GI Medications Flashcards
1
Q
Prototype PPI: omeprazole (Prilosec)
General information
A
- How to take PPI- activated by food intake, so should take 20-30 minutes before the first major daily meal. This way peak serum drug levels coincide when PPI activated
- PPI half life short at 1.5 hours, *yet continue to suppress acid for ~24 hours. They are able to do this as they are produced in a delay-released form
- Several days of PPT treatment needed before achieving maximal acid inhibition
- Long-term use: increased risk for osteoporotic fractures
- Precautions in patients with: pregnancy, lactating or have liver impairment
2
Q
Prototype PPI: omeprazole (Prilosec)
A
- Drug interactions:
- Coadministration of omeprazole and clarithomycin has been shown to increase plasma levels of both
- Potential to affect bioavailability of medications that depend on a lower pH for absorption
- Mineral deficiencies could occur with long-term use
- Decreased B2 absorption may occur
- Ginkgo and St. John’s wort may decrease plasma concentration
3
Q
Prototype PPI: omeprazole (Prilosec)
Side effects
A
Adverse effects include: headache, nausea, diarrhea, rash, and abdominal pain
•Serious adverse effects: blood disorders may occur, causing unusual fatigue and weakness
•Potential effects of taking long-term PPIs due to alteration in acidity:
•Increased risk for osteoporosis (due to interference with calcium absorption)
•increased risk of infection (due to changing the acidity of the stomach which is a natural barrier for bacterial infections); evidence suggests a possible link to developing pneumonia, clostridium difficile
4
Q
Prototype PPI: omeprazole (Prilosec)
Nursing responsibilities
A
- Nursing responsibilities
- Monitor liver function tests or ordered serum gastrin during prolonged drug use
- Monitor for vitamin B12 and folic acid malabsorption
- Teach the patient:
- Take 30 minutes before meals
- Eat foods with beneficial bacteria
- Sleep with a foam wedge or risers under the head of the bed frame
- Do not crush, break, or chew the tablets or capsules
- Avoid smoking, alcohol use, and foods that cause acid production and gastric discomfort
- Report GI bleeding, severe diarrhea, abdominal pain, nausea, vomiting, heartburn, pain with urination, or blood in urine to health care provider
5
Q
Prototype: ranitidine (Zantac)
General information
A
- Rapid absorption from small intestine
- 30-minute onset of action
- Not affected by food
- Half-life from 1 to 4 hours
- No known effects on the fetus
- Adverse effects if higher doses, renal disease (half the dose), or older adults:
- Confusion
- Restlessness
- Hallucinations
- Depression
6
Q
Prototype: ranitidine (Zantac)
Contraindications
Drug interactions
A
- Contraindication: NO antacids with H2 receptor antagonist, diminishes absorption
- Drug interactions:
- May decrease absorption of cefpodoxime, ketoconazole, and itraconazole
- Concurrent use can increase effects of alcohol, sulfonylureas, salicylates, and warfarin
- Antacids should not be given within 1 hour of H2-receptor antagonists
- Smoking decreases effectiveness
- Vitamin B12 deficiency may occur, and iron is better absorbed in an acidic environment
7
Q
Prototype: ranitidine (Zantac)
Side effects
And serious side effects
A
- Side effects: uncommon
- Serious adverse effects
- Blood dyscrasias neutropenia (decreased WBC) and thrombocytopenia (decreased platelets)
- Confusion may occur rarely, usually in elderly or with IV dosing
- With high doses - gynecomastia, impotence, or loss of libido in men
8
Q
Prototype: ranitidine (Zantac)
Nursing responsibilities
A
- Nursing responsibilities:
- Monitor gastric pain.
- Administer IV form of this medication slowly over several minutes to prevent bradycardia and hypotension
- Teach the patient taken with or immediately after meals.
- Share with the patient that antacids should be taken 2 hours before or after meals with a full glass of water
- Monitor kidney and kidney function
- Monitor elderly patients closely
- Inform the patient to take other prescription or nonprescription drugs, dietary supplements, or herbal products with approval of health care provider
- Nursing Responsibilities:
- Do not use OTC ranitidine for longer than 2 weeks
- Immediately report fever, excessive bruising, vomiting of blood, or black-colored stools to health care provider
- Teach the patient to avoid alcohol or smoking
- Instruct the patient to not breast-feed while taking it
- Tell the patient to immediately notify health care provider of any known or suspected pregnancy
- Low-dose OTC preparation is available
- Famotidine (Pepcid) is an alternative; it is the most potent H2 Receptor antagonist
9
Q
What are antacids?
A
- Antacids are alkaline substances that:
- Neutralize stomach acid to treat symptoms of heartburn
- Inactive pepsin
- Stimulates prostaglandin production in the mucosa and increase LES tone, which reduced gastric reflux
- Promote relief from heartburn; do NOT promote ulcer healing or eliminate H. pylori
- Do NOT coat the stomach
10
Q
How do antacids work?
A
- To work, the antacid needs to raise the gastric pH to at least 3.5
- *Frequently used in combination with other antiulcer drugs for symptomatic relief of heartburn due to PUD or GERD
- OTC medications safe if package directions followed
- Start working usually within 10-15 minutes; duration of action only 2 hours
- Rule of thumb:
- Antacids contain aluminum cause constipation
- Antacids that contain magnesium may cause diarrhea
11
Q
Types of antacids and possible disadvantages
A
- Types of antacids and possible disadvantages
- Bicarbonate
- Metabolic alkalosis (fatigue, mental status changes, twitching muscles, decreased RR)
- Gastric acid + bicarbonate causes bloating and belching
- Sodium
- Fluid retention; avoid if patient on a sodium restricted diet or if HTN, HF or renal impairment
- Magnesium
- Fatigue, hypotension, dysrhythmias (Sx of hypomagnesemia); diarrhea (laxative-effect)
- DO NOT TAKE IF YOU HAVE KIDNEY DISEASE
- Calcium
- Constipation, aggravated kidney stones, milk-alkali syndrome; renal failure may occur at high doses
- Carbonate antacids with milk or vitamin D can cause milk-alkali syndrome (HA, urinary frequency, anorexia, nausea, fatigue, permanent renal damage)
12
Q
Antacids
Drug interactions
A
- Drug interactions:
- Antacids increase stomach pH; so they affect the solubility and absorption of oral medications
- Acidic drugs may be less therapeutic; examples are NSAIDs, sulfonylureas, salicylates, warfarin, digoxin
- Basic drugs may have a greater effect; examples are morphine, antihistamines, TCA, amphetamines
- Enteric coated or delayed release drugs dissolve when reach more alkaline environment; earlier release may aggravate stomach lining and cause symptoms of N&V
- Form complexes with tetracyclines, prevents antibiotic from working; interferes with digoxin to
- Alters urine pH and increases excretion of acidic drugs and inhibits basic drug excretion like amphetamines
13
Q
Antacids
Nursing responsibilities or patient teaching
A
- Nursing responsibilities or patient teaching:
- Antacids are for occasional use only; seek medical attention if symptoms persist or recur
- Keep all scheduled laboratory visits
- Do not take antacids with magnesium if you have kidney disease
- Do not take antacids with sodium if you have heart failure or high blood pressure, or are on a sodium-restricted diet
- Take antacids at least 2 hours before other PO medications
- Report any increase in abdominal pain, diarrhea, or constipation
- Shake liquid preparations thoroughly before dispensing, and thoroughly chew antacid tablets until wet before swallowing
- Follow the label instructions carefully and keep within the recommended dosage range
14
Q
Miscellaneous Drugs to Treat PUD and GERD
Sucralfate
A
- Stimulates mucus, bicarbonate, and prostaglandin secretion that enhance mucosal defenses
- Acts locally and provides thick protective barrier that coats and binds to the ulcer preventing further erosion and a chance to heal.
- Effective in preventing NSAID ulcers
- May cause constipation
- Requires acid environment so do not take at same time as antacid, H2 receptor antagonist or PPI
- Needs to be taken four times daily
15
Q
Miscellaneous Drugs to Treat PUD and GERD
Simethicone
Bismuth
A
- Simethicone- antiflatulent, reduces gas
* Reduce bloating, discomfort or pain caused by excessive gas in the stomach or intestines
* Regular tablets, chewable tablets, capsules, and liquid to take by mouth
* Usually taken four times a day, after meals and at bedtime
* OTC examples- Maalox, Mylanta, Gas X - Bismuth subsalicylate (kaopectate, Pepto-Bismol):
* Stimulates mucosal bicarbonate and prostaglandin production and inhibits H. pylori by causing cell wall death to bacterium
* May be used to treat dyspepsia, heartburn and diarrhea
* SE: tinnitus, HA, N&V, dizziness
