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GI meds Flashcards

1
Q

drugs for peptic ulcer disease

A
  1. PPI
  2. Muscosal protectants
  3. Antacids
  4. Prostaglandin E analog
  5. Antibiotics
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2
Q

Where can you find peptic ulcers and what can they do

A

Stomach and duodenum

can cause perforation and imbalance of gastric acid and mucus secretion

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3
Q

prototype histamine 2 receptor antagonist

A
  1. ranitidine(Zantac)
  2. Citmethidine(tagament)
  3. Famotidine(pepcid)
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4
Q

histamine 2 receptor antagonist action

A

blocks secretion of gastric acid by blocking histamine 2 receptors on parietal cells in the stomach. This causes
1.Decrease in stomach acid ->increase in pH of stomach acid

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5
Q

Histamine 2 receptor antagonist SEs

A
  1. Impotence/reduced libido with cimetidine not ranitidine
  2. CNS (more common with cimetidine
    - Lethargy, depression, restlessness, seizures
  3. N/V/D/C
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6
Q

Histamine 2 receptor antagonists interventions

A
  1. Recommoned ranitidine to people with reduced libido
  2. monitor for CNS effects
    - switch to ranitidine
  3. N/V/D/C
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7
Q

Histamine 2 receptor admin

A
  1. go slowly to avoid bradycardia
  2. do not give antacids within 1 hour of admin because it will decrease absorption of H2A
  3. Make sure patients dissolve effervescent tablets in water and do not chew them, swallow them, or allow them to dissolve on the tongue
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8
Q

Histamine 2 receptor teaching

A
  1. report any changes in libidio
  2. report lethargy, depression, restlessness, or seizures
  3. report vomiting/diarrhea
  4. drink alot of fluids
  5. try antacids to help minimize symptoms but do not take them within 1 hr of taken this drug
  6. Signs of GI bleeding
    - fatigue, rigid board like abdomin, postivive guaic test, coffee ground emesis, Anemia, dark tarry stool,
  7. long term use of ranitidine decreases WBCs
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9
Q

histamine 2 antagonist contraindications

A
  1. children younger then 12 (parents should know b/c these are OTC)
  2. Acute porphyria
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10
Q

Histamine 2 antagonist interaction

A
  1. can increase serum levels of warfarin causing a severe bleed
  2. can increase levels of phenytoin leading to toxic levels
  3. coconcurrent use with theophylline can overstimulate the heart, lungs, and CNS
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11
Q

Proton pump inhibitors uses

A
  1. Gastric and duodenal ulcers
  2. prolonged dyspepsia
  3. GERD
  4. erosive esophagitis
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12
Q

Protomon pump inhibitors protoypes

A
  1. Pantoprazole (protonix)
  2. Lansoprazole (Prevacid)
  3. Esomeprazole (Nexium)
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13
Q

PPI action

A

inhibit hydrogen, potassium ATPase enzyme system in parietal cells causing

  1. a decrease in the basal rate of acid production
  2. Decreases the amount of acid produced secondary to food
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14
Q

PPI safety alert

A
  1. can take safety for up to 8 weeks at a time.
  2. the risk for osteoporosis increases the longer they are on this drug, it decreases absorption of calcium secondary to decrease in gastric acid
  3. Patients must ingest adequate amounts of calcium and vitamin D
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15
Q

PPI interventions

A
  1. try not to use long term

2. bone density scanning

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16
Q

PPIs admin

A

1.give before first meal

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17
Q

PPI teaching

A
  1. daily weight bearing exercise
  2. consume adequate calcium and vitamin D
  3. report D/V
  4. drink plenty of clear fluids
  5. use calcium antacids to minimize symptoms
  6. Report GI bleed
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18
Q

PPI contraindications

A

1.Children younger then 18 (OTC)

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19
Q

PPI interactions

A
  1. food can reduce absorption
  2. Gingko and St.Johns wort decrease levels
  3. Warfarin, phenytoin, diazepam Levels increase
  4. Atazanavir, ketoconazole, and itraconazol levels decrease
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20
Q

What are Mucosal protectants used for

A

Acute duodenal ulcers

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21
Q

Mucosal protectant prototype

A

Sucralfate

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22
Q

Mucosal protectant action

A

a chemical reaction in the stomach creates a gel in the stomach which 1.coats the ulcer
2.creates a barrier between the stomach and gastric secretions

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23
Q

Sucralfate SEs

A
  1. N/V/C/D

2. Dyspepsia (heart burn)

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24
Q

Sucralfate interventions

A
  1. monitor bowel function

2. administer stool softners

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25
Sucralfate admin
1. give on empty stomach 2. 4 times a day, 1 hour before meal and HC 3. do not give antacids within 60 mins of admin 4. do not given within 2 hours of fluoroquinolones,, warfarin, phenytoin, theophylline, digoxin, tetracycline, or diazepam
26
Sucralfate safety alert
1.can decrease absorption of warfarin, phenytoin, and digoxin
27
Mucosal protectant teaching
1. Increase fluids and fiber and activity 2. drink alot of clear fluids 3. report worsening diarrhea (can lead to GI bleed) 4. try antaids to minimize syptoms but dont take them within 30 mins of admin of sulcrafate
28
Sulcrafate contraindications
1.Children
29
Mucosal protects interactions
``` Decreases absorption of 1.Fluoroquinolones 2.Tetracycline 3.Dogoxin 4.Warfarin 5.Phenytoin 6.Theophylline 7.Diazepam Antacids reduce therapeutic effect ```
30
Antacids Uses
1. PUD | 2. GERD
31
Antacids prototypes
1. Aluminum hydroxide 2. Magnesium hydroxide 3. Calcium carbondate 4. Magnesium and aluminum hydroxide (Magaldrate)
32
Antacids action
Buffers
33
Antacids SEs
1. Constipation (aluminum and calcium antacids) 2. Diarrhea (magnesium) 3. Hypophosphatemia(aluminum chelates phosphate and magnesium)
34
Antacids interventions
1. Monitor bowel function 2. Stool softeners 3. Phosphorus and magnesium levels
35
Antacids admin
1.Make sure to chew tablets thoroughly then drink 4 oz of water or milk
36
Antacids teaching
1. Increase fluid and fiber and activity(aluminum and calcium) 2. report abdominal pain and dirrhea (magnesium antacids) 3. Report muscle weakness, cramps, difficulty swallowing or tremors (aluminum) 4. GI bleed
37
Antacids interactions
1. Warfarin 2. Digoxin 3. Phenytoin 4. Tetracycline 5. Isoniazid 6. Cimetidine 7. NSAIDs 8. Ciprofloxacin
38
Antacids safety alert
since antacids can affect the absorption of many drugs plan to admin 2 hours before or after all other drugs.
39
Prostaglandin E analog uses
Prevention of gastric ulcers from long term NSAID use
40
Prostaglandin E analog prototype
Misoprostol (cytotec)
41
misoprostol action
An endogenous prostaglandin causing 1. decrease gastric acid secretion 2. increases secretion of bicarb 3. increases secretion of protective mucus 4. Increases vasodilation of submucosal blood flow in gastric wall (increases perfusion to stomach)
42
Prostaglandin E analog SEs
1. N/V/D 2. Abdominal pain 3. Dyspepsia 4. Spotting, dysmenorrhea, uterine cramps
43
Prostagland E analog interventions
1. Monitor for severe diarrhea and abdominal pain | 2. Monitor for excessive menstrual pain or midcycle bleeding
44
Misoprostol admin
1. admin 4 times daily | 2. will kill baby in pregnant mom
45
Misoprostol safety alert
Stimulates uterine contractions which can lead to miscarriage or premature labor.
46
Prostaglandin E analog teaching
1. Drink alot of clear fluid (minimize dehydration) 2. Report worsening diarrhea or abdominal pain 3. some minor diarrhea is normal during first week of therapy 4. take with food to minimize GI effects 5. report menstrual changes and postmenopausal bleeding
47
Misoprostol interactions
Magnesdium antacids worsen dirrhea
48
Antibiotics for PUD
1. Amoxicillin 2. Metronidazole 3. Tetracycline
49
What are the categories of drugs that can be used to treat nausea
1. Serotonin antagonists 2. Antihistamines 3. Prokinetics
50
Serotonin antagonists uses
For N/V post chemo, radiation, or postoperative
51
Serotonin antagonists prototypes
1. Ondansetron (zofran) 2. Granistron (granisol) 3. Palonosetron (Aloxi)
52
serotonin antagonists actions
blocks 5-HT3 serotonin receptors located in the chemoreceptor trigger zone (CTZ) of the brain and the afferent vagal nerves that innervate the stomach and small intestine leading to decrease in nausea
53
Ondansetron SEs
1. Headache 2. Dizziness 3. Diarrhea
54
1.Serotonin antagonist interventions
1. monitor for severe or perisistant headaches | 2. monitor for dizziness, severe diarrhea (dehydration)
55
Ondansetron admin
1. Give slowly (over 15 mins) | 2. Give 1 hour pre-op or post op then every 8 hours as needed
56
Ondansetron safety alert
dizziness can put patients at great risk for fall. and can be aggravated by quick movements of the head or while riding in a vechile. Do falls teaching. - change position slowly - lie down for severe - call nurse prior to ambulating - clear pathway - drink alot of water
57
ondansetron contraindication
1.children younger then 4
58
Sertonin antagonist interactions
Rifampin decreases drug levels
59
Antihistamines uses
1. Motion sickness (antivertigo) | 2. Antiemetic
60
Antihistamine prototypes
1. Dimenhydrinate | 2. Scopolamine
61
Antihistamine action
Block h1 receptors located in the inner ear or chemoreceptor trigger zone (CTZ) in the brain
62
Antihistamine SEs
1. Sedation 2. Drowsiness/Dizziness 3. Anticholinergic effects - photosensitivity - constipation - dry secretions - urinary retention, hesitancy
63
Antihistamine safety alert
men who have an enlarged prostate are at greater risk for urinary retention. Antihistamines decrease the tone of the bladder (making complete emptying difficulte with an enlarged prostate) this puts patients at risk for bladder infection. make sure to do strict I and Os use bladder scanner right after voiding to see how much urine is being retained
64
Antihistamine admin
give orally or IM
65
antihistamine teaching
1. Avoid prior to activites that require mental alertness 2. Fall risk teaching 3. Anticholinergic teaching
66
Antihistamine contraindications
1. younger then 2 2. angle-closure glaucoma 3. Prostatic hypertrophy 4. GI or UT obstruction 5. CNS depression 6. Jaundice
67
Antihistamine interactions
1. TCAs increase anticholinergic effects | 2. Other CNS depressants increase sedative effect
68
Prokinetics uses
1. N/V from chemo, opioids, radiation 2. GERD 3. Diabetric gastroparesis
69
Prokinetic drug
Metoclopramide (Reglan)
70
Metoclopramide action
Dopamine receptor blocker which 1. increases tone of lower esophageal sphincter 2. increases peristalsis (both stomach and small intestine) 3. Increases CTZ threshold in brain (treats nausea of vomitting)
71
Metochlorpramide SEs
1. Sedation 2. Dry mouth 3. Diarrhea 4. EPS
72
Metochlorpramide interventions
1. Sedation - monitor patient when ambulating 2. Diarrhea - Monitor for dehydration 3. EPS - monior for restlessness, anxiety, spasms of head and neck 4. anticholinergic interventions
73
Metochlorpramide admin
Give orally or IV. 1. 10mg or less can be given over 2 mins 2. give oral form 30 mins before meal and at bedtime
74
Metochlorpramide teaching
1. falls teaching 2. anticholinergic teaching 3. EPS symptoms
75
metochlorpramide contraindications
1. GI obsturction, hemorrhage, perforation 2. Uncontrolled seizures 3. Pheochromcytoma 4. Breat cancer
76
Metochlorpramide safety alert
often used to treat functional GI obstructions such as paralytic ileus where peristalsis has stopped in the bowels. Using in a mechanical obstruction such as tumor or twisted bowel can cause severe pain and even rupture the intestine.
77
Metochlopramide interactions
1. CNS drugs increase sedative effect 2. Opioids and anticholinergics decrease theraputic effects 3. Phenothiazine worsens EPS 4. Decreases absorption of acetaminophen, aspirin, diazepam, tetracycline, digoxin, lithiu

Med surg (35 decks)

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