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NURS 572 Ch 77
Pharm Ch 77 Peptic Ulcer Disease
| Question | Answer |
|---|---|
| peptic ulcers are degrees of erosion of the gut wall the occur here | mostly duodenum, and stomach --> bleeding/perforation |
| what causes peptic ulcers | imbalance between mucosal defenses and opposing aggressive factors |
| name 5 aggressive factors | *H. pylori *NSAIDs *acid *pepsin *smoking |
| Name mediator of defensive factor and 3 processes it manages for defensive factors | prostaglandin activation mediates mucous, bicarbonate and blood flow (all defensive factors) |
| name classes of anti-ulcer drugs | *antacids *antisecretory *mucousal protectants *Pg enhancement of mucosal defenses *antibiotics |
| Two types of antisecretory agents | *H2 Blockers *PPIs |
| bacteria that is 2nd most common infection in world --> peptic ulcer disease | H. pylori |
| Antisecretory H2 blockers MOA | blocks histamine from binding H2 -->cAMP 2nd messenger --> thereby blocking proton pump |
| another name for proton pump | H+/K+/ATPase pump (H+ to lumen, K+ exchanged into parietal cell) |
| 5 H2RA (H2 blocking) drugs | *cimetidine *ranitidine *famotidine *nizatidine |
| which drug is shortest acting with most SEs/interactions in H2 blocking class | cimetidine, which is Rx/OTC ---oral/inj |
| pharmokinetics of cimetidine | hepatic CYP450 interactions, partially excreted in renal impaired (reduce dose in RF pts) |
| ADRs of cimetidine | *endocrine - adrogeneric/estrogenic actions *CNS - confusion, hallucinations, depression- all more likely in elderly, renal impaired |
| do ranitidine, famotidine or nizatidine have endocrine or CNS SEs | not, they are well tolerated, few interactions |
| cimetidine class | H2 blocker - shortest acting - most interactions |
| ranitidine class | H2 blocker - also available IV |
| famotidine class | H2 blocker - longest acting |
| nizatidine class | H2 blocker - similar to ranitidine |
| are H2 blocker drugs available OTC as well | yes, this class available OTC |
| PPI = proton pump inhibitor (antisecretory)MOA | this ACID LABILE class must be enterically coated so it can survive stomach acid before being released into bloodstream in duodenum where it travels through vasculature to directly inhibit PP |
| name 5 PPIs in class | *omeptrazole *lansoprazole *patoprazole *rabeprazole *esomeprazole |
| ADRs of PPIs | HA, A, N, D, V *carcinogenic potential ONLY seen in animals |
| which 2 PPIs are available OTC | *omeprazole, lansoprazole |
| unusual feature about PPI half life | this class has short half-life that is unrelated to duration of action |
| omeprazole class | PPI - oral only - rx/otc |
| lansoprazole class | PPI - oral/IV - rx/otc |
| patoprazole class | PPI - oral/IV |
| rabeprazole class | PPI like others in class |
| esomeprazole class | PPI - isomer of omeprazole |
| MOA of mucosal protectant drug | non-antisecretory - forms topical protective layer that lasts 6 hours (QID admin) |
| ADRs of mucosal protctant drug sucralfate | *constipation very common *Al+++ component --> drug interactions |
| name of mucosal protectant drug | sucralfate (carafate) |
| drug class that enhances action of mucosal protectants | prostaglindins - non-antisecretory, act by increasing action of protective mechanisms |
| misoprostol class | enhance mucousal protectant class |
| misoprostol indicated for | prevention of NSAID induced gastric ulcer, as well as other applications from other chapters |
| misoprostol MOA | exerts all protective effets that endogenous Pgs do for mucosal protection (+mucous, +bicarb, +blood flow). not-antisecretory |
| serious ADR misoprostol | ABORTIFACIENT contraindicated in pregnancy |
Created by:
lorrelaws
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