GI Flashcards
Treatment of peptic ulcer diease
combination of lifestyle and pharmacotherapy work best
goals of treatment are to eliminate infection by H.pylori, promote ulcer healing, prevent recurrence of sympotms
Drugs used to treat Peptic Ulcer Disease
H2-receptor antagonists proton pump inhibitors antacids antibiotics miscellaneous drugs
Antibiotics (used for PUD)
administered to treat H.Pylori infections of GI tract
two or more antibiotics are given concurrently to increase effectiveness and lower the potential of creating resistance to treatment
usually uses a proton pump inhibitor and bismuth compounds (which inhibit bacterial growth and prevent h.pylori from adhering to gastric mucosa)
Therapeutic Action of Miscellaneous Drugs (for PUD)
SUCRALFATE - coats ulcer and protects it from further erosion
MISTOPROSTOL - inhibits acid and stimulates production of mucus
PIRENZEPINE - inhibits autonomic receptors responsible for gastric secretion
Therapeutic Action of H2-Receptor Blockers
suppress the volume and acidity of stomach acid
often drugs of choice to treat PUD
also treats GERD and heartburn
H2-Receptor Antagonists (blockers)
cimetidine
famotidine
nizatidine
ranitidine
Ranitidine (zantac)
prototype h2-receptor blocker or antagonist
used to treat PUD
acts by blocking h2-receptors in stomach to decrease acid production
adverse effects are possible reduction in the number of red and white blood cells and platelets, impotence, or loss of libido in men
What are some risks nurses must monitor for with h2-receptor antagonist therapy?
assess kidney and liver function
evaluate cbc for possile anemia during long term use
risk of dysrythmia and hypotension with IV cimetidine
therapeutic action of proton pump inhibitors
binds with the enzyme H+, K+, ATPase - this enzyme increases HCl
used for short term therapy of PUD and GERD
more effective at reducing gastric-acid H2-receptor blockers
need to be taken 30 minutes prior to eating and may be administered at same time as antacids
proton pump inhibitors
esomeprazole lansoprazole omeprazole pantoprazole rabeprazole
omeprazole
reduces acid secretion in stomach by binding irreversibly to enzyme H+, K+, ATPase
primarily used for short term (4-8 week) treatment of peptic ulcers and GERD
adverse effects include headache, nausea, diarrhea, rash, abdominal pain, drug interactions
**long term use associated with an increased risk of gastric cancer
Therapeutic action of antacids
neutralize stomach acid
are inexpensive and effective
simethicone added to reduce gas
relieve symptoms but don’t promote ulcer healing
Antacids
aluminum hydroxide
calcium carbonate
calcium carbonate with magnesium hydroxide
magnesium hydroxide
magnesium hydroxide with aluminium hydroxide
magnesium hydroxide with aluminium hydroxide with simethicone
sodium bicarbonate
Aluminium Hydroxide
prototype antacid
neutralizes stomach acid by raising pH of stomach contents
primarily used in combination with other antiulcer agents for relief of heartburn due to GERD or PUD
adverse effects are constipation or drug interactions
Drugs for treating bowel disorders
laxatives
antidiarrheals
antiemetics
drugs for pancreatitis
therapeutic action of laxatives
promotes bowel movements
bulk forming agents absorb water, adding size to fecal mass
stool softeners or surfacants cause more water and fat to be absorbed into stools
stimulants irritate bowel to increase peristalsis
saline or osmotic laxatives are not absorbed in intestine (pull water into fecal mass to create more watery stool)
herbal agents are natural product available OTC, the most common is SENNA
misc. agents include mineral oil, which acts as poop lube
Laxatives and Cathartics: Bulk-forming Agents
calcium polycarbophil
methylcellulose
psyllium mucilloid
Laxatives and Cathartics: saline and somotic agents
magnesium hydroxide
polyethylene glycol
sodium biphosphate
Laxatives and Cathartics: stimulants
bisacodyl
castor oild
phenolphthalein
Laxatives and Cathartics: stool softeners
doxusate
Laxatives and Cathartics: misc. agents
mineral oil
What are important things to assess for when treating constipation?
colon cancer
esophageal obstruction
intestinal obstruction
fecal impaction
undiagnosed abdominal pain
psyllium mucilloid
prototype laxative, bulking agent
swells and increases size of fecal mass
primary use is to promote passage of stool
adverse effects are rare and cramping is less than with stimulant type laxatives
therapeutic action of antidiarrheals
for mild diarrhea
effective at returning elimination patterns to normal
for severe cases, opioids are the most efficacious antidiarrheal agents
Antidiarrheals: Opioids
belladonna with opium
diphenoxylate with atropine
loperamide
antidiarrheals: misc. agent
bismuth subsalicylate
bismuth subsalicylate with kaolin-pectin
For whom is antidiarrheal therapy countraindicated?
severely dehydrated, those with electrolyte imbalance
patients with liver and renal disorders
glaucoma patients
diphenoxylate with atropine
antidiarrheal, opioid
slows peristalsis
primarily used for moderate to severe diarrhea
adverse effects are dizziness and drowsiness
NOT recommended for children
Therapeutic action of drugs for Inflammatory bowel disears
mild to moderate is treated with 5-aminosalicylic acid or 5-ASA
corticosteroids used in more persistent cases
particularly severe may require immunosuppresent drugs
`therapeutic action of drugs for irritable bowel syndrome
treatment is supportive
targeted at symptoms
medications include bulk laxatives, anticholinergic drugs, serotonin agonists
therapeutic actions of antiemetics
drugs from at least 8 classes
used to prevent nausea and vomitting
act by inhibiting dopamine or serotonin receptors in brain
select antiemetics
anticholinergic: SCOPOLAMINE
antihistamines: DIMENHYDRINATE
DIPHENHYDRAMINE
HYDROXYZINE
benzodiazipines: DIAZEPAM
LORAZEPAM
cannabinoids:CANNABIDIOL
glucocorticoids: DEXAMETHASONE
METHYPREDNISOLONE
phenothiazines and phenothiazine like agents METOCLOPRAMIDE PERPHENAZINE PROCHLORPERAZINE PROMETHAZINE
serotonin receptor antagonists
DOLASETRONETRON
ONDANSETRON
GRANISETRON
What are emetics?
emetics are drugs that stimulate nausea or vomiting
prochloperazine
prototype antiemetic
blocks dopamine receptors to brain, inhibiting signals to vomiting center in medulla
primarily used for severe nausea and vomiting, but also to treat psychosis
adverse effects include dore-related anticholinergic side effects(dry mouth, sedation, constipation, orthostatic hypotension, tachycardia, extrapyrimidal symptoms**
**the serious concern with prolonged therapy
therapeutic action for pancreatitis
pancrease secretes essential digestive enzymes carboxypeptidase, chymotrypsin, and trypsin
lipase, amylase and nuclease require presence of bile
lack of secretion results in malabsorption disorders. replacement therapy is sometimes warrented
pancrelipase
prototype drug for pancreatitis
contains lipase, protease, and amylase of pork origin which: facilitates conversion of lipid into glycerol and fatty acids; converts starches to dextrin & sugars andconverts proteins to peptides
primarily used as replacement therapy for clients with insufficient pancreatic exocrine secretions
adverse effects include GI symptoms of nausea, vomiting and or diarrhea. can cause hyperuricosuria
