dysrhythmias |
| when taking cimetidine (Tagamet)and warfarin together what are the side effects? | increased warfarin levels--nurse needs to monitor blood levels |
| what does cimetidine (Tagamet) inhibit? | histamine action |
| what decreases the absorption of Tagamet? | food and antacids decreases the absorption rate, GIVE 1 Hr. apart |
| how is Tagamet excreted and absorbed? | absorbed rapidly through the GI and excreted renal |
| what generation is Tagamet? (H2RA) | 1st generation - prototype |
| what drugs decrease the absorption of sucralfate? | cimetidine, digoxin, tetracycline, ranitidine, flouroquinolones |
| how does Carafate (sucralfate) protect the ulcer cite? | gravitates towards inflammation, forms a gel/paste to adhere to existing ulcer and protects it from further erosion |
| what are the side effects of Carafate (sucralfate)? | minor constipation, risk for aluminum toxicity |
| Carafate (sucralfate) impedes the absorption of? | Digoxin, warfarin, some antibiotics ---Give 2 Hrs apart |
| why should you not give Carafate to a patient with renal failure? | they could get aluminum toxicity (if receiving dialysis), low RBC formation, and low Iron absorption |
| what interferes with absorption of Carafate? | antacids, give 1 hr apart |
| can you give sucralfate with or without food? | need to take it on an empty stomach |
| how is Carafate absorbed? | minimally in the GI tract |
| how is Carafate excreted? | in the feces |
| what chemical does Carafate react with to form a paste? | hydrochloric acid to form a paste to adhere to mucosa/ulcers, promotes healing lasts for 6 hours |
Created by:
deeld
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