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NCLEX Pharm > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

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1
Q

What are antacids?

A

Medications that react with gastric acids to produce neutral salts. They inactivate pepsin and enhance mucosal protection

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2
Q

What pH should stomach acid be to deem antacids effective?

A

The pH of the stomach should be above 5

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3
Q

What is Misoprostol?

- What is it used for?

A

A gastric protectant. Antisecretory medication that enhances mucosal defences.
- Used to prevent gastric ulcers caused by NSAID and aspirins

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4
Q

When should Misoprostol be given?

A

With meals

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5
Q

Contraindications for Misoprostol?

A

Abdominal pain and pregnancy

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6
Q

What is Sucralfate?

A

Gastric protectant that creates a protective barrier against acid and pepsin

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7
Q

When should Sucralfate be given?

A

On an empty stomach

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8
Q

Sucralfate impedes absorption of which meds?

- How do we stop this?

A

Warfarin, phenytoin, theophylline, digoxin, and some antibiotics.
- Admin these other meds 2 hours apart

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9
Q

What are histamine receptor antagonists?

A

Meds that suppress secretion of gastric acid, alleviate symptoms of heartburn, prevent and reduce the occurrence of ulcers, promote healing from GERD

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10
Q

Contraindications for histamine receptor antagonists?

A

hypersensitivity, and cautiously for those with renal or hepatic dysfunction

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11
Q

What is Cimetidine?

A

It is a histamine receptor antagonist

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12
Q

How should Cimetidine be taken?

A

On an empty stomach as food will slow it’s aborption. Also not to be given with antacids.

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13
Q

What is especially dangerous about Cimetidine?

- What effects of this would we see?

A

It can pass through the blood-brain barrier and cause CNS effects.
- mental confusion, agitation, psychosis, depression, anxiety and disorientation

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14
Q

What meds, when given with Cimetidine, are at increased risk of overdose?

A

Warfarin, phenytoin, theophylline, and lidocaine, because Cimetidine causes reduced hepatic drug-metabolizing enzymes.

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15
Q

What is ranitidine, famotidine and nizatidine?

A

They are all histamine receptor antagonists.

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16
Q

Name the (4) classifications of antacids

A

Aluminium compounds, Magnesium compounds, Calcium compounds, and Sodium Bicarbonate

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17
Q

Special considerations for Aluminium compounds

A

May cause hypophosphatemia (also a treatment for hyperphosphatemia), have high sodium so avoid in pts with HTN and heart failure, may cause constipation

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18
Q

Special considerations for Magnesium compounds

A

Magnesium hydroxyde is also a laxative, contraindicated with obstruction, appendicitis, abdominal pain NYD, and need to monitor for magnesium toxicity

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19
Q

Special considerations of Calcium compounds

A

May cause acid rebound, rapid-acting and cause carbon dioxide release in the stomach, avoid milk and vitamin D products to avoid Milk-Alkali syndrome

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20
Q

Special considerations for Sodium bicarbonate

A

Promotes flatulence by liberating carbon dioxide, Careful with pt’s with HTN or heart failure, can cause systemic alkalosis in pt’s with renal failure, useful for treating acidosis

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21
Q

What are proton pump inhibitors (PPIs)?

- Uses

A

Suppress gastric acid secretion

- Used to treat active ulcer disease erosive esophagitis, and pathological hypersecretory conditions

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22
Q

Side effects of PPIs

A

Headache, diarrhea, abdominal pain, nausea

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23
Q

Name the (5) PPIs

A

Esomeprazole, Lansoprazole, Omeprazole, Pantoprazole, Rabeprazole

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24
Q

What are the 2 types of treatment used to treat H. Pylori?

A

Triple therapy and quadruple therapy (combinations of either 3 or 4 meds)

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25
Q

Name the (3) combinations used for triple therapy of H. Pylori

A
  • Esomeprazole, amoxicillin, clarithromycin
  • Lansoprazole, amoxicillin, clarithromycin
  • Lansoprazole, amoxicillin, levofloxacin
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26
Q

Name the (2) combinations used for quadruple therapy of H. Pylori

A
  • Esomeprazole, metronidazole, tetracycline, bismuth subsalicylate
  • Ranitidine, metronadizole, tetracycline, bismuth subsalicylate
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27
Q

What are prokinetic agents?

- Name the most common one

A

Meds that stimulate the motility of the upper gastrointestinal tract and increase the rate of gastric emptying without stimulating gastric, biliary, or pancreatic secretions
- Metoclopramide is the most common one (and the only named in the Saunders book)

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28
Q

What are the uses of prokinetic agents?

A

Used to treat gastroesophageal reflux and paralytic ileus. Also used to treat nausea and vomiting.

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29
Q

Side effects of prokinetic agents

- What is the most major side effect?

A

Restlessness, drowsiness, extrapyramidal reactions, dizziness, insomnia and headache.
- It can cause parkinsonian reactions (muscle spasm, jerkyness, slow movement, tremors…)

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30
Q

When do we admin prokinetic agents?

A

Usually 30 mins before meals and then at bedtime

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31
Q

Contraindications of prokinetic agents

A

Mechanical obstruction, perforation, or GI hemmoraghe

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32
Q

What meds antagonize Metoclopramide?

A

Anticholinergics (like Atropine) and opioids

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33
Q

What meds produce an additive effect fort Metoclopramide?

A

Alcohol, sedatives, cyclosporine, and tranquilizers

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34
Q

What are Bile Acid sequestrants?

A

They are meds that act by abosrbing and combining with intestinal bile salts which then are secreted in feces preventing intestinal reabsorption

35
Q

What are the uses of Bile Acid sequestrants?

A

Used to treat hypercholesterolemia in adults, biliary obstruction, and pruritus associated with biliary disease

36
Q

What is the main reason for medication non-compliance for Bile Acide sequestrants?

A

The taste of the medication (especially if in powder form). We can fix this by combining the med with juices or other flavoured products.

37
Q

Side effects of Bile Acid sequestrants

A

Nausea, bloating, constipation, fecal impaction, and intestinal obstruction.

38
Q

Nam the (2) bile acid sequestrants

A

Colesevelam and Cholestyramine

39
Q

What medication is used to treat hepatic encephalopathy

A

Lactulose

40
Q

What is Lactulose used for?

A

Used to treat constipation but also used in the prevention and treatment of portal systemic encephalopathy , including hepatic precoma/coma by increases peristalsis and bowel evacuation. (Ammonia is secreted through the bowel).

41
Q

What is the normal ammonia level?

A

Normal ammonia level is 6-47 mcmol/L (10-80 mcg/dL)

42
Q

What are Pancreatic Enzyme replacement?

- Name the most common one

A

Meds used to supplement or replaceancreatic enzymes and thus improve nutritional status and reduce the amount of fatty stools.
- Most common oneis Pancrelipase

43
Q

When should Pancrelipase be taken?

A

Should be taken with all meals and snacks

44
Q

Side effects of Pancrelipase

A

Abdominal cramps, abdominal pain, nausea, vomiting, and diarrhea

45
Q

What medications interfere with the action of Pancrelipase?

A

Products containing calcium carbonate and products containing magnesium hydroxide

46
Q

What are the 2 forms of inflammatory bowel disease?

A

Ulcerative colitis and Crohns disease

47
Q

Name and explain the 5 categories of meds used to treat IBD?

A

Antimicrobials: Prevent or treat a secondary infection.
5-aminocalicylates: decrease GI inflammation
Corticosteroids: decrease GI inflammation
Immunosuppressants: suppress the immune response
Immunomodulators: modulate immune response to induce and maintain remission

48
Q

Name the (4) antimicrobial agents used to treat IBD

A

Cirpofloxacin, Metronidazole, Rifaximin, Clarithromycin

49
Q

Name the (3) 5-aminosalycilates used to treat IBD

A

Balsalazide, Mesalamine, Sulfasalazine

50
Q

Name the (3) corticosteroids used to treat IBD

A

Budesonide, Prednisone, Hydrocortisone

51
Q

Name the (4) immunosuppressants used to treat IBD

A

Azathioprine, Cyclosporine, Mercaptopurine, Tacrolimus

52
Q

Name the (4) immunomodulators used to treat IBD

A

Adalimumab, Certolizumab, Infliximab, Natalizumab

53
Q

What is IBS?

A

A gastrointestinal disorder that is characterized by crampy abdominal pain accompanied by diarrhea, constipation or both

54
Q

What are the 4 categories of laxatives used to treat IBS-consipation?

A

Bulk-forming, stimulants, emollients, osmotics

55
Q

What is Lubiprostone?

- When is it taken?

A

Lubiprostone: chloride channel activator that increases fluid in the intestines to promote bowel elimination. Used to treat IBD-C.
- Taken with food and water

56
Q

What is Linaclotide?

- When is it taken?

A

Linaclotide: Stimulates receptors in the intestines to promote bowel transit time.
Used to treat IBD-C.
- Taken daily 30 mins before breakfast

57
Q

Name the (3) bulk-forming laxatives

A

Methylcellulose, Polycarbophil, Psyllium

58
Q

Name the (2) stimulant laxatives

A

Bisacodyl and Senna

59
Q

Name the emollient laxative

A

Docusate sodium

60
Q

Name the (5) Osmotic laxatives

A

Magnesium hydroxide, magnesium citrate, Sodium phophates, polyethylene glycol and electrolytes, lactulose

61
Q

What is Alosetron?

- uses

A

It is a selective seratonin receptor antagonist

- Used to treat IBS-D

62
Q

Side effects of Alosetron

A

Constipation, impaction, bowel obstruction,perforation of bowel, ischemic colitis,

63
Q

What are the 2 categories of antidiarrheal medications

A
  • Opioids and related medications

- Other antidiarrheals

64
Q

Name the (2) opioids and such used to treat diarrhea

A

Diphenoxylate with atropine sulfate

Loperamide

65
Q

Name the (3) ‘other antidiarrheals’ used to treat diarrhea

A

Bismuth subsalicylate, bulk-forming medications, anticholinergic antispasmodics (dicyclomine, glycopyrolate)

66
Q

What should be monitored for antiemetics?

A

Vital signs, intake and output, signs of dehydration, fluid and electrolyte imbalances

67
Q

What are the 8 categories of antiemetics?

A

Seratonin antagonists, glucocorticoids, substance P/neurokinin-1 antagonists, benzodiazepine, dopamine antagonists (3 sub-categories: phenothiazine, butyrophenines, others), cannabinoids, anticholinergics, antihistamines

68
Q

Name the 3 Seratonin antagonist antiemetics

A

Dolasetron, Granisetron, Ondansetron

69
Q

Name the 2 Glucocorticoid antiemetics

A

Dexamethasone, methylprednisolone

70
Q

Name the 2 Substance P/Neurokinin-1 antagonist antiemetics

A

Aprepitant and Fosaprepitant

71
Q

Name the Benzodiazepine antiemetic

A

Lorazepam

72
Q

Name the 4 Phenothiazine antiemetics

A

Chlorpromazine, Perphenazine, Prochlorperazine, Promethazine,

73
Q

Name the 2 Butyrophenone antiemetics

A

Haloperidol, Droperidol

74
Q

Name the 2 ‘other’ Dopamine Antagonist antiemetics

A

Metoclopramide, Trimethobenzamide

75
Q

Name the 2 Cannabinoid antiemetics

A

Dronabinol, Nabilone

76
Q

Name the Anticholinergic antiemetic

A

Scopolamine transdermal

77
Q

Name the 5 Antihistamine antiemetic

A

Cyclizine. Dimenhydrinate, Diphenhydramine, Hydroxyzine, Meclizine hydrochloride

78
Q

What are bulk-forming laxatives?

A

Meds that absorb water into the feces and increase bul to produce large and soft stools

79
Q

What are stimulant laxatives?

A

Meds that stimulate motility of large intestine

80
Q

What are emollient laxatives?

A

Meds that inhibit absorption of water so fecal mass remains large and soft

81
Q

What are osmotic laxatives?

A

Attract water into the large intestine to produce bulk and stimulate peristalsis

82
Q

What are the interventions for diarrhea

A

Treat underlying cause, treat dehydration, replace fluids and electrolytes, relieve abdominal discomfort and cramping, reduce passage of stool

83
Q

When do we not use opioids as antidiarrheals?

A

When we suspect poisons, infections or bacterial toxins

NCLEX Pharm (7 decks)

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