GI Flashcards
What does the mucosal layer of the stomach do?
secretes mucus to protect the inner layers of the stomach from hydrochloric acid and pepsin
What does the submucosal layer of the stomach do?
it contains the structure that produces mucus, stomach acid, pepsin, and bicarbonate (keeps the pH balanced)
What stomach in the stomach produces secretin?
duodenum. It stimulates the pancreas to produce bicarb and cholecystokinin
What does cholecystokinin do?
stimulates the gallbladder to release bile
What does bile do?
it neutralizes the acidity of chyme as it leaves stomach
What are six categories of drugs that support the treatment of peptic ulcers?
histamine H2 agonist
PPI
Mucosa protectants
antacids
prostaglandin E analonges
antibiotics
What is a factor that can increase the risk of peptic ulcers?
H. pylori
What do histamine H2 agonist
treat?
hypersecretory disorders, GERD, heartburn, dyspepsia and aspiration pnumonitis
What kind of drug can treat Zollinger-Elison syndrome?
histamine H2 agonist
What are some differenttypes of histamine H2 agonist?
cimetidine aka Tagamet
famotide aka Pepcid
nizatide aka Axid
How do histamine H2 agonist work?
block the histamine receptors in the stomach located on the parietal cells, decreasing the amouth of stomach acid
What are some adverse reactions to histamine H2 agonist?
impotence
gynecomastia (overdevelopment or enlargement of the breast tissue in men or boys)
increased chance of pneumonia
arrhythmias
lethargy
How should histamine H2 agonist be given?
orally, IM or IV with or without food because mals will prolong effects
What medications should be avoided with histamine H2 agonists?
NSAIDs
alcohol
increases warfarin, (anticoagulant drug)
lidocane,
phenytoin (drug to control seizures)
What vices should be avoided with histamine H2 agonists?
alcohol and smoking are a no-no
Histamine H2 agonists should be used with caution for older adults with what?
kidney or liver dysfunction or porphyria ( buildup of chemicals that result in many disorders)
What can reduce absorption of histamine H2 agonists?
antacids
Cimetidine should not be taken with what and what and why and why?
warfarin –> bleeding
phenytoin –> neuro effects
theophylline–> overstimulation of heart, lungs and CNS
What is Zollinger-Ellison syndrome and what drug treats it?
group of symptoms comprised of severe peptic ulcer disease
PPI
What are some PPI’s?
pantoprazole aka Protonix
lansopraxole aka Prevacid
esomeprazole aka Nexium
How do PPI’s work?
lower the amount of acid that hydrogen potassium ATPase enzyme proton pumps in the stomach produces
What are some long-term side effects of PPI use?
increased risk for bone loss and hypomagnesemia for those taking drug for longer than three months
What are some supplements to take with PPI’s
calcium and vitamin D
What are some dosing considerations for PPI’s
remain on the lowest dose possible for the shortest time needed to achieve desired effects
When should PPI’s be administered?
orally once before the first meal of the day
What types of patients should use PPI’s carefully?
pregnant, lactating, or those with liver problems
What supplement can reduce the drug levels of omeprazole?
St. John’s wort
What drugs can treat duodenal ulcers?
mucosal protectants
What are some types of mucosal protectants?
sucralfate aka Carafate
How do mucosal protectants such as sucralfate work?
creates a gel that coats ulcers and creates barriers between the stomach and gastric secretions
How should sucralfate be given?
on an empty stomach four times a day, not within 30 minutes of antacids and two hours of fluoroquinolone antibiotics, warfarin, phenytoin, theophylline, digoxin, tetracycline, or diazepam
What are some patient teachings for mucosal protectants?
increase fluids, fiber, and fitness
What are antacids used to treat?
peptic ulcer disease and GERD
What drugs are considered antacids?
aluminum hydroxide aka Amphojel
magnesium hydroxide aka milk of magnesia
calcium carbonate aka Tums
What are some adverse drug reactions of antacids?
constipation and hypophosphatemia because aluminum binds with phosphate
How should antacids be administered?
orally and up to four times a day, chewed with water
What are patient teachings for antacids?
increase fluids, fiber, and fitness
what are Prostaglandin E Analogs used for?
prevent gastric ulcers that can results from long-term use of NSAIDs
Prostaglandin E Analog drugs
misoprostol aka Cytotec
How does misoprostol work?
it decreases gastric acid secretion, increases bicarbonate secretion, and increases mucus, and increases vasodilation of submucosal wall
What are some adverse reactions of misoprostol?
diarrhea and abdominal pain, miscarriage, spotting, uterine cramps, and dysmenorrhea
What are client instructions for misoprostol?
expect diarrhea after first week
increase fluids and food if necessary
report menstrual changes
What are some common nausea classifications?
serotonin antagonists, antihistamines, and dopamine antagonists
What are some types of serotonin antagonists?
ondansetron aka Zofran
granisetron aka Sancuso/Granisol
palonosetron aka Aloxi
How do serotonin antagonists work?
they blod 5-HT3 seotonin receptors on the chemoreceptor trigger zone in the brain and the nerve terminals of afferent vagal nerves that innervate stomach and small intestine and the drugs antagonize at these sits to minimize nausea and subsequent vomiting
What are some adverse drug reactions from serotonin antagonists?
serotonin syndrome (sivering and diarrhea, seizures)
torsade de pointes- type of ventricular tacycardia
Stevens-Johnson syndrome
What are some client instructions when taking serotonin antagonists?
report severe or persistent headaches
dizziness
dehydration
What are some patients who should be careful with serotonin antagonists?
those with phenylketonuria, hepatic disease, ab surgery, preggo or lact women, those under three y.o.
What are some drugs that affect serotonin antagonists?
SSRI, SNRI
tricyclic antidepressants
MAOIs
fentanyl, lithium
etc
What are some types of antihistamines for antinausea?
dimenhydrinate
How do antihistamines prevent vertigo, nausea and vomiting?
they block the release of Histamine H1 receptors in the inner ear and nurons that connect the inner ear to the chemoreceptor trigger zone
What are some adverse drug effects of antihistamines?
sedation and drowsines and dizziness
dry mouth, constipation
urinary retention
What type of patients are contraindicated to take antihistamines?
angle-closure glaucoma and preemies or newborns
What type of patients should cautiously take antihistamines?
hyperthyroidism
CVD
hepatic disease
pyloric obstruction
prostatic hypertorphy
pregnant or lactating women
What are some interactions with antihistamines?
CNS depressants
MAI inhibitor antidepressants cause anticholinergic effects
What are dopamine antagonists good for?
anti nausea an vomitting associated with chemotherapy, opioids and radiation therapy to increase GI motility in GERDS and diabetic gastroparesis
What are some types of prokinetic/dopamine antagonists?
metoclopramide aka Reglan
How does metoclopramide work?
GERDS- increases tone of the lower esophageal sphincter
diabetic gastroparesis- increases peristalsis in both the stomach and intestines
treats nausea and vomitting by increasing the threshold of the cTZ in the brain
What are some adverse reactions to metoclopramide ?
sedation,
extrapyramidal rxns (tardive dyskinesia when metoclopramide is taken long-term or high dose)
restlessness, and neuroleptic malignant syndrome
What are some things to watch for with clients on metoclopramide?
extrapyramidal effects, anxiety, spasms, lip-smacking etc
dehydration
diarrhea
What are some client instructions with metoclopramide?
don’t operate machinery that require mental alertness
lie or sit if drowsy
fluids
What are some contraindications for metoclopramide?
GI obstruction
hemorrhage
perforation
uncontrolled seizure disorder
pheochromocytoma (a type of neuroendocrine tumor that grows from cells called chromaffin cells developing in adrenal gland)
breast cancer
What interacts with with metoclopramide to have sedative effects?
CNS depressants
What happens if you give metoclopramide with opioids and anticholinergics
decrease metoclopramide’s therapeutic effects on the GI tract
Metoclopramide can negatively affect the absorption of what types of drugs?
Tylenol, aspirin, diazpam (Valium), tetracycline, digoxin (Lanoxin) and lithum (lithobid)
What are some types of bulk-forming agents?
psyllium aka Metamucil
calcium polycarbophil aka FiberCon
methylcellulose aka Citrucel
How do bulk-forming agents work?
they absorb water from the intestin to form a glutinous mass that adds bulk to the stool
Why should bulk-forming agents be taken with water?
the supplement swell when mixed with fluid and if there is not enough, they can become a thick glutinous mass in their intestine creating a blockage
How long should you wait to see soft stool after taking bulk-forming agents?
1-3 days after starting therapy
What are some types of surfactant laxatives/stool softeners?
docusate sodium aka Colace
docusate sodium with senna aka Peri-Colace
What kind of drug works aby changing the surface tension of stool?
stool softeners/ surfactant laxatives
What are some adverse effects of stool softeners?
diarrhea, mild abdominal cramps, throat irritation and rashes
Who are stool softeners contraindicated for?
those with GI obstruction or perf
fecal impaction
n/v
mineral oil use
some ab pain from somewhere
Stool softeners should not be used with what?
mineral oil and laxatives
What should be given to patients who have constipation from opioid use?
stimulant laxatives
What are types of stimulant laxatives?
Bisacodyl aka Dulcolax
senna aka Senokot
How do stimulant laxatives work?
stimulate intestinal motility by causing decreased absorption of fluids through it while increasing secretion of water and electrolyte
Why do stimulant laxatives have more side effects than fiber supplements and stool softeners?
waste takes longer to travel through the colon and can cause more cramps
Why is it bad to use stimulant laxatives long term?
it can result in abuse and dependence
What are some risks of taking stimulant laxatives?
buring with suppository (bisacodyl
dehydration
mild abdominal cramps
stimulant laxatives should not be taken with what?
antacids or milk becase they can dissolve the enteric coating
Why are opiods good for diarrhea?
they promote gastric immobility
What are some drugs for diarrhea?
diphenoxylate with atropine and loperamide
diphenoxylate with atropine aka Lomotil
loperamide aka Imodium
How do opioids decrease intestinal paralysis?
the bolus has more time in the intestinal tract, which allows for more water absorptionand results in smaller and harder feces
What are some adverse drugs reactions of antidiarrheal opioids?
cardiac arrest and arrhythmias
drowsiness
constipation
dizziness
altered urinary elimination patterns
electrolyte imbalances
Who should not take antidiarrheal opioids?
those younger than two, inflammatory bowel disease, advanced hepatic disease, glaucoma, etc
What drugs can interact with antidiarrheal opioids?
CNS depressants
MAOI will increase risk for hypertensive crisis
use of cimetidine, erhthromycin and quinine can increase cardiac arrhythmias
What is a drug approved to treat women with IBS and diarrhea that has lasted more than six months and has not responded to conventional treatment?
alosetron aka Lotronex
What does Lubiprostone aka Amitiza treat?
IBS with constipation
How does alosetron aka Lotronex work?
it blocks serotonin 5-HT3 receptors by decreasing visceral pain, slowing peristalsis, increasing absorption of water and sodium through the intestinal wall, and reducing the secretion of water and electrolytes from the intestinal wall
What are some adverse reactions to alosetron aka Lotronex?
constipation –> impaction –> perforation
alosetron aka Lotronex is contraindicated for what types of clients?
chronic and complicated constipation, diverticulitis, Chron’s disease, ulcerative or ischemic colitis, thrombophlebitis or another hypercoagulable state, toxic megacolon, and any type of GI perforation
What are some interactions with alosetron aka Lotronex?
drugs that interfere with cytochrome P450 enzymes like phenobarbital, carbamazipine, cimetidne
quinolone antibiotics aka Luvox increases alostron levels
Who should take lubiprostone aka Amitiza
IBSC with constipation in women 18 y.o.+ and Linaclotide
Who is Linaclotide (Linzess) approved for?
people with IBSC and CIC
What is Lubiprostone used for?
decrease visceral pain
increase peristalsis
increase secretion of water and electrolytes form the intestinal wall by activating chloride channels in the intestinal wall
Lubiprostone side effects
n/v
diarrhea and farting
Lubiprostone contraindications
severe diarrhea, diverticulitis, Crohn’s disease, ulcerative colitis, volvulus, and GI obstruction.
5- Aminosalicylates are used to treat what?
mild to moderat inflammatory bowel disease
5- Aminosalicylates types are what?
sulfasalazine aka Azulfidine
mesalamine- Asacol and Rowasa
How does sulfasalazine work?
gets converted in the intestine into 5-aminosalicylic acid (mesalamine) and sulfapyridine. The mesalamine inhibits prostaglandin, which controls the inflammation process and contractions
What are some adverse effects of sulfasalazine?
nausea, fever, sore throat, rash, headaches, agranulocytosis and megaloblastic or hemolytic anemia
What physiological changes are expected when taking sulfasalazine?
change in urine (orange-yellow) and skin color (photosensitivity)
What are some contraindications for sulfasalazine?
salicylates (NSAIDs) sulfonamides, or trimethoprim, folate deficiency, megablastic anemia, agranulocytosis, renal failure, porphyria, and GI or UT obstructions
do not give to those younger than 2 y.o.
What are some interactions with sulfasalazine ?
iron or antibiotics will increase absorption of sulfasalazine
mesalamine with digoxin will decrease absorption of digoxin.
What are some immunosuppressants for IBD?
azathioprine
What are some adverse drug reactions for immunosuppressants?
nausea, vomiting, anorexia, hepatotoxicity, fever, and bone marrow suppression including neutropenia and thrombocytopenia
What are some things to watch out for when patient is taking immunosuppressants?
persistent n/v and anorexia
liver function tests such ALT and AST or ALP
lowered WBC
What do high levels of ALT in the blood indicate?
damaged liver or injury
What are some precautions for people who are taking immunosuppressants for IBD?
handwashing
unnecessary invasive procedures
meticulous wound care
restrict visitors and staff with upper respiratory infection
no raw fruits or veggies
What are some contraindications for people who are taking immunosuppressants for IBD?
active infection
pancreatitis
anuria
myasthenia gravis (autoimmune n/m disease causing weakness
renal/hepatic dysfunction
What are some interactions with immunosuppressants?
azathioprine and allopurinol (gout drug) because they can increase the blood levels of azathioprine
