GI pharm Flashcards by Timothy Sapienza

Peptic Ulcer Disease (PUD) symptoms

gnawing, burning upper abdominal pain. maybe losing weight

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PUD at risk factors

genetics, blood group O, caffeine, smoking, corticosteroids, NSAID, stress, H. Pylori

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GERD symptoms

intense heart burn & belching, N/V, dyspepsia

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GERD high risk

obesity, new borns, pregnant women

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Pharm intervention for both PUD & GERD

Proton Pump Inhibitors
H2-receptor blockers
Antacids

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drug of choice for short term PUD & GERD therapy

Proton Pump Inhibitors

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Mechanism of Action for Proton Pump Inhibitors (PPI)

bind irreversibly to H+, K+- ATPase which is responsible for secreting hydrochloric acid in the stomach

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Proton Pump Inhibitor (PPI) protoype drug [generic and Trade name]

omeprazole (Prilosec)

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Drug that can be given with antacids

omeprazole

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omeprazole classification (T&P)

therapeutic- antiulcer

pharmacological- proton pump inhibitor

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omeprazole side effects

headache, nausea, diarrhea, rash, abdominal pain

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Mechanism of Action for H2-receptor blockers

suppress volume and acidity of parietal cell secretions by blocking H2 receptors

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What are H2 receptors responsible for?

increasing acid secretion in the stomach

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H2-receptor blockers prototype drug [generic and Trade name]

ranitidine (Zantac)

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ranitidine classification (T&P)

therapeutic- antiulcer

pharmacological- H2 receptor blocker

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ranitidine side and adverse effects

headache
possible reduction in # of red and white blood cells and platelets,
impotence or loss of libido in men

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Nursing considerations for H2 Receptor Antagonists

Give after meals
Monitor LFTs, bilirubin, Alk Phos, and renal function
no antacids w/in 1 hour of administration (decreases absorption)
tobacco decreases effectiveness

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What are antacids

alkaline substances used to neutralize stomach acid

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Antacids are seen in combination with…

aluminum, magnesium, sodium, or calcium

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True or False: Antacids promote healing of ulcer

False

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Mechanism of Action for antacids

neutralizes stomach acid by raising pH of stomach contents

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Antacid prototype drug [generic and Trade name]

aluminum hydroxide (AlternalGEL)

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aluminum hydroxide classification (T&P)

therapeutic- antiheartburn drug

pharmacological- antacid

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True or False: Side effects of antacids are severe

False. Minor only constipation

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What are the nursing considerations for antacids

-give @ least 2hrs before or after other drugs -rapid onset (20mins) short duration (2hrs) -monitor for constipation and phosphate depletion w/high doses -magnesium- and aluminum-based products may cause diarrhea calcium-based products may cause constipation

Pharmacological Treatment for PUD only (not GERD)

- Pepsin Inhibitors - Prostaglandin Analogues - Prokinetic Agents

"Pepsin Inhibitors" prototype/trade name

p: sucralfate t: Carafate

What are mucosal protective drugs?

Pepsin Inhibitors

what does sucralfate consist of?

sucrose (sugar) and aluminum hydroxide (antacid)

sucralfate method of action

combines w/protein to form thick paste covering ulcer, protects from acid and pepsin (does not affect secretion of gastric acid)

Nursing intervention for sucralfate (pepsin inhibitors)

administer 30mins before meals and bedtime (4x a day)

Side effects of pepsin inhibitors

constipation

Prostaglandin Analogue prototype drug and trade name

misoprostol (Cytotec)

Primary use for misoprostol

prevention of peptic ulcers in patients who are taking high doses of NSAIDs or corticosteroids

Action of misoprostol

increases mucous production decreases acid protects mucosa

side effects of misoprostol (Prostaglandin Analogue)

diarrhea and abdominal cramping

Prokinetic Agent prototype/trade name

p: metoclopramide t: Reglan

uses for metoclopramide

short term, used if failed 1st drug therapy | post op emesis & cancer treatments

method of action for metoclopramide

causes muscles in upper intestines to contract, resulting in faster emptying of the stomach, and blocks food from re-entering the esophagus from stomach

side effects of metoclopramide

drowsiness, fatigue, confusion, insomnia

blackbox warning for metoclopramide

tardive dyskinesia

types of laxatives

osmotic (saline), stimulant (irritant) bulk forming emollient (stool softener)

What are cathartics?

stronger and more complete emptying than usual laxatives

Causes of constipation

``` bowel obstruction (fecal impaction) chronic laxative use (ignoring use to defecate) neurological disorders side effects lack of exercise lack of adequate water ```

Contraindications for laxatives

``` undiagnosed abdominal pain inflammatory disorders of GI tract spastic colon bowel obstruction pregnancy ```

bulk-forming laxatives contain

fiber (which absorbs water and increases mass)

b.f. laxative prototype drug

psyllium (Metamucil)

method of action for bulk-forming (b.f.) laxative

absorbs water into intestines, increases bulk & peristalsis

True or False: psyllium raises cholesterol

False- it lowers cholesterol

True or False: psyllium is the drug of choice for rapid effect

False- it has a slow onset

Method of action for osmotic (saline) laxative

hyperosmolar salt pulls water into colon and increase water in feces to increase bulk, which stimulates peristalsis

Uses for osmotic laxatives

colonoscopy prep since it is fast and rapid

Osmotic laxative drugs

``` polyethylene glycol (GoLYTELY) lactulose (Chronulac) ```

True or False: osmotic laxatives are not absorbed in the intestines

true

Method of action of stimulant laxatives

increase peristalsis by irritating sensory nerve endings in intestinal mucosa; acts on smooth muscle

Stimulate laxative drugs

prn- bisacodyl (Dulcolax) | daily- senna (Senokot)

Side effects of stimulant laxatives

abdominal cramps weakness reddish brown urine (common) diarrhea

Adverse/side effect of sulfasalazine

photosensitivity- teach patients to use sunblock

administration of ondansetron [Serotonin (5-HT3) receptor antagonist]

infuse 30 mins prior infuse slowly over 15 mins repeat 4 hrs after chemo

adverse effect of metoclopramide

tardive dyskinesia

common side effects of ondansetron

dizziness and lightheadedness

Nurse should monitor phosphorus levels for which drug?

aluminum hydroxide

Nursing assessments after sulfasalazine admin

temperature skin integrity (rash) CBC report: sore throat or fatigue

sulcrafate interaction with phenytoin

Sucralfate decreases the absorption of phenytoin. The nurse should instruct the client to allow at least 2 hr between taking the two drugs and should monitor the client's phenytoin levels.

Diphenoxylate/atropine should be used with caution in what condition

inflammatory bowel disease

sulfasalazine, a 5-aminosalicylic acid (5-ASA), is contraindicated for what issue?

aspirin sensitivity

First line drug therapy for Inflammatory bowel disease (IBD)

5-ASA (aminosalicylic acid)

What is the pharmacological class for sulfASAlazine?

5-ASA (amino salicylic acid)

Nursing considerations for sulfASAlazine

not for children under 2 caution w/hepatic impairment caution w/diabetics (increases insulin production) Sulfa, lasix, salicylate (aspirin) allergies monitor I/O, electrolytes, daily weights, encourage fluid/fiber

Side effects of sulfASAlazine (think GI symptoms)

``` photosensitivity headache anorexia dyspepsia (indigestion) skin rash (Steven Johnson Syndrome) ```