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Hydrochloric Acid [HCl] secreted by parietal cells maintains stomach pH at 1 to 4 stimulants to secretion: large, fatty meals excessive amounts of ETOH emotional stress
Antacids Pharmacodynamics Agents used to reduce gastric hyperacidity large group Rx & OTC drugs
Antacids Pharmacotherapeutics Gastritis; indigestion; PUD; Reflux Esophagitis; phosphate binder in chronic renal failure (CRF)
Drug Interactions Antacids Tetracyclines; quinidine; flecanide; amphetamine Slows absorption of most oral medications
Nursing Implications Antacids Take medications 1 hour after meals Avoid taking antacids for 2 hours when taking other medications Monitor for adverse effects Reinforce need to alter life-styles to avoid/reduce hyperacidity; avoid spicy, greasy foods, alcohol Limit intake of ASA,
Antiflatulents drugs used to relief painful symptoms associated with gas gas in GIT results from: diverticulitis, dyspepsia, peptic ulcers, postoperative gaseous distention, spastic or irritable colon; paralytic ileus Major agent: simethicone
nti-Ulcer Agents Axid Pepcid Tagam
H-2 Antagonists histamine type 2 receptor [H-2] antagonist prototypical acid secretory antagonists reduce not abolish acid secretion one of most frequently Rx’d drugs efficacy & safety profile four FDA-approved: cimetidine [Tagamet] / famotidine [Pepcid] nizatidi
Pharmacotherapeutics: H-2 Antagonists proven effective: PUD = gastric & duodenal ulcer gastroesophageal reflux dz [GERD] upper GI bleed [GIB] may be effective: stress ulcers peptic esophagitis prevention & mgt allergic conditions
Adverse Effects: H-2 Antagonists overall low < 3% Specific: CNS: lethargy, confusion, depression, & hallucinations ENDO: impotence, increased prolactin, & gynecomastia HEME: thrombocytopenia
PPI omeprazole Prilosec lansoprazole Prevacid
Proton Pump Inhibitors General Description: omeprazole = first lansoprazole = newest [1995] Pharmacodynamics final common step in acid production energy needed to pump out H+ ions a.k.a. “Proton Pump”
Pharmacotherapeutics Proton Pump Inhibitors GERD unresponsive to conventional tx Erosive esophagitis endoscopically proven Zollinger-Ellison syndrome [ZE] PUD recurrent [Helicobacter pilori]
Adverse Effects & Drug Interactions Proton Pump Inhibitors Proton Pump Inhibitors similar to those of the H-2 antagonists low & uncommon
Other Drugs sucralfate Carafate & misoprostol Cytotec
Nursing Implications sucralfate Carafate & misoprostol Cytotec Teach patient best time to take meds: AC & HS Do not stop taking meds abruptly Avoid alcohol and other CNS depressants Avoid taking meds with antacids Monitor for drug interactions and adverse effects Reinforce alteration in life-styles t
Diarrhea defined as abnormal frequent passage of loose stools acute diarrhea sudden in onset in a previously healthy person lasts 3 to 14 days self-limiting resolves without sequelae chronic diarrhea lasts 3 to 4 weeks recurring diarrhea, fever, loss of
Antidirrheal Agents Description: Act systemically or locally to slow down or inhibit intestinal peristalsis Pharmacodynamics slows down the effects of the mesenteric plexus of the intestines inhibits intestinal peristalsis decreases expulsive contractions
Pharmacodynamics Anticholinergics decrease muscle tone of GIT& decrease Peristalsis
Pharmacodynamics Absorbents coat walls of GIT absorbing bacteria or toxins causing diarrhea and passing them out with stool
Pharmacodynamics Intestinal Flora Modifiers bacterial cultures Lactobacillus natural bacterial flora supplies missing bacteria suppresses growth of diarrhea causing bacteria
Pharmacodynamics Opiates decrease motility of bowel reduce pain assoc w/ rectal spasms decrease transit time / permit longer absorptive surface of bowel contact of intestinal contents with
Prototype: Specific Agents Adsorbents bismuth subsalicylate [Pepto-Bismol] attapulgite [Kaopectate] Anticholinergics belladonna alkaloids [Donnatal] Intestinal Flora Modifiers Lactobacillus acidophilus [Lactinex] Opiates (tincture of…) diphenoxylate & atropine [Lomotil]
Adverse Effects bismuth subsalicylate ncreased bleeding time constipation & dark stools hearing loss & tinnitus blue gums & black tongue
Adverse Effects anticholinergics urinary retention, hesitancy, & impotence HA dizziness, confusion, anxiety, & drowsiness dry skin, rash, and flushing blurred vision, photophobia, & inc. IOP
Adverse Effects opiates drowsiness, sedation, and lethargy n/v/anorexia and constipation respiratory depression urinary retention, flushing, rash, and urticaria
Nursing Implications Antidirrheal Agents Monitor closely for adverse effects and drug interactions Do not administer opium preparations to patients with conditions that contraindicate its use Teach patient/family that diarrhea is a symptom that should last only 48 hours. If it persists longe
Antiemetics Pharmacotherapeutics Indicated to relieve nausea and vomiting. All agents work at some site along the vomiting pathway leading to the vomiting center located within the brain.
Antiemetics Major Drug Groups Antihistamines Phenothiazines Anticholinergics Serotonin Blockers Prokinetic
Antiemetics Pharmacokinetics Absorbed well throughout the body Metabolized by the liver Excreted by the kidneys
Antiemetics Pharmacodynamics Motion sickness Vertigo Post-op nausea / vomiting Chemotherapy antiemetic
Antiemetics Prototypes: Specific Agents Antihistamines promethazine (Phenergan) Phenothiazines prochlorperazine (Compazine) Serotonin Blockers ondansetron (Zofran) Prokinetic metoclopramide (Reglan)
Antiemetics Additional Agents benzquinamide HcL (Emete-Con) scopolomine (Trans-Derm) ganisetron (Kytril) droperinol (Inapsine) dimenhydrinate (Dramamine)
Antiemetics Adverse Effects Antihistamine / Phenothiazines CNS reactions Anticholinergic effects Hypersensitivity reactions Blood dyscrasias Hypotension, tachycardia, orthostatic hypotension syncope and dizziness
Antiemetics Nursing Implications changes in V.S; LOC administered ½hr - 3hrs prior to chemotherapy for therapeutic effect monitor safety when taking antiemetics as they can cause changes in perception Administer antihistamine antiemetics with food or milk to minimize nausea
Emetics Pharmacodynamics Designed to stimulate the vomiting center in the medulla of the brain
Emetics Prototype: Specific Agents Ipecac syrup (Orally) High doses can lead to dysrythmias; overdose may lead to heart failure or death Apomorphine HcL (SQ) Used when ipecac is ineffective Activated charcoal (Orally) For use when caustic substances have been ingested
Emetics Nursing Implications 1 Do not administer emetics if patient has ingested lye or caustic substances Do not administer to semi-conscious patients or patient with loss of gag reflex; seizures If necessary, repeat initial dose in 30 minutes
Emetics Nursing Implications 2 Administer water or clear liquid following ipecac syrup to aid in absorption If caustic agent has been ingested, administer activated charcoal to neutralize agent prior to vomiting
Created by: d4w751
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