antiemectic, gi motility, antacids

Question 1

Prompt neutralization of gastric acid. Not associated with acid rebound. Has laxative effect. Systemic absorption may be sufficient to cause neurologic, neuromuscular, and cv impairment in pts with renal dysfunction. Renal dysfunction can also lead to development of metabolic alkalosis in some pts.

Answer 1

Magnesium hydroxide (mom)

Question 2

can produce metabolic alkalosis with chronic therapy. Symptomatic hypercalcemia may occur in pts with renal disease. May result in hypophosphatemia. Appendicitis has been reported due to impact calcium carbonate fecaliths

Answer 2

Calcium Carbonate

Question 3

Mixture of aluminum hydroxide, aluminum oxide, and some fixed CO2 as carbonate. System absorption may be high in renal disease. Encephalopathy in pts undergoing hemodialysis has been attributed to intoxication with aluminum, especially in pts who ingest solutions containing citrate. Slows gastric emptying and causes Constipation)

Answer 3

Aluminum hydroxide

Question 4

Less likely to cause foreign body reaction if aspirated and mixing with gastric fluid is more complete than with particulate antacids such as Tums or Rolaids (which can lead to pneumonitis and histological changes in lungs). 15-30 cc of a 0.3 mol/liter administered 30 minutes before induction of anesthesia is effective in reliably increasing gastric pH in pregnant and nonpregnant pts.

Answer 4

Non particulate antacids (Sodium Citrate):

Question 5

Acid rebound is unique to _____________

Answer 5

calcium containing acids

Question 6

Hypercalcemia, increased BUN and plasma creatinine concentrations. Have system alkalosis; marked decrease in renal function; Most commonly associated with ingestion of large amounts of calcium carbonate and > 1 L milk every day

Answer 6

Milk-Alkali Syndrome

Question 7

Ingesting large doses of aluminum salts because they bind phosphate ions in the GI tract and prevent their absorption. May be beneficial in pts with renal disease because it can decrease their plasma phosphate concentration but renal pts may develop toxicity from the aluminum.

Answer 7

Phosphorus depletion

Question 8

__________may result in anorexia, skeletal muscle weakness and malaise. Osteomalacia, osteoporosis, and fractures may occur. If aluminum containing antacids are given chronically should consider a phosphate supplement

Answer 8

Hypophosphatemia

Question 9

H2 receptor antagonists competitively and selectively inhibit the binding of histamine to H2 receptors, thereby decreasing the intracellular concentration of cAMP and the subsequent secretion of hydrogen ions by parietal cells.

Answer 9

Cimetidine, ranitidine, famotidine, and nizatidine

Question 10

________ least potent and __________ the most potent.

Answer 10

cimetidine, famotidine

Question 11

Most effective at controlling gastric acidity and volume

Answer 11

PROTON PUMP INHIBITORS( PPI)

Question 12

PROTON PUMP INHIBITORS( PPI)

Answer 12

Omeprazole, esomeprazole, Iansoprazole, pantoprazole, rabeprazole

Question 13

PROTON PUMP INHIBITORS( PPI) MOA

Answer 13

Last phase of gastric acid secretion is the membrane enzyme proton pump (hydrogen-potassium-ATPase) that moves hydrogen ions across the gastric parietal cell membranes in exchange for potassium ions. The secretion of hydrochloric acid by gastric parietal cells depends on the function of the proton pump.

Question 14

PPIs are more effective than H2-receptor antagonists for healing ________ and preventing relapse

Answer 14

esophagitis

Question 15

Acts as a prodrug that becomes a PPI

Answer 15

OMEPRAZOLE

Question 16

omeprazole takes _________to exert its maximal inhibitory effect on gastric acid secretion.

Answer 16

several days

Question 17

Heals duodenal and possible gastric ulcers more rapidly than H2 receptor antagonists

Answer 17

OMEPRAZOLE

Question 18

In pts with bleeding PUD and signs of recent bleeding, treatment with ________ decreases the rate of bleeding and the need for surgery

Answer 18

omeprazole

Question 19

Administered the night before surgery, increases gastric fluid pH, whereas administration on day of surgery (up to 3 hours before) fails to improve the environment of gastric fluid

Answer 19

omeprazole

Question 20

Omerprazole side effects

Answer 20

Crosses BBB and may cause: headache, agitation and confusion

GI: abd pain, flatulence, n/v

No need to adjust dose in renal or hepatic dysfunction

Question 21

Increase lower esophageal sphincter tone, enhances intraduodenal coordination and promotes gastric emptying of liquids and solids in pts with diabetic gastroparesis; patients awaiting emergent surgery; normal pts; ICU pts with food intolerance

Answer 21

MACROLIDES: Erythromycin, Azithromycin

Question 22

Decreases GERD; Increases lower esophageal sphincter tone; improves gastric motility and increases motility in small and large intestine by enhancing the release of acetylcholine from nerve endings in the myenteric plexus of the gastrointestinal mucosa.

Answer 22

5-HT4-RECEPTOR AGONISTS:

Cisapride and Mosapride

Question 23

Opioid induced gastric stasis (can cause post op n/v) is reversed by _________

Answer 23

cisapride

Question 24

Due to nonselectivity, ______ and _______ are associated with prolongation of QT interval.

Answer 24

cisapride and mosapride

Question 25

PONV RISK FACTORS PEDIATRICS

Answer 25

Age:  Weak Association
Herniorrhaphy
T&A
Strabismus Surgery
Male Genitalia Surgeries:  Highest Risk
Risk reduced in adults as they age

Question 26

PONV RISK FACTORS ANESTHETICS

Answer 26

Inhalation Agents
Nitrous Oxide
Neostigmine
Opioids
Correlation is limited with these factors and PONV

Question 27

PONV RISK FACTORS Surgical Factors

Answer 27

Length of Surgery
Laparotomies
Gynecologic surgeries
Laparoscopic procedures
ENT
Breast
Plastic
Ortho

Question 28

CENTRAL ANTICHOLINERGIC SYNDROME treatent

Answer 28

Physostigmine (lipid-soluble tertiary amine) 15-60 mcg/kg IV is a specific treatment. Treatment may need to be repeated every 1-2 hours.

Question 29

Atropine 0.6 mg IV or Glycopyrrolate 0.2 – 0.3 mg IV decreases ____________________ and decreases barrier pressure

Answer 29

lower esophageal sphincter pressure

Question 30

The difference between ______ and _____ sphincter pressure is “barrier pressure.”

Answer 30

gastric pressure, lower esophageal

Question 31

stimulates GI tract via cholinergic mechanism resulting in:
Contraction of lower esophageal sphincter and gastric fundus
Increased gastric and small intestinal motility
Decreased muscle activity in the pylorus and duodenum when stomach contracts

Answer 31

Benzamides: Metoclopramide and Domperidone

Question 32

Because of antidopaminergic activity, Reglan should be used with caution if at all in:

Answer 32

Parkinson’s disease
RLS
Pts with movement disorders related to dopamine inhibition or depletion.

Question 33

Can give _______ prior to Reglan to prevent side effects

Answer 33

versed

Question 34

reglan Potential gastric emptying benefits:

Answer 34

Patients who have recently ingested solid food
Patients with DM and symptoms of gastroparesis
Trauma patients
Obese
Parturients (especially with esophagitis/heartburn suggesting LES dysfunction and gastric hypomotility

Question 35

Reglan Should not be administered to patients with:

Answer 35

Known Parkinson’s Disease
Restless Leg Syndrome
Movement disorders r/t dopamine inhibition or depletion

Question 36

Reglan May increase sedative actions of CNS depressants and the incidence of extrapyramidal reactions cause by certain drugs: Should avoid administering in combination with:

Answer 36

Phenothiazine
Butyrophenone drugs
Patients with preexisting extrapyramidal symptoms
Seizure disorders
Avoid in patients taking MOAI or Tricyclic antidepressants
Decreases bioavailability of orally administered cimetidine by 25-50%
Do not give to suspected or known mechanical obstruction to gastric emptying
Do not administer after GI surgery such as pyloroplasty or intestinal anastomosis because it stimulates gastric motility and may delay healing
Inhibiting effect on plasma cholinesterase activity: May cause prolonged responses to succinylcholine and mivacurium: Parturients may be at increased risk for developing this response, considering the already decreased plasma cholinesterase activity associated with pregnancy.
Metabolism of ester LA could be slowed by reglan induced decreases in plasma cholinesterase activity