GI Drugs

Question 1

Which upper GI drugs INCREASE protective factors

Answer 1

antacids and sucralfate

Question 2

Which upper GI drugs DECREASE aggressive factors

Answer 2

treat H. Pylori
H2 Blockers
PPI

Question 3

how do you treat h. pylori?

Answer 3

several antibiotics plus a gastric acid inhibitor for 10-14 days
must have positive test to treat due to high resistance

Question 4

why do you use combination therapy to treat h. pylori?

Answer 4

minimize resistance, H.pylori like acidic environment

adherence low due to cost

Question 5

what are two drug classes target gastric production

Answer 5

Blocks H2 receptors, inhibits proton pump

Question 6

what role does histamine play in gastric acid production?

Answer 6

causes the production of gastric acid

Question 7

what role does the proton pump play in gastric acid production?

Answer 7

makes gastric acid

Question 8

Which medications are H2 receptor agonists?

Answer 8

cimetidine

famotidine

Question 9

what is the MOA of H2 receptors?

Answer 9

block H2 receptors
reduces gastric acid
increases stomach pH

Question 10

indications of use for H2 receptors

Answer 10

GERD
PUD
ulcer prophylaxis
heartburn
dyspepsia

Question 11

nursing considerations for H2 receptors

Answer 11

give at least 1 hour apart from antacids
can increase warfarin, phenytoin, theophylline levels
give IV slowly to avoid bradycardia
can increase CNS effects and pneumonia risk in elderly

Question 12

which meds are PPI’s

Answer 12

omeprazole
pantoprazole
esomeprazole magnesium

Question 13

What is the MOA of PPI’s

Answer 13

binds to proton pump

irreversibly inhibits the secretion of HCl
turns off the pump

Question 14

indications of use for PPI’s

Answer 14

short term tx of PUD and GERD

Question 15

adverse effects of PPI’s

Answer 15

short term- safe

long term- increased risk of pneumonia, BONE LOSS, hip fx, stomach cancer

Question 16

nursing considerations for PPI’s

Answer 16

short term use only

if used long term usually good outweighs the bad

Question 17

which meds are mucosal protectant’s?

Answer 17

sucralfate

Question 18

what is the MOA of mucosal protectants?

Answer 18

alters gastric acid and makes sticky, thick gel to form protective barrier
composed of sucrose-base, and aluminum hydroxide

Question 19

what are the indications for mucosal protectants?

Answer 19

duodenal ulcers
gastric ulcers
chronic gastritis

Question 20

nursing considerations for mucosal protectants

Answer 20

decreased drug absorption, take 2 hours apart ( take last) Always given PO suspension or tablet

Question 21

what are the major forms of antacids and their side effects?

Answer 21

aluminum- constipation (amphojel)
calcium- tums (tums)
magnesium- diarrhea (milk of mag)
aluminum + magnesium- balanced approach (maalox, mylanta)

Question 22

what is the MOA of antacids?

Answer 22

neutralizes acid

Question 23

indications of use for antacids?

Answer 23

PUD
GERD
Stress Ulcers

Question 24

adverse effects of antacids

Answer 24

diarrhea or constipation (depends on base)

acid rebound

Question 25

nursing considerations with antacids

Answer 25

chelation (dont take antacids with other meds, take 2 hours apart) altered gastric absorption separate from other drugs by 1-2 hours

Question 26

what meds are serotonin blockers

Answer 26

ondansetron

Question 27

what is the MOA for serotoin blockers?

Answer 27

blocks serotonin receptors in trigger zone in brain and afferent vagal nerves in stomach and small intestine used to treat chemo/rad induced vomiting but can be used for all

Question 28

side effects of serotonin blockers? (ondansetron)

Answer 28

HA, dizziness, diarrhea, serotonin syndrome | use caution with psych meds

Question 29

which meds are antihistamines

Answer 29

dimenhydrinate meclizine hydroxyzine

Question 30

MOA of antihistamines

Answer 30

blocks release of histamine H1 in the inner ear

Question 31

side effects of antihistamines

Answer 31

sedation, drowsiness, dizziness, nausea

Question 32

nursing considerations for antihistamines

Answer 32

treat motion sickness fall risk due to sedation NEVER give hydroxyzine IV can cause gangrene

Question 33

what meds are dopamine antagonists? (prokinetic agent)

Answer 33

metoclopramide

Question 34

MOA of dopamine antagonists

Answer 34

blocks dopamine receptors, increases tone of lower esophageal sphincter, increases peristalsis in stomach and intestine

Question 35

indications of use for dopamine antagonists

Answer 35

n/v associated with chemo/rad/opioids increases GI motility paralytic ileus

Question 36

Side effects of dopamine antagonists (metoclopramide)

Answer 36

sedation extrapyramidal symptoms restlessness neuroleptic malignant syndrome

Question 37

what is extrapyramidal symptoms

Answer 37

akathisia - restless, tense, constant need to move acute dystonia - involuntary muscle contractions parkinsonism tardive dyskinesia neuroleptic malignant syndrome ( very rare but deadly rigid muscles)

Question 38

dystonia

Answer 38

spasms of tongue, neck, back, and legs causes unnatural positioning or neck abnormal eye movements and excessive salvation

Question 39

akathisia

Answer 39

continuous restlessness, inability to sit still, constant movement

Question 40

pseudoparkinsonism

Answer 40

muscle tremors cogwheel rigidity shuffling gate slow movements

Question 41

tardive dyskinesia

Answer 41

abnormal lip smacking, tongue darting, chewing movements, slow and aimless arm and leg movements

Question 42

what drugs are 5-aminosalicylates

Answer 42

sulfasalazine

Question 43

MOA of 5-aminosalicylates

Answer 43

sulfonamide antibiotic that converts the intestine into 5-aminosalicylic acid and sulphapyridine sulphapyridine has no therapeutic effect for IBD *reduces symptoms of uc and crohns flares

Question 44

what are 5-aminosalicylates used for?

Answer 44

Mild to moderate IBD

Question 45

side effects of sulfasalazine

Answer 45

nausea, fever, rash, ha, hematologic disorders

Question 46

nursing considerations for 5-aminosalicylates (sulfasalazine)

Answer 46

do not give to patients allergic to sulfa, or certain types of anemia

Question 47

what meds are DMARDS

Answer 47

infliximab

Question 48

what are DMARDS used for

Answer 48

IBD

Question 49

MOA of DMARDS (infliximab)

Answer 49

monoclonal antibody that neutralizes TNF-alpha | turns off inflammatory response

Question 50

side effects of infliximab

Answer 50

immune suppression requires therapeutic monitoring and biomarker (CRP) monitoring pt must be prescreened for infections, TB, HIV, AIDS, ETC