GI and Hormones Flashcards
Antiulcer antibiotics Drugs
Amoxicillin Bismuth Clarithromycin Metronidazole Tetracycline Tinidazole
Antiulcer Antibiotics MOA
Eradicate H. pylori
Antiulcer-secretory agents
H2 receptor antagonists
PPI
Antiulcer Mucosal protectant Drugs
Sucralfate
Antiulcer Antisecretory agent that enhances mucosal defenses
Misoprostol
Antiulcer Antacids
Aluminum hydroxide/ Calcium Carbonate/ Magnesium hydroxide
H2 receptor antagonist Drug
Cimetidine*
Ranitidine
Famotidine
Nizatidine
Cimetidine MOA
Blocks H2 receptors, reducing both volume of gastric juice and its hydrogen ion concentration
Suppresses basal acid secretion
Cimetidine Use
Gastric, Duodenal ulcers from H. pylori GERD Zollinger-Ellison syndrome Heartburn Acid indigestion Sour stomach
Cimetidine A/E
Rare: (most likely to occur in elderly or renal/ hepatic impairment) -confusion -hallucinations -CNS depression and excitation Pneumonia Imbalance of microbiome Gynecomastia Impotence Hematological effects
Cimetidine A/E IV bolus
Hypotension
Dysrhythmias
Cimetidine Therapy duration
normally 8-12 wk for PUD, can be longer
Cimetidine Reduced dosing
Renal impairment– reduce by 50%
Cimetidine Drug interactions
Increase levels of: -Warfarin -Theophylline -Phenytoin -Lidocaine Antacids decrease level of Cimetidine
Cimetidine Food interactions
Food may extend the effects of the drug
Proton Pump Inhibitor Drugs
Omeprazole
Pantoprazole
Omeprazole MOA
More efficiently and longer than H2 receptor antagonists
Blocks gastric acid production by irreversibly inhibiting H, K, ATPase (enzyme that generates gastric acid)
Omeprazole Use
Gastric, Duodenal ulcers from H. pylori Esophagitis GERD Hypersecretion conditions Stress ulcers
Omeprazole A/E
Rare:
- HA
- N/V/D
- Pneumonia
- FRACTURES – from decreased Ca reserves
- Rebound acid hypersecretion– taper off
- HYPOMAGNESEMIA
- B12 deficiency ( Cobalamin)
C. dif– report diarrhea immediately
Omeprazole Drug interactions
reduce effects of some HIV drugs
reduce absorption for some antifungals
↓ effects of Clopidogrel
CYP3A4
Omeprazole Patient educations
increased diet in Ca, Mag, B12
Omeprazole Nursing thoughts
should not be used longer than absolutely necessary → 6-12 wk
some patients may need longer (hiatal hernia)
Pantoprazole Use
IV for stress ulcers in the ICU
Pantoprazole Dosing
IV → 40mg vial to be reconstituted for IV use
Convert to PO ASPA
Pantoprazole A/E
Diarrhea❊ Dyspepsia ❊ Hypomagnesemia❊ Osteoporosis/fractures❊ Nausea Dizziness Thrombophlebitis
Sucralfate MOA
Undergoes polymerization and cross-linking reactions
- creates a barrier over the ulcer
- last >6 hours
Sucralfate Use
Promote healing of ulcer
duodenal ulcers
-NOT CURATIVE (only promotes healing)
Sucralfate A/E
Constipation → increase fluid intake
Sucralfate Drug interactions
DO NOT give oral meds within 30 minutes of this drug → impedes absorption ↳Phenytoin ↳Theophylline ↳Warfarin ↳Fluoroquinolones ABX (give 2 hr apart) Antacids with Al
Sucralfate Nursing considerations
can be crush, dissolved in water, or given as a suspension
Sucralfate Dose
QID
Misoprostol MOA
Prostaglandin E1 analog
Suppresses secretion of gastric acid, promotes secretion of bicarbonate and cytoprotective mucous
-Protective mucous that protects the lining of the GI tract ( makes the lining of the intestine healthier)
Misoprostol Use
Prevents gastric ulcers caused by long term used of NSAIDs
Misoprostol A/E
Diarrhea
Abdominal pain
Women may have spotting and dysmenorrhea
Misoprostol Contraindications
Pregnancy
↳must have negative pregnancy test
Antacids drugs
Magnesium hydroxide
Aluminum hydroxide
Calcium carbonate
Sodium bicarbonate
Antacid MOA
Neutralize stomach acid decreasing destruction of the stomach wall
Can reduce pepsin activity
Stimulate prostaglandin to improve mucosal protection
Antacid Use
PUD
GERD
Ulcers: need to be taken on a regular schedule
Antacids A/E
Can be unpleasant to take Constipation: Al Diarrhea: Mg Sodium loading (HTN, HF): Na Flatulence: Ca, Na
Antacids Drug interactions
interferes with dissolution and absorption of many drugs (Cimetidine)
-give 30 min -1 hr apart
Antacids Caution
renal impairment
Laxatives Types
Bulk forming
Surfactant
Osmotic
Stimulant
Bulk forming drugs
Methylcellulose
Psyllium
Polycarbophil
Surfactant Drugs
Docusate sodium
Docusate Calcium
Osmotic Drug
Lactulose
Stimulant Drug
Bisacodyl
Bulk forming MOA
Same as fiber
Docusate Na, Ca MOA
lower the surface tension, inhibit fluid absorption and stimulate secretion of water and electrolytes into the intestinal lumen
Bisacodyl MOA
Stimulate intestinal motility
Increase the amount of water and electrolytes within the intestines
Lactulose MOA
Osmotic action draws water into the intestine, causing feces to soften, swell, thereby stretching the intestines and stimulate peristalsis
Laxative Use
Stool Softener Adjunct to antihelminthic treatment Surgical/Dx prep Modifying effluent from ileostomy/colostomy Prevent fecal impaction Removal of ingested poisons Correcting constipation
Lactulose Uses
High dose: bowel prep for Dx procedures
intestinal excretion of ammonia
Bulk forming DOC
constipation
Bulk forming Other uses
Diverticulosis
IBS
Docusate Use
Stool softener
Bisacodyl Use
Opioid induced constipation
Constipation from slow intestinal transit
Bisacodyl Drug interactions
Milk increases the speed of dissolution, should be avoided
Bisacodyl A/E
burning
proctitis
Lactulose A/E
Dehydration
Hypermagnesemia
Docusate Sodium A/E
Fluid retention
HF exacerbation
HTN
Edema
Laxative Contraindications
Abdominal pain Nausea Cramps Acute abdomen Fecal impactions Bowel obstruction
Laxative Cautions
pregnancy and lactating
Lactulose Cautions
renal impairment
↳can cause hypermagnesemia
Bulk forming/Surfactants Nursing considerations
take with lost of fluids
Bisacodyl Nursing considerations
Can be abused
Lactulose Nursing considerations
Fluid loss
Good for those with hepatic encephalopathy, chronic liver diseases
Laxative Nursing considerations
Hypermagnesemia w/Mg salts
Fluid retention w/Na salts
Serotonin antagonist Antiemetic
Ondansetron
Ondansetron MOA
Blocks type 3 serotonin receptors (5-HT)
Ondansetron Use
Relief and prevention of nausea and vomiting related to chemo, cancer, anesthesia, viral gastritis, pregnancy
Ondansetron A/E
HA Dizziness Diarrhea ❊Prolonged QT interval ↳increases risk for torsades de pointe Exacerbate fluid/electrolyte imbalance
Ondansetron Combo
sometimes combined with Dexamethasone to increase effects
Benzo Antiemetic Drug
Lorazepam
Lorazepam MOA
Sedation, suppression of anticipatory emesis, anteretrograde amnesia
Lorazepam Use
Combo with other drugs to reduce CINV
May help control EPS
Dopamine Antagonist Antiemetic Drugs
Phenothiazine
Metoclopramide
Phenothiazine MOA
Suppresses emesis by blocking dopamine 2 receptors in the chemoreceptor trigger zone
Phenothiazine Use
reduce emesis associated with surgery, cancer, chemo, other toxins
Phenothiazine A/E
Extrapyramidal reactions
Anticholinergic effects
Hypotension
Sedation
Promethazine A/E
respiratory depression and local tissue injury are serious concerns
Motion sickness drug
Scopolamine
Scopolamine MOA
Muscarinic antagonist (anticholinergic) Suppresses the nerve traffic in the neuronal pathway that connects vestibular apparatus of inner ear to the vomiting center
Scopolamine Route
Transdermal behind the ear
Scopolamine A/E
Dry mouth Blurred vision Drowsiness Less common: -Urinary retention -Constipation -Disorientation
Antidiarrheal Opioids Drug
Loperamide (Imodium)
Diphenoxylate
Loperamide MOA
Structural analog of meperidine
Low potential for abuse
Does not cross the BBB
Diphenoxylate MOA
Activate opioid receptors in the GI tract, decreasing intestinal motility and slowing intestinal transit time
Allows more time for absorption of fluid and electrolytes
Fluid, volume, and frequency of defecation is reduced
Diphenoxylate A/E
High dose: morphine like effects
Those with IBD may develop toxic megacolon
Diphenoxylate Drug interactions
Add Atropine to prevent abuse
Diphenoxylate Antidote
Naloxone
Prokinetic Agent Drug
Metoclopramide
Metoclopramide Use
Suppress emesis
Increase upper GI motility
N/V in pregnancy
Metoclopramide Oral Use
GERD
Diabetic gastroparesis
Metoclopramide IV Use
Post op N/V, chemo, facilitation of small bowel intubation/ GI tract
Metoclopramide A/E
High doses:
-Sedation
-Diarrhea
Tardive dyskinesia: elderly
Metoclopramide Contraindications
Hemorrhage
Perforation
Obstruction
Metoclopramide Nursing considerations
give 30 min before a meal or before chemo
give smallest amount for shortest time
IBS-D Drug
Alosetron
Alosetron MOA
Blocks 5HT3 receptors in the viscera, causing an increase in colonic transit time, reduced intestinal secretions, more normal bowel pattern with less pain
Alosetron Use
Women with IBS-D for more than 6 mo
Alosetron A/E
CONSTIPATION ❊ impaction bowel obstruction perforation fatal GI toxicity Ischemic Colitis
Alosetron Drug interactions
CYP3A4 Carbamazepine Phenobarbital Cimetidine Quinolone Ketoconazole
Alosetron Contraindications
History of other bowel problems
Alosetron Nursing considerations
Very dangerous
Must have a patient/physician agreement signed
IBS-C Drugs
Lubiprostone
Linaclotide
Sulfasalazine MOA
Metabolized in the gut to form 5-ASA and sulfapyridine
5-ASA reduces inflammation in the gut
Sulfasalazine Use
Acute, mild-moderate ulcerative colitis Crohn's disease RA Pregnancy Inflammatory bowel disease
Sulfasalazine A/E
Nausea Fever Rash Arthralgias Hematologic disorders (anemias) Increased risk for infection
Sulfasalazine Monitoring
CBC regularly
Immunomodulator for IBD
Infliximab
Infliximab MOA
Monoclonal antibody products which modulate immune responses
Tumor necrosis factor alpha-inhibitor
Infliximab Use
May be 1st line for inducing remission for IBD
1st line for severe disease or perianal Crohn’s disease
RA
Infliximab dosing
0,2,6 wk, followed by infusions every 8 wk
Infliximab A/E
Infusion reaction Fever Chills Pruritus Cardiopulmonary complications ↑R/f lymphoma Immunosuppressant: ↑r/f -bacterial sepsis -TB -HIV -invasive fungal infection
Palifermin MOA
Synthetic form of human keratinocyte growth factor (KGF), a naturally occurring compound but produced by recombinant DNA technology
Increases epithelium cell level
Palifermin Use
1st drug for Mucositis
✔︎ pt with hematological malignancies (but only in those receiving high dose chemo and whole body irradiation
Palifermin A/E
Rash, Erythema (most common, skin and mouth)
↑Amylase/ lipase
Distorted taste
Thickening and or discolored tongue
Oral/periodontal diseases
Growth in lens of eye can cause vision problems
Palifermin Drug interaction
Binds with Heparin
Give 2hr before or after chemo since it can make mucositis worse
Estrogen
Premarin, Estradiol
Estrogen produced
Produced by the follicular cells for the 1st 14 days
Premarin, Estradiol Use
Menopausal hormone therapy Female hypogonadism Acne Cancer palliative care Transgender transition
Premarin, Estradiol A/E
W/O progestin: endometrial hyperplasia*, cancer* Breast cancer Thromboembolic event (MI over 60) Gallbladder disease Accentuate preexisting liver disease HA Nausea Fluid retention Breast tenderness
Premarin, Estradiol Route
Any
Transdermal and intravaginal decrease risk for liver injury and 1st pass effect
Premarin, Estradiol Drug interactions
P450 Drugs
Antidiabetic
thyroid
Anticoagulants
Premarin, Estradiol Absolute Contraindications
History of DVT, PE, MI, liver disease, estrogen dependent tumor, breast cancer
Pregnancy
Undiagnosed vaginal bleeding: can be vaginal hyperplasia= cancer
Premarin, Estradiol Nursing considerations
Screening is most important
Use smallest dose for the shortest time possible
Nursing considerations for Estrogen and Progestin
Educate regarding personal risk profile Non-pharm strategies for symptom relief With uterus need estrogen and progestin Without uterus only estrogen Combo given PO continuously Some combos can be given cyclically Educate on taking correctly D/C estrogen then progestin
Transdermal Application
Daily or twice weekly
Vaginal ring
left in for 3 mo
Progestin Use
Menopausal hormone therapy - counter weight for estrogen
Dysfunctional uterine bleeding
Amenorrhea (women who don’t bleed give progestin for a few days then stop= bleeding)
Infertility
Prematurity prevention
Endometrial carcinoma and hyperplasia
Balance estrogen
Pregestin A/E
Breast tenderness HA Abdominal pain Spotting, irregular bleeding Feeling heavy Depression Decreased cervical mucus/ reduced endometrial layer ↑r/f breast cancer
Combo Oral Contraceptives
YAZ (Ethinyl estradiol + Drospirenone)
Loestrin (Ethinyl estradiol + Norethindrone)
Ortho-tri-cyclen (Ethinyl estradiol + Norgestimate)
COC MOA
Causes uterine lining to be hostile
Inhibits follicular maturation and thereby ovulation
Thickening cervical mucus
COC Decrease risk of
Iron deficiency anemia acne ovarian cysts PID ovarian cancer endometrial cancer benign breast disease
COC A/E
Thromboembolic disorders Breast cancer HTN Abnormal bleeding Stroke Benign Hepatic adenoma
COC Drug interactions
P450 ↓ effects of COC: rifampin, ritonavir, antiseizure, St. John wort
↓effects of: Warfarin, hypoglycemic agents
↑effects of theophylline, TCA, Diazepam, Chlordiazepoxide
COC Absolute Contraindications
Thromboembolic disorders Thrombophlebitis CV diseases Liver abnormalities Breast cancer Undiagnosed vaginal bleeding Pregnancy Smokers >35y/o
COC Relative Contraindications
HTN Heart disease DM History of Cholestatic jaundice or pregnancy Gallbladder disease Uterine leiomyoma Epilepsy Migraines
COC Patient education
S/S of thromboembolic problem, HTN risk Take as prescribed -1st day of meses or Sunday -may need back up for the 1st week -take same time everyday
Nexplanon
3 yr implant
Depo
3mo IM/SubQ
Mirena, Skyla, Liletia
IUD 3-5 yr
28 day
levels of hormone vary with pill color
inert pill is only iron
Extended cycle
84 days active pill/ 7 days no pill
84 days active pill/ 7 days low estrogen
fewer a/e
Testosterone Use
Male hypogonadism Male reproductive therapy Delay puberty Replacement therapy in menopausal women Transgender transition Cachexia Anemia
Testosterone A/E
Thrombosis Virilization in women, girls and boys Premature epiphyseal closure Worsening cholesterol profile promotes prostate cancer Edema Substance abuse
Testosterone Toxicity
Hepatotoxic
Testosterone Contraindications
Pregnancy
those over 65y/o
Testosterone Patient education for topical use
Cover area to prevent transference
Testosterone Monitoring
LFTs periodically
Sulfasalazine Use
Inflammatory bowel disease
RA
Sulfasalazine MOA
Intestinal bacterial metabolize the drug unto 2 compounds (5-ASA and Sulfapyridine)
Results in reduced inflammation (Most effective for acute episodes of ulcerative colitis and Crohn’s
Sulfasalazine A/E
Nausea Arthralgia Rash Fever Agranulocytosis** - report immediately
Estrogen suppresses release of
FSH and inhibits follicular maturation
Progestin suppresses
Luteinizing hormone and prevents ovulation
Non contraceptive benefits of COC Tx of menstrual symptoms
Cramps are reduced
Menstrual flow is reduced
Menses are more predictable
