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nurs 252 > Acid controlling drugs > Flashcards

Acid controlling drugs Flashcards

1
Q

the stomach secretes

A

hcl, bicarbonate, pepsinogen, intrinsic factor, mucus, prostaglandins

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2
Q

3 glands of the stomach

A

cardiac, pyloric, gastric

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3
Q

cells in the gastric gland

A

parietal, chief, mucous, endocrine, enterochromaffin

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4
Q

parietal cells

A

produce and secrete hcl
site of action for many drugs to treat acid related disorders

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5
Q

chief cells

A

secretes pepsinogen which becomes pepsin which breaks down proteins

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6
Q

mucous cells

A

provide a protective mucus coat to protect against self digestion by hcl and digestive enzymes

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7
Q

hydrochloric acid

A

secreted from parietal cells when stimulated by food, caffeine, chocolate and alcohol

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8
Q

hydrochloric acid maintains stomach pH of..

A

1-4

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9
Q

what does acidity do for the GI tract

A

aids in proper digestion and defenses against microbial infection via the GI tract

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10
Q

hcl secretion is also stimulated by

A

large fatty meals and emotional stress

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11
Q

peptic ulcer disease

A

gastric or duodenal ulcers that involve digestion of the GI mucosa by the enzyme pepsin

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12
Q

helicobacter pylori

A

bacterium found in the GI tract of 90% of pts with duodenal ulcers and 70% of those with gastric ulcers

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13
Q

triple therapy for h.pylori (in red)

A

7-14 day course of a proton pump inhibitor and the antibiotics clarithromycin and either amoxicillin or metronidazole or quadruple therapy of a PPI, bismuth subsalicylate and the antibiotics tetracycline and metronidazole.

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14
Q

stress-related mucosal damage

A
  • GI lesions in CCU pts within 24 hours after admission
  • factors include decreased blood flow, mucosal ischemia, hypoperfusion and reperfusion activity
  • NG tubes and ventilators predispose for GI bleeding
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15
Q

what is given for the prevention of stress-related mucosal damage

A

histamine receptor blocking drug or a PPI (proton pump inhibitor)

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16
Q

types of acid controlling drugs

A

antacids, H2 antagonists, PPIs

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17
Q

antacids are used to

A

neutralize stomach acid

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18
Q

antacids are made of

A

salts of Al, Mg, Ca or Na bicarbonate or all of these

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19
Q

many antacid preparations contain

A

antiflatulent (antigas) drug simethicone

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20
Q

magnesium in Al and Ca based antacids contributes to

A

the acid neutralizing capacity and counteracts the constipating effects of Al and Ca

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21
Q

Ca antacids may lead to the development of

A

kidney stones and increases gastric acid secretions

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22
Q

avoid antacids with Mg in ppl with

A

renal failure

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23
Q

which is a highly soluble antacid form with a quick onset and short duration of action

A

sodium bicarbonate

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24
Q

antacids MOA

A
  • doesn’t help acid overproduction but helps neutralize acid secretions
  • promotes mucosal defensive mechanisims
  • stim secretions of mucous, bicarbonate and prostaglandins (which prevents activation of proton pump)
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25
antacids drug effects
- reduction of pain and reflux associated with acid-related disorders - raising the gastric pH. Neutralizes 90% of the gastric acids
26
reducing acidity reduces pain as a result of
- base mediated inhibition of the protein-digesting ability of pepsin - increase in the resistance of the stomach lining to irritation -increase in the tone of the cardiac sphincter
27
antacid indications
acute relief of symptoms associated with peptic ulcer, gastritis, gastric hyperacidity and heartburn
28
antacid contraindications
-allergy - sever renal failure or electrolyte disturbances - GI obstruction: tumour or stricture. (antacids may stimulate GI motility)
29
antacids OTC formulations available as
- capsules and tablets - powders - chewable tablets - suspension - effervescent granules and tablets
30
antacids types
used alone or in combination - aluminum hydroxide - magnesium hydroxide -simethicone - combination of aluminum hydroxide and magnesium hydroxide contain a local anesthetic (mucaine)
31
aluminum salts have a ___ effect
constipating
32
aluminum salts are often used with ___ to
magnesium
33
aluminum salts are recommended for pts with
renal disease
34
examples of aluminum salts (combination products)
antacid plus, diovol, gelusil, maalox, multiaction
35
magnesium salts commonly cause
diarrhea. use with other drugs to counteract this efect
36
magnesuim salts are dangerous when used for pts with
renal failure. the kidney cant excrete extra magnesium resulting in accumulation
37
magnesium salts examples
magnesium hydroxide and mineral oil (magnolox)
38
calcium salts most common form
carbonate
39
calcium salts may cause
constipation and kidney stones
40
calcium salts are not recommended for pts with
renal disease (toxicity)
41
calcium salts have a __ duration of action that may cause
-long duration of action that may cause increased gastric acid secretion
42
ex of calcium salts
calcium carbonate and simethicone (maalox, rolaids)
43
sodium bicarbonate
- highly soluble - buffers the acidic properties of hydrochloric acid - quick onset and short duration
44
sodium bicarbonate sodium content may cause problems in pts with
heart failure, hypertension or renal insufficiency
45
antiflatulents
- used to relieve the painful symptoms associated with gas - often combined with antacids
46
antiflatulent example
simethicone
47
antacids adverse effects (overuse)
metabolic alkalosis
48
adverse effects of aluminum and calcium
constipation
49
magnesium adverse effects
diarrhea
50
calcium adverse effects
kidney stones and rebound hyperacidity
51
calcium carbonate adverse effects
produces gas and belching, often combined with simethicone
52
53
antacid adsorption of other drugs
reduces the ability of the other drug to be observed into the body
54
chelation
- chem binding or inactivation of another drug - produces insoluble complexes - result= reduced drug absorption
55
antacid increased stomach pH
- increased absorption of basic drugs - decreased absorption of acidic drugs
56
antacids increased urinary pH
- increased excretion of acidic drugs - decreased excretion of basic drugs
57
H2 receptor antagonists
- reduces acid secretion - all available OTC in lower dosage forms - most popular drugs for treatment of acid related disorders
58
examples of H2 receptor antagonists
ranitidine hydrochloride (Zantac) and famotidine (Pepcid)
59
H2 antagonist MOA
- block H2 receptors of acid producing parietal cells - reduce H ion secretion from parietal cells - increase pH in stomach - relieve symptoms of hyperacidity conditions
60
H2 drug indications
- GERD - peptic ulcer disease - erosive esophagitis - adjunct therapy to control upper GI bleeding - zollinger-Ellison syndrome
61
H2 antagonist adverse effects
- very few - confusion and disorientation in elderly - cimetidine= erectile dysfunction - thrombocytopenia= ratidine hcl and famotidine
62
cimetidine drug interactions
- binds with P-450 in liver resulting in inhibited oxidation of drugs and increased drug levels
63
all H2 antagonist drug interactions
- inhibited absorption of drugs that require an acidic gastric environment for absorption
64
due to drug interactions, cimetidine has been largely replaced with
ranitidine and famotidine
65
smoking and H2 antagonists
smoking decreases effectiveness of H2 blockers
66
when to take H2 antagonists with antacids
take H2 antagonists 1 hr before antacids
67
what is the proton pump
parietal cells release positive hydrogen ions (protons) during hydrochloric acid production
68
T or F antihistamines and H2 antagonists can inhibit proton pump
false
69
proton pump inhibitor examples
lansoprazole (prevacid), omeprazole (losec), pantoprazole sodium IV (pantoloc)
70
proton pump inhibitors MOA
- irreversibly bind to H+ and K+ ATPase enzyme - this bond prevents movement of H= from parietal cells into stomach - results in achlorhydria (all gastric acid secretions temporarily blocked)
71
PPI indications
- GERD - erosive esophagitis - short term treatment of active duodenal and benign gastric ulcers - zollinger- ellison syndrome - NSAID ulcers - stress ulcer prophylaxis -treatment of H, pylori-induced infections
72
PPI adverse effects
- generally well tolerated - possible predisposition to GI tract infections (clostridium difficile) - osteoporosis and risk of wrist, hip and spine fractures in long term users -pneumonia - depletion of magnesium
73
PPI drug interactions
- increase serum levels of diazepam and phenytoin -warfarin: increased chance of bleeding - absorption of ketoconazole, ampicillin, iron salts and digoxin - clopidogrel - sucralfate ( delay absorption of PPIs) - food may decrease absorption of PPIs
74
miscellaneous acid controlling drugs
sucralfate, misoprostol, simethicone
75
sucralfate is used for
- is a cytoprotective drug -used for stress ulcers, peptic ulcer disease -attracted to and binds to the base of ulcers and erosions forming a barrier - protects these areas from pepsin (which breaks down proteins)
76
sucralfate absorption
- little absorption from the gut
77
sucralfate may cause
constipation, nausea and dry mouth
78
when to give sucralfate with other drugs
give other drugs 2hrs before sucralfate because of impaired absorption
79
sucralfate binds with
phosphate - can be used in chronic renal failure to reduce phosphate levels
80
misoprostol
- prostaglandin E analogue - has cytoprotective activity - protects gastric mucosa from injury by enhancing local production of mucous or bicarbonate - promotes local cell regeneration - maintains mucosal blood flow
81
misoprostol is used for prevention of
NSAID-induced gastric ulcers
82
doses that are therapeutic enough to treat duodenal ulcers often produce
abdominal cramps and diarrhea
83
simethicone
- antiflatulent drug - reduce discomfort of gastric or intestinal gas - alters elasticity of mucous-coated gas bubbles breaking them into smaller ones - result= decreased gas pain and increased expulsion via mouth or rectum
84
pre-existing conditions that restrict the use of antacids
- fluid imbalance - renal disease - GI obstruction - heart failure - pregnancy
85
pts with ____ or ____ shouldnt use antacids with high sodium content
heart failure or hypertension
86
when to administer antacids
take other meds 1-2 hours before the antacid.
87
antacids and enteric coated medications
antacids may cause premature dissolving of enteric coated medications resulting in stomach upset
88
give antacids with how much water
240 ml to enhance absorption
89
long term self medication of antacids
masks symptoms of underlying diseases such as malignancy or bleeding ulcers
90
antacid adverse effects
-nausea, vomiting, abd pain, diarrhea, - constipation and acid rebound with calcium-containing products
91
what to assess before giving H2 antagonists
allergies and impaired renal or liver function
92
use H2 antagonists with caution in pts who are
confused, disoriented or older adults
93
PPIs may increased serum levels of
diazepam and phenytoin - may increase chance for bleeding with warfarin
94
granules of pantoprazole capsules
may be given via nasogastric tubes - can be mixed with apple juice - dont crush delayed granules
95
misoprostol and pregnancy
dont use with pregnant ppl because it can induce uterine contractions
96
when should you take PPI with food
30 -60 mins before meal

nurs 252 (23 decks)

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