Gastrointestinal Drugs (82) Flashcards by Ella Thorsteinson

Body of the stomach contains

-parietal cells
-ECL cells
-chief cells

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Parietal cells

Produce and secrete HCl to keep stomach at pH of 1 to 2

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What is the primary site of action for many acid controller drugs

Parietal cells

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ECL cells

Secrete histamine
-stimulate parietal cells

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H.pylori percentage in duodenal ulcers/gastric ulcers

90%- duodenal
70%- gastric

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What is used to eradicate H pylori

Antibacterials

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Inhibitors of gastric acid secretion/action (4)

-H2 antagonists
-proton pump inhibitors
-antacids
-other agents protecting mucosa

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Antacid examples (4)

-mg salts
-calcium salts
-sodium bicarbonate
-aluminum salts

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what do H2 Atagonists reduce?

Acid secretion

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How can H2 Atagonists be sold OTC?

They are sold in much lower dosage forms

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H2 Atagonists are the most popular drugs for

Treatment of acid related disorders

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Example of H2 Atagonists

Cimetidine

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Cimetidine has some..

Drug interactions
-so less used

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MOA of H2 Atagonists

Block histamine H2 receptors of acid producing parietal cells
-receptor antagonist

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H2 Atagonists cause a decreased production

Of HCl

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Indications of H2 Atagonists

-GERD
-PUD
-adjunct therapy in control of upper GI bleeding
-pathological gastric hypersecretory conditions

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AE H2 Atagonists

Low incidence
-impotence and gynecomastia
-CNS depression and confusion in elderly patients

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Cimetidine AE

May induce impotence and gynecomastia
-antiandrogenic effect

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Cimetidine MOA

Inhibits liver cytochrome P-450

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Cimetidine could affect what aspects of other drugs?

Affects the metabolism of other drugs causing increased drug levels
-example warfarin

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Need increased care with Cimetidine in patients with

Impaired renal or liver function, and cautiously in confused, disoriented or elderly patients

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Cimetidine need to be take 1 hour before taking..

Antacids
-affects absorption

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Proton pump inhibitors work by

Inhibition of the pump that moves H+ into stomach of lumen

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Proton pump inhibitors are more effective than

H2 antagonists

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Proton pump inhibitors MOA

Irreversibly bind to H+/K+ ATPase enzyme -normal acid secretion needs parietal cell to synthesize new H+/K+ ATPase

Examples of Proton pump inhibitors

Omeprazole

Enteric coated and broken down by acid

Indications of Proton pump inhibitors

-GERD maintenance therapy -erosive esophagitis -short term tax of active duodenal and benign gastric ulcers -zollinger Ellison syndrome

Zollinger Ellison syndrome

Gastric producing tumour

AE Proton pump inhibitors

Safe for short term therapy -headaches, GI

Proton pump inhibitors should be used in caution in patients with

Liver disease

Drug interactions with Proton pump inhibitors

Inhibit the absorption of drugs that require an acidic GI environment for absorption

Typical therapy for H pylori infection

Triple therapy -antibacterials -Proton pump inhibitors -takes seve to fourteen days

Proton pump inhibitors may increase the serum of what three drugs

-diazepam -phenytoin -inc risk of bleeding with warfarin

Proton pump inhibitors + diazepam

BZD used in many CNS conditions

Instructions when taking omeprazole (3)

-capsule should be swalllowed whole, never crushed, open or chewed -it may be given with antacids -treatment is short term

Antacids MOA

chemically neutralize acid

Antacids do not prevent

Acid production

Antacids can be used alone or in combination with

-aluminum salts -magnesium salts -calcium salts -sodium bicarbonate

Aluminum salts: salts are made up of

Carbonate and hydroxide

Aluminum salts may cause

Constipation

How do you reduce constipation in Aluminum salts

Take them with magnesium salts

Example of Aluminum salts

Aluminum hydroxide

Magnesium salts: salts made up of

Carbonate, hydroxide, oxide trisilicate

Magnesium salts commonly cause

Diarrhea -usually paired with agents to counteract the diarrhea

Magnesium salts can be dangerous when used with

Renal failure -due to accumulation

Calcium salts: salts made up of

Many, but carbonate is most common

Calcium salts may cause

Constipation and kidney stones

Example of calcium salts

Calcium carbonate

Sodium bicarbonate (3)

-highly soluble -quick onset, short duration -may cause metabolic alkalosis

Sodium component of sodium bicarbonate

May cause problems in clients with HF, hypertension or renal insufficiency

AE of antacids:

I’m nail and depends on compound used

AE of antacids: aluminum and calcium

Constipation

AE of antacids: magnesium

Diarrhea

AE of antacids: calcium carbonate

Constipation, produces gas and belching

Calcium carbonate is often combined with

Simethicone

Interactions of antacids can effect

Absorption of other drugs -reduce absorption of other drugs given at the same time

Drug interactions with chelation

Chemical binding, inactivation of another drug -produces insoluble complexes

Insoluble complexes of chelation causes

Reduced drug absorption -tetracycline

Need to assess for ____ when giving antacids

Allergies and pre-existing conditions that may restrict the use of antacids

Clients with HF or hypertension should use ____ antacids

Low sodium

Most medications should be given how many hours before antacids?

1 to 2 hours

Antacids may cause premature dissolving of

EC medications

Administer antacids with

At least 240 mL of water to enhance dispersion

Caffeine, alcohol, harsh spices and black pepper may do what

Aggregate an underlying GI condition

Other agents that protect the mucosa

Sucralafate and misoprostol

Sucralfate

Binds directly to ulcer surface

Misoprostol

Prostaglandin agent

What type of agent is sucralfate

Cytoprotective agent

MOA of sucralfate

-Forms gel with mucus in low pH -attracted to and binds to the base of ulcers and erosions = protective barrier -inhibits pepsin

Indications of sucralfate

Intestinal erosions

Sucralfate has little

Absorption from the gut

Sucralfate adverse effects

May cause constipation, nausea, dry mouth, and impair absorption of other drugs

Sucralfate binds with

Phosphate -may be used in chronic renal failure to reduce phosphate levels

Misoprostol MOA

Does the job of endogenous PGs -12 and E2

Prostaglandins have cytoprotective activity

-production of mucus and bicarbonate -reduce acid secretion -promote local cell regeneration -help to maintain mucosal blood flow

Misoprostol indications

Reduce gastric effects of NSAIDs

Misoprostol is never used

In pregnancy -can be used to terminate pregnancy