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Pharm Exam 2 > GI and Hormones > Flashcards

GI and Hormones Flashcards

1
Q

Antiulcer antibiotics Drugs

A 
Amoxicillin
Bismuth 
Clarithromycin 
Metronidazole 
Tetracycline 
Tinidazole
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2
Q

Antiulcer Antibiotics MOA

A

Eradicate H. pylori

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3
Q

Antiulcer-secretory agents

A

H2 receptor antagonists

PPI

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4
Q

Antiulcer Mucosal protectant Drugs

A

Sucralfate

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5
Q

Antiulcer Antisecretory agent that enhances mucosal defenses

A

Misoprostol

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6
Q

Antiulcer Antacids

A

Aluminum hydroxide/ Calcium Carbonate/ Magnesium hydroxide

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7
Q

H2 receptor antagonist Drug

A

Cimetidine*
Ranitidine
Famotidine
Nizatidine

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8
Q

Cimetidine MOA

A

Blocks H2 receptors, reducing both volume of gastric juice and its hydrogen ion concentration
Suppresses basal acid secretion

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9
Q

Cimetidine Use

A 
Gastric, Duodenal ulcers from H. pylori
GERD
Zollinger-Ellison syndrome
Heartburn
Acid indigestion 
Sour stomach
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10
Q

Cimetidine A/E

A 
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
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11
Q

Cimetidine A/E IV bolus

A

Hypotension

Dysrhythmias

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12
Q

Cimetidine Therapy duration

A

normally 8-12 wk for PUD, can be longer

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13
Q

Cimetidine Reduced dosing

A

Renal impairment– reduce by 50%

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14
Q

Cimetidine Drug interactions

A 
Increase levels of: 
-Warfarin
-Theophylline
-Phenytoin
-Lidocaine 
Antacids decrease level of Cimetidine
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15
Q

Cimetidine Food interactions

A

Food may extend the effects of the drug

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16
Q

Proton Pump Inhibitor Drugs

A

Omeprazole

Pantoprazole

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17
Q

Omeprazole MOA

A

More efficiently and longer than H2 receptor antagonists

Blocks gastric acid production by irreversibly inhibiting H, K, ATPase (enzyme that generates gastric acid)

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18
Q

Omeprazole Use

A 
Gastric, Duodenal ulcers from H. pylori 
Esophagitis
GERD
Hypersecretion conditions
Stress ulcers
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19
Q

Omeprazole A/E

A

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

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20
Q

Omeprazole Drug interactions

A

reduce effects of some HIV drugs
reduce absorption for some antifungals
↓ effects of Clopidogrel
CYP3A4

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21
Q

Omeprazole Patient educations

A

increased diet in Ca, Mag, B12

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22
Q

Omeprazole Nursing thoughts

A

should not be used longer than absolutely necessary → 6-12 wk
some patients may need longer (hiatal hernia)

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23
Q

Pantoprazole Use

A

IV for stress ulcers in the ICU

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24
Q

Pantoprazole Dosing

A

IV → 40mg vial to be reconstituted for IV use

Convert to PO ASPA

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25
Q

Pantoprazole A/E

A 
Diarrhea❊
Dyspepsia ❊
Hypomagnesemia❊
Osteoporosis/fractures❊
Nausea
Dizziness
Thrombophlebitis
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26
Q

Sucralfate MOA

A

Undergoes polymerization and cross-linking reactions

  • creates a barrier over the ulcer
  • last >6 hours
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27
Q

Sucralfate Use

A

Promote healing of ulcer
duodenal ulcers
-NOT CURATIVE (only promotes healing)

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28
Q

Sucralfate A/E

A

Constipation → increase fluid intake

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29
Q

Sucralfate Drug interactions

A 
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
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30
Q

Sucralfate Nursing considerations

A

can be crush, dissolved in water, or given as a suspension

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31
Q

Sucralfate Dose

A

QID

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32
Q

Misoprostol MOA

A

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)

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33
Q

Misoprostol Use

A

Prevents gastric ulcers caused by long term used of NSAIDs

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34
Q

Misoprostol A/E

A

Diarrhea
Abdominal pain
Women may have spotting and dysmenorrhea

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35
Q

Misoprostol Contraindications

A

Pregnancy

↳must have negative pregnancy test

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36
Q

Antacids drugs

A

Magnesium hydroxide
Aluminum hydroxide
Calcium carbonate
Sodium bicarbonate

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37
Q

Antacid MOA

A

Neutralize stomach acid decreasing destruction of the stomach wall
Can reduce pepsin activity
Stimulate prostaglandin to improve mucosal protection

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38
Q

Antacid Use

A

PUD
GERD
Ulcers: need to be taken on a regular schedule

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39
Q

Antacids A/E

A 
Can be unpleasant to take 
Constipation: Al
Diarrhea: Mg
Sodium loading (HTN, HF): Na
Flatulence: Ca, Na
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40
Q

Antacids Drug interactions

A

interferes with dissolution and absorption of many drugs (Cimetidine)
-give 30 min -1 hr apart

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41
Q

Antacids Caution

A

renal impairment

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42
Q

Laxatives Types

A

Bulk forming
Surfactant
Osmotic
Stimulant

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43
Q

Bulk forming drugs

A

Methylcellulose
Psyllium
Polycarbophil

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44
Q

Surfactant Drugs

A

Docusate sodium

Docusate Calcium

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45
Q

Osmotic Drug

A

Lactulose

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46
Q

Stimulant Drug

A

Bisacodyl

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47
Q

Bulk forming MOA

A

Same as fiber

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48
Q

Docusate Na, Ca MOA

A

lower the surface tension, inhibit fluid absorption and stimulate secretion of water and electrolytes into the intestinal lumen

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49
Q

Bisacodyl MOA

A

Stimulate intestinal motility

Increase the amount of water and electrolytes within the intestines

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50
Q

Lactulose MOA

A

Osmotic action draws water into the intestine, causing feces to soften, swell, thereby stretching the intestines and stimulate peristalsis

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51
Q

Laxative Use

A 
Stool Softener
Adjunct to antihelminthic treatment 
Surgical/Dx prep
Modifying effluent from ileostomy/colostomy 
Prevent fecal impaction 
Removal of ingested poisons
Correcting constipation
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52
Q

Lactulose Uses

A

High dose: bowel prep for Dx procedures

intestinal excretion of ammonia

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53
Q

Bulk forming DOC

A

constipation

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54
Q

Bulk forming Other uses

A

Diverticulosis

IBS

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55
Q

Docusate Use

A

Stool softener

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56
Q

Bisacodyl Use

A

Opioid induced constipation

Constipation from slow intestinal transit

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57
Q

Bisacodyl Drug interactions

A

Milk increases the speed of dissolution, should be avoided

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58
Q

Bisacodyl A/E

A

burning

proctitis

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59
Q

Lactulose A/E

A

Dehydration

Hypermagnesemia

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60
Q

Docusate Sodium A/E

A

Fluid retention
HF exacerbation
HTN
Edema

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61
Q

Laxative Contraindications

A 
Abdominal pain 
Nausea
Cramps
Acute abdomen
Fecal impactions
Bowel obstruction
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62
Q

Laxative Cautions

A

pregnancy and lactating

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63
Q

Lactulose Cautions

A

renal impairment

↳can cause hypermagnesemia

64
Q

Bulk forming/Surfactants Nursing considerations

A

take with lost of fluids

65
Q

Bisacodyl Nursing considerations

A

Can be abused

66
Q

Lactulose Nursing considerations

A

Fluid loss

Good for those with hepatic encephalopathy, chronic liver diseases

67
Q

Laxative Nursing considerations

A

Hypermagnesemia w/Mg salts

Fluid retention w/Na salts

68
Q

Serotonin antagonist Antiemetic

A

Ondansetron

69
Q

Ondansetron MOA

A

Blocks type 3 serotonin receptors (5-HT)

70
Q

Ondansetron Use

A

Relief and prevention of nausea and vomiting related to chemo, cancer, anesthesia, viral gastritis, pregnancy

71
Q

Ondansetron A/E

A 
HA
Dizziness
Diarrhea
❊Prolonged QT interval
↳increases risk for torsades de pointe 
Exacerbate fluid/electrolyte imbalance
72
Q

Ondansetron Combo

A

sometimes combined with Dexamethasone to increase effects

73
Q

Benzo Antiemetic Drug

A

Lorazepam

74
Q

Lorazepam MOA

A

Sedation, suppression of anticipatory emesis, anteretrograde amnesia

75
Q

Lorazepam Use

A

Combo with other drugs to reduce CINV

May help control EPS

76
Q

Dopamine Antagonist Antiemetic Drugs

A

Phenothiazine

Metoclopramide

77
Q

Phenothiazine MOA

A

Suppresses emesis by blocking dopamine 2 receptors in the chemoreceptor trigger zone

78
Q

Phenothiazine Use

A

reduce emesis associated with surgery, cancer, chemo, other toxins

79
Q

Phenothiazine A/E

A

Extrapyramidal reactions
Anticholinergic effects
Hypotension
Sedation

80
Q

Promethazine A/E

A

respiratory depression and local tissue injury are serious concerns

81
Q

Motion sickness drug

A

Scopolamine

82
Q

Scopolamine MOA

A 
Muscarinic antagonist (anticholinergic) 
Suppresses the nerve traffic in the neuronal pathway that connects vestibular apparatus of inner ear to the vomiting center
83
Q

Scopolamine Route

A

Transdermal behind the ear

84
Q

Scopolamine A/E

A 
Dry mouth 
Blurred vision 
Drowsiness
Less common: 
-Urinary retention 
-Constipation
-Disorientation
85
Q

Antidiarrheal Opioids Drug

A

Loperamide (Imodium)

Diphenoxylate

86
Q

Loperamide MOA

A

Structural analog of meperidine
Low potential for abuse
Does not cross the BBB

87
Q

Diphenoxylate MOA

A

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

88
Q

Diphenoxylate A/E

A

High dose: morphine like effects

Those with IBD may develop toxic megacolon

89
Q

Diphenoxylate Drug interactions

A

Add Atropine to prevent abuse

90
Q

Diphenoxylate Antidote

A

Naloxone

91
Q

Prokinetic Agent Drug

A

Metoclopramide

92
Q

Metoclopramide Use

A

Suppress emesis
Increase upper GI motility
N/V in pregnancy

93
Q

Metoclopramide Oral Use

A

GERD

Diabetic gastroparesis

94
Q

Metoclopramide IV Use

A

Post op N/V, chemo, facilitation of small bowel intubation/ GI tract

95
Q

Metoclopramide A/E

A

High doses:
-Sedation
-Diarrhea
Tardive dyskinesia: elderly

96
Q

Metoclopramide Contraindications

A

Hemorrhage
Perforation
Obstruction

97
Q

Metoclopramide Nursing considerations

A

give 30 min before a meal or before chemo

give smallest amount for shortest time

98
Q

IBS-D Drug

A

Alosetron

99
Q

Alosetron MOA

A

Blocks 5HT3 receptors in the viscera, causing an increase in colonic transit time, reduced intestinal secretions, more normal bowel pattern with less pain

100
Q

Alosetron Use

A

Women with IBS-D for more than 6 mo

101
Q

Alosetron A/E

A 
CONSTIPATION ❊
impaction
bowel obstruction
perforation 
fatal GI toxicity 
Ischemic Colitis
102
Q

Alosetron Drug interactions

A 
CYP3A4
Carbamazepine 
Phenobarbital 
Cimetidine 
Quinolone
Ketoconazole
103
Q

Alosetron Contraindications

A

History of other bowel problems

104
Q

Alosetron Nursing considerations

A

Very dangerous

Must have a patient/physician agreement signed

105
Q

IBS-C Drugs

A

Lubiprostone

Linaclotide

106
Q

Sulfasalazine MOA

A

Metabolized in the gut to form 5-ASA and sulfapyridine

5-ASA reduces inflammation in the gut

107
Q

Sulfasalazine Use

A 
Acute, mild-moderate ulcerative colitis 
Crohn's disease
RA
Pregnancy 
Inflammatory bowel disease
108
Q

Sulfasalazine A/E

A 
Nausea
Fever
Rash 
Arthralgias
Hematologic disorders (anemias) 
Increased risk for infection
109
Q

Sulfasalazine Monitoring

A

CBC regularly

110
Q

Immunomodulator for IBD

A

Infliximab

111
Q

Infliximab MOA

A

Monoclonal antibody products which modulate immune responses
Tumor necrosis factor alpha-inhibitor

112
Q

Infliximab Use

A

May be 1st line for inducing remission for IBD
1st line for severe disease or perianal Crohn’s disease
RA

113
Q

Infliximab dosing

A

0,2,6 wk, followed by infusions every 8 wk

114
Q

Infliximab A/E

A 
Infusion reaction 
Fever
Chills
Pruritus
Cardiopulmonary complications 
↑R/f lymphoma 
Immunosuppressant: ↑r/f 
-bacterial sepsis
-TB
-HIV
-invasive fungal infection
115
Q

Palifermin MOA

A

Synthetic form of human keratinocyte growth factor (KGF), a naturally occurring compound but produced by recombinant DNA technology
Increases epithelium cell level

116
Q

Palifermin Use

A

1st drug for Mucositis

✔︎ pt with hematological malignancies (but only in those receiving high dose chemo and whole body irradiation

117
Q

Palifermin A/E

A

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

118
Q

Palifermin Drug interaction

A

Binds with Heparin

Give 2hr before or after chemo since it can make mucositis worse

119
Q

Estrogen

A

Premarin, Estradiol

120
Q

Estrogen produced

A

Produced by the follicular cells for the 1st 14 days

121
Q

Premarin, Estradiol Use

A 
Menopausal hormone therapy 
Female hypogonadism 
Acne
Cancer palliative care
Transgender transition
122
Q

Premarin, Estradiol A/E

A 
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
123
Q

Premarin, Estradiol Route

A

Any

Transdermal and intravaginal decrease risk for liver injury and 1st pass effect

124
Q

Premarin, Estradiol Drug interactions

A

P450 Drugs
Antidiabetic
thyroid
Anticoagulants

125
Q

Premarin, Estradiol Absolute Contraindications

A

History of DVT, PE, MI, liver disease, estrogen dependent tumor, breast cancer
Pregnancy
Undiagnosed vaginal bleeding: can be vaginal hyperplasia= cancer

126
Q

Premarin, Estradiol Nursing considerations

A

Screening is most important

Use smallest dose for the shortest time possible

127
Q

Nursing considerations for Estrogen and Progestin

A 
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
128
Q

Transdermal Application

A

Daily or twice weekly

129
Q

Vaginal ring

A

left in for 3 mo

130
Q

Progestin Use

A

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

131
Q

Pregestin A/E

A 
Breast tenderness
HA
Abdominal pain
Spotting, irregular bleeding 
Feeling heavy 
Depression
Decreased cervical mucus/ reduced endometrial layer
↑r/f breast cancer
132
Q

Combo Oral Contraceptives

A

YAZ (Ethinyl estradiol + Drospirenone)
Loestrin (Ethinyl estradiol + Norethindrone)
Ortho-tri-cyclen (Ethinyl estradiol + Norgestimate)

133
Q

COC MOA

A

Causes uterine lining to be hostile
Inhibits follicular maturation and thereby ovulation
Thickening cervical mucus

134
Q

COC Decrease risk of

A 
Iron deficiency anemia
acne
ovarian cysts
PID
ovarian cancer
endometrial cancer
benign breast disease
135
Q

COC A/E

A 
Thromboembolic disorders
Breast cancer
HTN
Abnormal bleeding 
Stroke
Benign Hepatic adenoma
136
Q

COC Drug interactions

A

P450 ↓ effects of COC: rifampin, ritonavir, antiseizure, St. John wort
↓effects of: Warfarin, hypoglycemic agents
↑effects of theophylline, TCA, Diazepam, Chlordiazepoxide

137
Q

COC Absolute Contraindications

A 
Thromboembolic disorders
Thrombophlebitis 
CV diseases
Liver abnormalities 
Breast cancer 
Undiagnosed vaginal bleeding 
Pregnancy
Smokers >35y/o
138
Q

COC Relative Contraindications

A 
HTN
Heart disease
DM
History of Cholestatic jaundice or pregnancy 
Gallbladder disease
Uterine leiomyoma
Epilepsy
Migraines
139
Q

COC Patient education

A 
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
140
Q

Nexplanon

A

3 yr implant

141
Q

Depo

A

3mo IM/SubQ

142
Q

Mirena, Skyla, Liletia

A

IUD 3-5 yr

143
Q

28 day

A

levels of hormone vary with pill color

inert pill is only iron

144
Q

Extended cycle

A

84 days active pill/ 7 days no pill
84 days active pill/ 7 days low estrogen
fewer a/e

145
Q

Testosterone Use

A 
Male hypogonadism
Male reproductive therapy 
Delay puberty 
Replacement therapy in menopausal women 
Transgender transition 
Cachexia
Anemia
146
Q

Testosterone A/E

A 
Thrombosis
Virilization in women, girls and boys
Premature epiphyseal closure 
Worsening cholesterol profile
promotes prostate cancer
Edema
Substance abuse
147
Q

Testosterone Toxicity

A

Hepatotoxic

148
Q

Testosterone Contraindications

A

Pregnancy

those over 65y/o

149
Q

Testosterone Patient education for topical use

A

Cover area to prevent transference

150
Q

Testosterone Monitoring

A

LFTs periodically

151
Q

Sulfasalazine Use

A

Inflammatory bowel disease

RA

152
Q

Sulfasalazine MOA

A

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

153
Q

Sulfasalazine A/E

A 
Nausea
Arthralgia
Rash 
Fever
Agranulocytosis** - report immediately
154
Q

Estrogen suppresses release of

A

FSH and inhibits follicular maturation

155
Q

Progestin suppresses

A

Luteinizing hormone and prevents ovulation

156
Q

Non contraceptive benefits of COC Tx of menstrual symptoms

A

Cramps are reduced
Menstrual flow is reduced
Menses are more predictable

Pharm Exam 2 (4 decks)

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