GI/GU Exam 3 Flashcards
3 goals of treatment for PUD
Alleviate the symptoms
Promote healing
Prevent complications (Hemorrhage/perforation)
We can cure H. pylori ulcers. True or false
True
What is the guideline recommendation for H. pylori antibiotic treatment
2 antibiotics combo’d with a proton pump inhibitor or H2 receptor blocker
Cimetidine brand name
Tagamet
Use of Cimetidine (Tagamet) (3)
Treats gastric Ulcers
Duodenal ulcers
GERD
MOA of of Cimetidine
Blocks H2 Receptors on parietal cells to decrease acid production
Cimetidine Distribution be aware
Can cross BBB
Side affects of Cimetidine? Serious
Generally well tolerate- serious can be pneumonia because it increases PH in GI tract (alkaline)- over proliferation of bacteria also in lungs.
“Tidine”
All H2 blockers
MAR drugs for Tidines
Antacids- affects absorption of drug
PMH (2) for Cimetidine
Renal or hepatic dysfunction
Monitor patient and educate patient on what for Cimetidine (3)
- Gastric bleed S/S
- Respiratory Infection (Pneumonia risk)
- PUD factors (alcohol, smoking, aspirin/NSAID use
Omeprazole
Prilosec- Proton pump inhibitor
Use of Omeprazole
Gastric and duodenal ulcers, GERD
MOA of Omeprazole
irreversible inhibition of H+K- ATPase (proton pump)- the enzyme that generates gastric acid- final stage
All proton pump inhibitors end with _____
prazole
Proton pump inhibitors any common adverse effects?
Generally well tolerated
Serious side affects of Omeprazole
- Fractures- decreased CA absorption (Take Vitamin D and Calcium supplement)
- Rebound Acid Hyper secretion when stop taking the med
- Hypomagnesemia (General electrolyte concerns)
- Pneumonia- Just like H2RA
3 MAR concerns for Omeprazole
Diuretics- Electrolyte concerns
Clopidogrel- Drug reaction- causes platelets not to be as sticky
Certain HIV Drugs- HARD NO
Omeprazole administration PO (1)
Take the lowest dose for the shortest period of time possible
Patient education for Omeprazole (4)
- S/S of gastric bleeding
- S/S of hypomagnesemia
- Limit the factors contributing to PUD (smoke, drink, nsaid, etc)
- S/S of respiratory infection (pneumonia)
**Same patient monitoring and education as H2 receptor agonists, plus the electrolyte disturbance)
Sucralfate Use and MOA
(My fate is to crate)
Duodenal ulcer, sticks to ulcer crates and coats it- protecting it from acid
Sucralfate Adverse reaction and drug interaction
No serious adverse, can affect absorption of other drugs, separate by 2 hours
Misoprostol (cytotec) use and MOA
Ulcers due to NSAID use and it is the analog of prostaglandin E1
Misoprostol Adverse effects (Hard No 1)
Pregnancy- Category X, stimulate uterine contractions
Common- Diarrhea and abdominal cramping
Aluminum hydroxide antacid use, effect on bowel?
treat hyperphosphatemia and causes constipation not diarrhea
Magnesium hydroxide adverse effects and effect on bowel
Can cause mag toxicity (CNS depression) in patients with renal impairment- no constipation but causes diarrhea
Sodium bicarbonate use and effect on bowel
Not routinely used for ulcers- used to treat acidosis and to alkalinize urine- systemic effect on PH , releases CO2
NO constipation or Diarrhea effect
Differences between Laxative effect and catharsis
Laxative- production of soft, formed stool over a day or more- prevent constipation or treat acute or chronic constipation
Catharsis- Evacuation of bowel- poison, parasites, diagnostic study requires empty gut (fast and furious)
Group 1 Laxative Therapeutic Effect
Rapid action (2-6 hours), prep for surgery, educate patient on safety (bedside commode and call bell within reach)
Group 2 Therapeutic Effect
Intermediate (6-12 hours), semifluid stool
Group 3 Laxatives Therapeutic Effect
Most frequently abused by public (act 1-3 days) soft formed stool, treat constipation or straining
Contraindications for Laxative Use
- Any appendicitis symptoms, enteritis, diverticulitis, UC
- obstruction or impaction,
- habitual use
- use with caution in pregnancy and lactation
Psyllium brand name, group, what type of agent
Metamucil (II), bulk forming
Psyllium (metamucil) use
Preferred temp treatment of constipation, can also slow diarrhea in colostomy and ileostomy patients
Psyllium (Metamucil) MOA
pull water into stoole (form a gel that swells), provide bulk, pushes on GI to promote peristalsis
Psyllium (metamucil) hard no and patient education
Esophageal obstruction and tell px to drink plenty of fluids to prevent obstruction
Docusate sodium brand name, Class, type of agent
Colace (III), surfactant
Docusate sodium (Colace) Use
Prevent constipation, common in hospital for immobile patients
Colace MOA
Pull water and fat into stool, prevent reabsorption of water by intestines
Colace adverse?
Minimal
Castor oil group
I
Bisacodyl Use
Opioid constipation and slow intestinal transit time constipation
MOA of bisacodyl
Stimulate intestinal motility and increase water and electrolytes that stay in the GI tract
Route of bisacodyl (treat from attic and basement)
Oral and rectal
Bisacodyl Group type of agent
II, stimulant
Osmotic laxatives (I and II)
Magnesium salts (mag citrate) (1) or Polyethylene glycol ( Peg - Miralax) (II)
Use of Miralax
Chronic constipation
Use of Magnesium salts or Mag Citrate
Bowel prep, evacuation of parasites or poison
Adverse effects of osmotic laxatives
dehydration and hypermagnesemia in renal impaired
Lactulose Use
osmotic laxative, used for individuals who have high ammonia levels- liver failure
Mineral oil use
Laxative used for lubrication for fecal impaction
Mineral oil adverse effect
Lipid pneumonia, deposit of mineral oil in the liver, anal leakage
Glycerin Suppository use
Osmotic agent laxative, softens impacted feces and can stimulate rectal contraction- effects 30 minutes after insertion
Ondansetron Brand name and class
Zofran
Serotonin antagonist
Use of Ondansetron (CPR)
Chemo, postoperative, radiation
MOA of Ondansetron
Block serotonin receptors on vagal afferents and in chemoreceptor trigger zone
Serious side effect of Ondansetron
Prolonged QT Interval
Prochlorperazine (AZINE) class of anti-emetic
Dopamine antagonist
Prochlorperazine use (CPG)
chemo, post op, general
MOA of Prochlorperazine
Block dopamine receptors in CTZ
Adverse effects of Prochlorperazine
Anti-cholinergic effects. hypotension, sedation, tardive dyskinesia
Cannabinoids Drug name
Dronabinol (Marinol)
Use for Marinol
Chemo