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