Exam 3 - 50 51 52 54 Flashcards
Acid-related diseases are caused by?
imbalance of the three cells of gastric gland their secretions
What is the most common acid relate disease?
hyperacidity
What symptoms do clients report of acid-related diseases?
Clients report symptoms of overproduction of HCl by the parietal cells as indigestion, sour stomach, heartburn, acid stomach
What are some acid-related diseases?
PUD: peptic ulcer disease
GERD: gastroesophageal reflux disease
Helicobacter pylori (H. pylori)
Bacterium found in GI tract of 90% of patients with duodenal ulcers, and 70% of those with gastric ulcers is what bacteria?
H. Pylori
What therapy is used most often to eradicate H.pylori?
Combination therapy
What is the treatment for H.Pylori?
- Eight regimens approved by the FDA
- H. pylori is not associated with acute perforating ulcers
- It is suggested that factors other than the presence of H. pylori lead to ulceration
What are the types of acids-controlling agents?
- Antacids
- H2 antagonists
- Proton pump inhibitors
What is the mechanism of action for antacids?
Promote gastric mucosal defense mechanisms
Antacids have secretions of the mucus, bicarbonate, and prostaglandins. What are the mechanism of action for those?
- Mucus: protective barrier against HCl
- Bicarbonate: helps buffer acidic properties of HCl
- Prostaglandins: prevent activation of proton pump which results in HCl production
Antacids _____ prevent the over-production of acid?
DO NOT
Antacids _____ neutralize the acid once it’s in the stomach?
DO
What are some drug effects of antacids?
- Reduction of pain associated with acid-related disorders
- Raising gastric pH from 1.3 to 1.6 neutralizes 50% of the gastric acid
- Raising gastric pH 1 point (1.3 to 2.3) neutralizes 90% of the gastric acid
- Reducing acidity reduces pain
What 2 forms of antacids of aluminum salts are there?
Carbonate and Hydroxide
Aluminum salts can cause what kind of effects?
constipating effects
The counteract constipation with aluminum salts, what should you do?
It is often used with magnesium
What are some examples of aluminum salts?
- Aluminum carbonate: Basaljel
- Hydroxide salt: AlternaGEL
- Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel
What forms of magnesium salts are there?
Forms: carbonate, hydroxide, oxide, trisilicate
Magnesium salt commonly causes what?
diarrhea; usually used with other agents to counteract this effect
what antacid is dangerous to use with a pt with renal failure?
magnesium salt; the failing kidney cannot excrete extra magnesium, resulting in hypermagnesemia
Hypermagnesemia is the result when the kidney what?
when the failing kidney cannot excrete extra magnesium
What is MOM abbreviation?
Milk of Magnesia (magnesium hydroxide)
What are some examples of magnesium salts?
Hydroxide salt: magnesium hydroxide (MOM)
Carbonate salt: Gaviscon (also a combination product)
Combination products such as Maalox, Mylanta (aluminum and magnesium)
which antacid tastes like chalk?
Hydroxide salt: magnesium hydroxide (MOM)
What are some adverse effects using MOM?
- Abdominal cramping
- Diarrhea
- dehydration
If using MOM in the A.M., what happens in the P.M.?
a bowel movement
Milk of Mag stops the burning and keeps it under control where?
the stomach
What is the forms of calcium salts?
Many forms, but carbonate is most common
Calcium salts can cause diarrhea? T or F
False, Causes constipation
Using calcium salts too long may result in ___ ___?
- kidney stones; Those with kidney stones should stay away from a calcium base
- hyperacidity rebound
What is hyperacidity rebound?
increased gastric acid secretrion
how can hyperacidity rebound occur?
using antacid calcium salt too long; the acid action may cause increased gastric acid secretion
What is an example of a calcium salts?
-Tums (Calcium carbonate)
Calcium salt is often advertised as ?
An extra source of dietary calcium
Sodium bicarbonate offers as a buffer, it is a quick onset but short duration, the problem using this may cause what?
May cause metabolic alkalosis because of the Sodium content may cause problems in patients with HF, hypertension, or renal insufficiency (fluid retention)
True of false? Where ever salt goes, water will follow?
True
Along with antacids comes with antiflatulents. Antiflatulents are used for ?
- to relieve the painful symptoms associated with gas
- Several agents are used to bind or alter intestinal gas and are often added to antacid combination products
What are some drugs of antiflatulents?
- activated charcoal
- simethicone
What does simethicone do?
antiflatulent
- Alters elasticity of mucus-coated bubbles causing them to break
- it is used often, but there are limited data to support effectiveness
- walking also relieve gas bubbles
Another name for Amphojel?
aluminum hydroxide
Amphojel does what?
lowers the phosphate and raise the pH
what must use watch for when using aluminum hydroxide?
- fecal impaction
- instestinal obstruction
- hypophosphatemia
what type of salts are there for antacids?
- Aluminum, Magnesium, and Calcium salts
- Sodium bicarbonate is also an antacid
What are some side effects of antacids for the following:
- Aluminum and Calcium
- Magnesium
- Calcium Carbonate
- Aluminum and Calcium is constipation
- Magnesium is diarrhea
-Calcium Carbonate
produces gas and belching; often combined with simethicone
What does H2 Antagonists do?
Reduce acid secretion
All H2 antagonists are available OTC in lower dosage forms, any higher doses requires prescriptions
What are some popular drugs of H2 Antagonists?
- cimetidine (tagamet)
- famotidine (Pepcid)
- ranitidine (zantac)
What is the mechanism of action for H2 antagonists?
- Block histamine (H2) at the receptors of acid-producing parietal cells
- Production of hydrogen ions is reduced, resulting in decreased production of HCl
When would you use an H2 Antagonists?
The presence of:
- GERD
- PUD
- Erosive esophagitis,
- Adjunct therapy in control of upper GI bleeding
- Pathologic gastric hypersecretory conditions (Zollinger-Ellison syndrome)
What are some of the side effects of H2 Antagonists?
- Not many side effects; overall less than 3% incidence of side effects.
- Cimetidine may induce impotence and gynecomastia
- May also see Headaches, lethargy, confusion, diarrhea, urticaria, sweating, flushing, other effects
Another name for Cimetidine?
Tagamet
Cimetidine (Tagemet) binds with ____ in the liver resulting in ____?
Binds with P-450 microsomal oxidase system in the liver, resulting in inhibited oxidation of many drugs and increased drug levels
All H2 antagonists may inhibit the absorption of drugs that require an what?
Acidic GI environment for absorption
Another drug interaction with H2 antagonists is smoking. Smoking does what to the H2 antagonist?
Smoking has been shown to decrease the effectiveness of the H2 blockers (increases gastric acid production)
Proton Pump Inhibitors are?
They are the parietal release positive hydrogen ions (protons) during HCl production also known as the process of the proton pump
The parietal cells release positive hydrogen ions (protons) during HCl production is called what process?
Proton pump
Can H2 blockers and antihistamines stop the action of the proton pump?
H2 blockers and antihistamines do not stop the action of this pump
What is the mechanism of action for the proton pump inhibitor?
- Irreversibly bind to H+/K+ ATPase enzyme
- Result: achlorhydria —ALL gastric acid secretion is blocked
What are some PPI Drugs?
Total inhibition of gastric acid secretion:
- lansoprazole (Prevacid)
- omeprazole (Prilosec)
- rabeprazole (AcipHex)
- pantoprazole (Protonix)—only IV form used in the hospital
- esomeprazole (Nexium)
*The first in this new class of drugs
What are some indications to use PPI?
- GERD maintenance therapy
- Erosive esophagitis
- Short-term treatment of active duodenal and benign gastric ulcers
- Zollinger-Ellison syndrome
- Treatment of H. pylori–induced ulcers
Side effects of PPI?
Not so many side effects
- Safe for short-term therapy
- Incidence low and uncommon
What are some other drugs of PPI?
- sucralfate (Carafate)
- misoprostol (Cytotec)
What type of agent is sucralfate and what is it used for?
- It is a cytoprotective agent.
- Used for stress ulcers, erosions, PUD.
Another name for sucralfate?
carafate; good drug to use, also used for codeine purposes
Sucralfate should not be taken with any other medication. It is attracted to and binds to the what?
-binds to the base of ulcers and erosions, forming a protective barrier over these areas
What drug protects these areas from pepsin, which normally breaks down proteins (making ulcers worse)?
Sucralfate (carafate)
Sucralfate has little absorption from the gut, but it may cause what?
- May cause constipation, nausea, and dry mouth
* May impair absorption of other drugs, especially tetracycline
This drug Binds with phosphate; may be used in chronic renal failure to reduce phosphate levels
Carafate (sucralfate)
True or false. We can mix drugs with sacralfate (carafate)
False, DO NOT administer with other medications
Cytotec is another name for?
misoprostol
Cytotec (misoprostol) does what?
- Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate
- Promote local cell regeneration
- Help to maintain mucosal blood flow
Misoprostol is used to prevent?
Used for prevention of NSAID-induced gastric ulcers
Adsorbents coat the walls of the GI tract. Binds to the causative bacteria or toxin, which is then eliminated through the stool.
What are some examples
Examples: bismuth subsalicylate (Pepto-Bismol), kaolin-pectin, activated charcoal, attapulgite (Kaopectate)
Anticholinergices decrease the intestinal muscle tone and peristalsis of GI tract resulting in?
Result: slowing the movement of fecal matter through the GI tract
Belladonna alkaloid (donnatal), and atropine are examples of?
anticholinergics
Intestinal flora modifiers are bacterial cultures of _____ organisms work by supplying ___ ?
Lactobacillus; supplying missing bacteria to the GI tract, suppressing the growth of diarrhea-causing bacteria
Example of an intestinal flora modifier?
L.acidophilus (Lactinex)
Opiates?
- Decrease bowel motility and relieve rectal spasms
- Decrease transit time through the bowel, allowing more time for water and electrolytes to be absorbed
Examples of opiates?
Examples:
- paregoric
- opium tincture
- codeine
- loperamide (Imodium OTC)
- diphenoxylate (Lomotil-Rx)
Loperamide is another name for ?
imodium
Another name for lomotil?
diphenoxylate hydrochloride with atropine sulfate
Adsorbents SE can cause what?
- Increased bleeding time
- Constipation, dark stools
- Confusion, twitching
- Hearing loss, tinnitus, metallic taste, blue gums
Anticholinergics SE can cause what?
- Urinary retention, hesitancy, impotence
- Headache, dizziness, confusion, anxiety, drowsiness
- Dry skin, rash, flushing
- Blurred vision, photophobia, increased intraocular pressure
- Hypotension, hypertension, bradycardia, tachycardia
Opiates make you sleepy. What SE can it cause?
- Drowsiness, sedation, dizziness, lethargy
- Nausea, vomiting, anorexia, constipation
- Respiratory depression
- Bradycardia, palpitations, hypotension
- Urinary retention
- Flushing, rash, urticaria
Adsorbents ____ the absorption of many agents, including digoxin, clindamycin, quinidine, and hypoglycemic agents.
decrease
Adsorbents cause ___ bleeding time when given with anticoagulants.
increased
Antiacids can _____ effects of anticholinergic antidiarrheal agents.
decrease
Examples of bulk forming Laxatives?
- psyllium (Metamucil)
- methylcellulose (Citrucel)
- Polycarbophil (FiberCon)
Mechanism of action for Bulk Forming laxatives?
- High fiber
- Absorbs water to increase bulk
- Distends bowel to initiate reflex bowel activity
Surfactant Laxative mechanism of action?
- Stool softeners (colace) and lubricants (mineral oil)
- Promote more water and fat in the stools
- Lubricate the fecal material and intestinal walls
Examples for surfactant laxative?
Stool softeners: docusate salts (Colace)
Lubricants: mineral oil
Osmotic laxative mechanism of action and result?
Increases fecal water content resulting in bowel distention, increased peristalsis and evacuation
Examples of osmotic laxatives?
- polyethylene glycol (GoLYTELY)
- sorbitol (increases fluid movement into intestine)
- glycerin
- lactulose (Chronulac)
Lactulose smells like?
rotten eggs
What must you check before using lactulose?
Check ammonia labs
What are some saline laxative examples?
- magnesium sulfate (Epsom salts)
- magnesium hydroxide (MOM)
- magnesium citrate
- sodium phosphate (Fleet Phospho-Soda, Fleet enema)
Dulcolax goes up the?
booty hole!!! hahahahaha no but seriously. Bisacodyl is another name for it.
All laxatives can cause what?
electrolyte imbalance
Antiemetic and anti nausea does what?
stops nausea and vomiting.
Reglan (prokinetic agent) is an antiemetic, and should not be used for more than __ days because it can cause major what?
3 days and cause major psychotic disorders
Zofran (ondansetron) is a?
serotonin blocker
Name a tetrahydrocannabinoid (THC) ?
dronabinal marinol
What is tetrahydrocannabinoid used for?
-Used for N&V associated with chemotherapy, and anorexia associated with weight loss in AIDS patients
Serotonin blockers used for?
Used for N&V for patients receiving chemotherapy and postoperative nausea and vomiting
Prokinetic agents block dopamine in the CTZ but also cause?
- Cause CTZ to be desensitized to impulses it receives from the GI tract
- Also stimulate peristalsis in GI tract, enhancing emptying of stomach contents
Reglan is also used for?
Also used for GERD, delayed gastric emptying
