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Stack #1533256

Drugs for peptic ulcer disease

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