pharm final
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| 3 cells that produce acid in the stomach | chief cells, parietal cells, mucoid cells
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| How do chief cells produce stomach acid? | produce pepsionogen which converts to pepsin (protein)
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| What do parietal cells have | proton pumps and H2 (histamine) receptors
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| How much HCl is produced daily | 1 to 3 liters
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| pH of stomach | 2.5 to 3.5
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| what happens to the production of stomach acid when the individual is anxious? | stomach produces more acid
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| 4 functions of parietal cells | breaks food; activates pepsinogen; kills microbes; secretes intrinsic factor
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| What is intrinsic factor necessary for? | B12 production
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| What do mucoid cells produce | thick mucous lining around stomach and bicarbonate
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| Health alterations in GI system | GERD, heartburn, belching, esophogitis
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| Age most affected by GERD | infants and over 40 years old; obesity
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| Life style changes to prevent GERD | elevating HOB; avoiding fatty or acidic foods; smaller meals at least 3 hours before sleep; eliminating tobacco and alcohol
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| What physiologic dysfunction causes GERD? | cardiac sphincter is loose and acid gets up into esophagus
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| What is one cause of asthma in adults | GERD; acid comes up; goes into lungs; coughing occurs
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| define peptic ulcer disease | erosion of GI mucosa
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| risk factors for peptic ulcer disease | smoking; caffine; family history; stress; drugs; H. pylori
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| drugs that can cause peptic ulcer disease | glucocorticoids, NSAIDs, aspirin
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| symptoms of peptic ulcer disease | gnawing or burning, upper abdominal pain, worse when stomach is empty (eating helps stomach pain)
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| why do NSAIDs cause peptic ulcer disease | destroy mucous membrane in stomach
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| How does H. pylori survive in stomach | has protective surrounding mucous that prevents stomach acid from damaging bacteria; then implants into stomach lining
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| relation of vagus nerve and acid production | vagus nerve helps produce more acid
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| What bacteria causes 85% of peptic ulcers | H. pylori
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| What does CLOtest detect? | determines if H. pylori is present
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| goals of pharmacotherapy for GI problems | relief, promote healing, prevent future occurrence
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| 3 drugs for GI problems | antacids; H2 receptor antagonists; proton pump inhibitor
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| Antacid dynamics | neutralize stomach acid
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| 4 minerals seen in antacids | magnesium; aluminum; calcium carbonate; bicarbonate
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| antacid prototype | aluminum hydroxide (Amphojel); calcium carbonate (Tums); magnesium hydroxide (MOM) sodium bicarbonate (Alka-Seltzer)
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| aluminum hydroxide (amphojel) | antacid
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| aluminum hydroxide (amphojel) side effect | constipation
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| calcium carbonate (tums) | antacid
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| calcium carbonate (Tums) side effect | constipation
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| magnesium hydroxide (MOM) | antacid
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| magnesium hydroxide (MOM) side effects | diarrhea
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| sodium bicarbonate (Alka-Seltzer) | antacid
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| sodium bicarbonate (Alka-Seltzer) side effects | metabolic alkalosis, hypernatremia, abdominal distention
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| Best choice of antacid | calcium carbonate (Tums) = naturally occurring
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| What is a very strong antacid | sodium bicarbonate (Alka-Seltzer)
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| calcium carbonate with magnesium hydroxide (Mylanta, Rolaids) | combination antacid
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| magnesium with aluminum (Maalox) | combination antacid
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| magnesium, aluminum, simethicone (Mylanta, Maalox Plus) | combination antacid
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| Calcium, magnesium plus famotidine (pepcid complete) | combination antacid
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| Clacium carbonate with magnesium hydroxide (Mylanta, Rolaids) side effects | hypercalcemia, renal calculi, metabolic alkalosis, constipation
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| Magnesium with aluminum (Maalox) side effect | hypermagnesemia
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| magnesium, aluminum, simethicone (Mylanta, Maalox Plus) side effects | hypermagnesemia
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| What OTC medication is simethicone in? | gas reliever Beno; gas-ex
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| Kinetics of antacids | po
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| When do antacids start working | 10-15 minutes
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| How long do antacids last | 2 hours
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| Nursing education for antacids | liquid better than tablet; don't give with milk or other medications
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| What nursing intervention should be performed when administering antacids in NG tube | check patency and flush tube (interacts with other medications)
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| Excessive use of antacids can cause | systemic problems, rebound acidity; phosphate depletion (osteoporosis)
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| use caution with antacids with what disorders | kidney, heart failure
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| common ending for H2 receptor antagonist | "tidines"
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| H2 receptor antagonist dynamics | occupy histamine 2 receptors; prevents acid secretion
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| H2 receptor antagonist prototype | ranitidine HCl (Zantac)
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| ranitidine Hcl (Zantac) | H2 receptor antagonist
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| H2 receptor antagonist kinetics | IV, po at bedtime
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| H2 receptor antagonist therapeutic uses | prevent or healing of ulcers
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| Side effects of H2 receptor antagonist cimetadine (Tagamet) | confusion, drowsiness, headache in elderly, fatigue, gynecomastia
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| Nursing education for H2 receptor antagonist | do not take with antacids, report any blood in stool
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| Why are H2 receptor antagonist not given with antacids | if taken together, one will undo the other
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| Long term use of H2 receptor antagonist causes what? | anemia; B12 and iron deficiency
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| Tongue condition seen with anemia | red tongue; atrophic glossitis
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| what chemicals in body contribute to proton pump | acetylcholine, gastrin, histamine
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| common ending for proton pump inhibitors | "prazole"
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| PPI dynamics | reduce acidity by binding histamine, potassium + ATPase (proton pump enzyme)
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| PPI prototype | emeprazole (Prilosec); pantoprazole (protonix)
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| emeprazole (prilosec) | PPI
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| pantoprazole (protonix) | PPI
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| Therapeutic uses for PPIs | erosive esophatitis, short term for ulcer, GERD
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| How long should PPIs be used | no more than 3 months
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| kinetics of PPI | po, prior to eating
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| CNS side effects of PPI | increase dizziness
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| GI side effects of PPI | diarrhea, abdominal pain, nausea, vomiting
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| Integumentary side effects of PPI | rash = urticaria
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| Side effects from long term use of PPI | increased gastric cacner; infections (pneumonia in elderly) c. diff infections
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| nursing education for PPI | give before meals; do not crush/break; avoid smoking/alcohol/spicy foods; eat food with probiotics (yogurt)
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| why do PPIs predispose patients to infections | acid in stomach kills of bacteria on food = PPI block acid production = cause infection
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| cytoprotective agent dynamics | coat ulcer surfaces (acid shield); protects ulcer when eating so stomach acid does not pour into ulcer
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| cytoprotective agent prototype | sucralfate (Carafate)
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| sucralfate (Carafate) | cytoprotective agent
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| therapeutic usage for cytoprotective agents | peptic ulcer disease
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| Kinetics for cytoprotective agents | po with water; before meals/bedtime; up to 6 hours
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| When should antacids be given if taken with cytoprotective agents | 30 minutes before cytoprotective agents or 1 hour after cytoprotective agents
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| misoprostol (Cytotec) | cytoprotective agent; can cause miscarriages or cervix to dilate
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| misoprostol (cytotec) dynamics | synthetic prostaglandin E1 to suppress gastric acid and heal gastric ulcers
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| misoprostol (cytotec) kinetics | po with or after meals
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| physiological conditions contributing to nausea/vomiting | infection; pain; anesthetic; migraine; trauma; inner ear; motion sickness; diabetes; pregnancy; food poisoning; drugs; chemotherapy
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| psychological conditions contributing to nausea/vomiting | nervousness, stress, unpleasant smells
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| selection of antiemetics depends on... | cause and severity of nausea and vomiting
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| herbal antiemetic | peppermint, ginger
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| anticholinergic: Antihistamine antiemetic therapeutics | motion sickness; nausea
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| anticholinergic: antihistamine prototype | diphenhydramine (Benadryl); Scopolamine (Transderm)
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| diphenhydramine (Benadryl) | anticholinergic: antihistamine
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| scopolamine (Transderm) | anticholinergic: antihistamine
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| side effects of anticholinergic: antihistamine | drowsiness, dry mouth
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| phenothiazine dynamics | blocking brain dopamine receptors, inhibit signal to vomiting center
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| phenothiazine prototype | prochlorperazine (compazine); promethazine (Phenergan)
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| prochlorperazine (comazine) | phenothiazine
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| promethazine (Phenergan) | phenothiazine
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| Kinetics of phenothiazine | po, rectal suppository
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| side effects of phenothiazine | dry eyes, dry mouth, drowsiness, constipation
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| SSRIs therapeutic uses | vomiting related to surgery, radiation therapy or chemotherapy
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| SSRIs prototype | ondansetron (Zofran)
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| benefit of ondansetron (Zofran) | does not cause drowiness
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| neurokinin receptor antagonist | antiemetic (po)
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| cannabinoid | antiemetic (product of marijuana)
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| aprepitant (Emed) | neurokinin receptor antagonist
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| Dronabinol (marinol) | cannabinoids
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| glucocorticoids | antiemetic
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| dexamethasone (Decadron) | clucocorticoids
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| benzodiazepine | antiemetic
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| lorazepam (Ativan) | benzodiazepine (IV)
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| when are patients given dronabinol (Marinol) | nausea/vomiting related to HIV or chemotherapy
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| nursing interventions for antiemetics | change position slowly; avoid driving or hazardous tasks
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| Client safety/nursing education for antiemetics | drowsiness (risk for fall); report vomiting of blood or severe abdominal pain;
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| nonpharmacological ways to reduce nausea | ice chips, cool cloth around neck
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| is constipation a disease or symptom | symptoms
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| causes of constipation | lack of exercise, dietary fiber, fluids, medications, foods, health problems, aging
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| medications causing constipation | opiods, anticholinergic, antihistamine, antacids, iron
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| foods causing constipation | white flour, dairy products, chocolate, bananas
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| health problems causing constipation | hypothyroidism, diabetes, irritable bowel
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| why does aging cause constipation | slower transit time
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| rationale for using Laxatives | prophylactic for surgery; prevent straining; cathartic
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| another name for straining | valsalva maneuver
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| effects of straining on body | increases BP, abdominal pressure, intraoccular pressure, intracranial pressure
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| define cathartic | cleanse bowel prior to procedures
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| dynamics of bulk forming laxatives | absorb water to fecal mass
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| Therapeutic uses for bulk forming laxatives | first choice for prevention and treatment of constipation
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| bulk forming laxative prototypes | psyllium mucilloid (Metamucil); methycellulose (Citrucil)
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| psyllium mucilloid (Metamucil) | bulk forming laxative
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| methycellulose (Citrucil) | bulk forming laxative
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| side effects of bulk forming laxatives | cramping
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| teaching for bulk forming laxatives | take with 1-2 glasses water; may take 24-48 hours to work
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| stool softeners/surfactant dynamics | more water and fat absorbed in stool
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| therapeutic uses for stool softeners/surfactant | persons at risk for constipation
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| stool softener/surfactant prototype | docusate (Colace)
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| docusate (Colace) | stool softener/ surfactant
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| side effects of stool softener/ surfactant | abdominal cramping, diarrhea
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| Caution for Colace | don't give colace to person on sodium restriction or abdominal pain
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| stimulant dynamics | irritate the bowel to increase peristalsis
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| stimulant prototype | bisacodyl (Dulcolax)
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| side effects of stimulants | abdominal cramping, fluid and electrolyte loss, laxative dependency if taken frequently
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| bisacodyl (Dulcolax) | stimulant
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| Educaiton for stimulants | enteric coating: no dairy products or coating will break down - gastric irritation
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| dynamics of saline/osmotic | not absorbed, pull water into fecal mass
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| saline/osmotic prototype | sodium biphosphate (Fleet enema); polyethylene glycol (Miralax)
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| sodium biphosphate (Fleet enema) | saline/osmotic
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| polyethylene glycol (Miralax) | saline/osmotic
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| isotonic prototype | polyethylene glycol (PEG) and electrolytes (GoLytely) powder mixture
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| polyethylene glycol (PEG) and electrolytes (GoLytely) powder mixture | isotonic
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| therapeutic uses for isotonics | bowel cleansing before colonoscopy
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| preparation for isotonic powder mixture | reconstitution (4 liters - 1 glass every 10 minutes) refirgerate
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| When does isotonic powder mixture start working | within 1 hour of starting
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| Diarrhea a disease or symptoms | symptom
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| Causes of diarrhea | infections, toxins and pathogens, medications
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| medications causing diarrhea | antibiotics, lactose
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| diarrhea contributes to what | fluid and electrolyte loss
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| Natural therapy for diarrhea | lactobacillus acidophilus (probiotic bacterium)
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| ABC diet for diarrhea | apples, banana, carrot (contain pectin)
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| BRAT diet for diarrhea | bananas, rice, applesauce, tea (toast) older diet
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| antidiarrheal: opioid dynamics | slow peristalsis
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| antidiarrheal: opioid prototype | codeine, diphenoxylate with atropine (Lomotil)
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| codeine | antidiarrheal: opioid
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| diphenoxylate with atropine (Lomotil) | antidiarrheal: opioid
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| OTC antidiarrheal: opioids | ioperamide (Imodium) - analogue of meperidine (demerol)
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| Schedule V antidiarrheal: opioid | diphenoxylate with atropine (Lomotil)
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| side effects of antidiarrheal: opioid | drowsiness, dry mouth, constipation, paralytic ileus
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| dynamics of bismuth salt (Pepto-Bismol) | bind and absorbs toxins
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| nursing education for diarrhea/constipation | monitor for electrolyte imbalance, fever, record frequncy of stools, presence of blood, ice or hard candy for dry mouth, avoid colas (high sugar), stop medicaiton when diarrhea stopped
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| Why should you avoid colas (high sugar) with diarrhea | contributes to more diarrhea
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