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NUR 326: exam 3 > GI pharm > Flashcards

GI pharm Flashcards

1
Q

drug therapy for GERD and PUD

A

H2 receptor antagonists
proton pump inhibitors (PPI)
mucosal protectants
antacids
antiemetics

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2
Q

goal for upper GI distress

A

increase protective factors (antacids and sucralfate)

decrease aggressive factors (treat H. pylori, H2 blockers, PPIs)

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3
Q

how do we treat H. pylori?

A

several antibiotics + gastric acid inhibitor –> combine to minimize resistance and it likes an acidic environment

10-14 days

~$200 for 12 pills, so expensive

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4
Q

what are 2 ways drugs target gastric acid production?

A

block H2 receptors (histamine)
inhibit proton pump

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5
Q

H2 receptor antagonists

A

cimetidine
famotidine

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6
Q

H2 receptor antagonists: MOA

A

block H2 receptors in stomach -> increases pH and reduces gastric acid by 60-70%

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7
Q

H2 receptor antagonists: indications + route

A

GERD, PUD, ulcer prophylaxis, heartburn/dyspepsia

PO, IV —> give at least 1 hour apart from antacids

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8
Q

H2 receptor antagonists: side effects/interactions

A

well tolerated
CNS effects and risk for PNA in elders

interactions:
inhibits CYP450 enzymes (cimetidine - older agent)
^newer gen (famotidine) does not have this problem

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9
Q

H2 receptor antagonists: safety alert

A

can increase levels of warfarin, phenytoin, theophylline
give IV form slowly to avoid bradycardia

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10
Q

proton pump inhibitors

A

-prazoles

omeprazole
pantoprazole
esomeprazole magnesium

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11
Q

PPIs MOA

A

binds to proton pump –> inhibits hydrogen potassium ATPase enzyme system (proton pump)
irreversibly inhibits secretion of HCl

***more effective than H2RA

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12
Q

PPI’s indications

A

short term treatment of PUD and GERD

OTC or prescription

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13
Q

PPIs: adverse effects/interactions

A

short term: relatively safe
long term: increased risk for PNA, bone loss/hip fracture, stomach cancer

few interactions

only use SHORT TERM

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14
Q

mucosal protectant

A

sucralfate

unique drug composed of sucrose-base and aluminum hydroxide

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15
Q

mucosal protectant: MOA

A

alters when exposed to gastric acid — sticky, thick gel (protective barrier)

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16
Q

mucosal protectants: indications/route

A

duodenal ulcers (FDA approved)
gastric ulcers (chronic gastritis)

PO– tablet or suspension

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17
Q

mucosal protectants: side effects/interactions

A

no major SE – maybe constipation

decreased drug absorption**
take at least 2 hours apart from other meds

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18
Q

major forms of antacids

A

aluminum
calcium
magnesium
Al + Mg

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19
Q

aluminum antacid

A

amphojel

SE: constipation

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20
Q

calcium antacid

A

tums

SE: constipation

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21
Q

magnesium antacid

A

milk of magnesia

SE: diarrhea

22
Q

Al + Mg antacid

A

maalox, mylanta

SE: balanced approach

23
Q

antacids MOA

A

neutralize acid by 50%

ex: MgOH + HCl –> MgCl + H2O

24
Q

antacids: indications

A

PUD (healing)
GERD (symptoms)
stress ulcers (prophylaxis)

can help some with heartburn and indigestion

25
Q

antacids: SE

A

diarrhea or constipation
acid rebound (can help, once you stop symptoms return)

26
Q

antacids: interactions

A

chelation (connect with other drugs and do not let body digest)
altered gastric absorption of many drugs —- separate dugs by 1-2 hours

27
Q

antiemetics

A

nasuea

serotonin blockers
antihistamines
anticholinergics
dopamine antagonists
prokinetics

28
Q

serotonin blockers

A

ondansetron

29
Q

serotonin blocker/ondansetron MOA

A

blocks serotonin receptors in trigger zone in brain and in afferent vagal nerves in stomach and SI

30
Q

serotonin blocker/ondansetron: indication/route

A

treat N/V (esp chemo/radiation induced)

PO/IV

31
Q

serotonin blocker/ondansetron: SE/interactions

A

common –>
mild: HA, diarrhea, dizzy
serious: serotonin syndrome
** be aware of other drugs that affect serotonin syndrome (SSRIs, SNRIs, TCAs, MAIs, buspirone, tramadol)

32
Q

antihistamines

A

dimenhydrinate
meclizine
hydroxyzine

33
Q

antihistamines MOA

A

blocks the release of histamine H1 receptors in inner ear

34
Q

antihistamines: indications

A

dizziness and nausea

antiemetic and antivertigo associated with motion sickness

35
Q

antihistamines SE

A

sedation, drowsiness, dizziness, and anticholinergic effect – fall risk

36
Q

dopamine antagonists

A

pro kinetic agent

metoclopramide

37
Q

dopamine antagonists/metoclopramide MOA

A

blocks dopamine receptors
increases tone of lower esophageal sphincter (GERD)
increases peristalsis in stomach and intestine (diabetic gastroparesis)

38
Q

dopamine antagonists/metoclopramide: indications

A

N/V (chemo/radiation/opioid)
GI motility issues
paralytic ileus

(ex: cystic fibrosis)

39
Q

dopamine antagonists/metoclopramide: SE

A

severe: extrapyramidal symptoms (EPS)
restlessness
neuroleptic malignant syndrome (high fever, sweating, unstable BP)

40
Q

extrapyramidal symptoms

A

akathisia - restless, tense, constant desire to move

acute dystonia - involuntary muscle contractions
*parkinsonism
*tardive dyskinesia
*neuroleptic malignant syndrome

41
Q

drug therapy for diarrhea

A

diphenoxylate with atropine
loperamide

42
Q

diphenoxylate with atropine
loperamide
MOA

A

decrease intestinal peristalsis
reduce intestinal effluent

43
Q

diphenoxylate with atropine
loperamide

SE

A

drowsiness + constipation

fall and driving precautions – esp with other CNS Depressants

anticholinergic effects of the atropine

SERIOUS: cardiac arrest/arrythmias

44
Q

IBD drug therapy

A

sulfasalazine
infliximab

45
Q

5-aminosalicylates + MOA

A

sulfasalazine

sulfonamide antibiotic that converts the intestine into 5-aminosalicyclic acid AND sulphapyridine

46
Q

sulfasalazine/5-aminosalicylates indications

A

mild to moderate IBD

47
Q

sulfasalazine SE

A

nausea, fever, rash, HA, hematologic disorders

48
Q

who should not receive sulfasalazine?

A

patients who are allergic to SULFA drugs
or have certain types of anemia
*caution for use for pt with many diseases

49
Q

sulphapyridine

A

no therapeutic effect for IBD and bc of its SE, some patients prefer mesalamine alone

(part of sulphasalazine)

50
Q

disease modifying anti rheumatic drug (DMARD)

A

infliximab
monoclonal ATB which neutralizes TNF-alpha (inflammatory mediator)

51
Q

infliximab indications

A

IBD + a lot more

52
Q

infliximab SE

A

IMMUNE SUPPRESSION
infection, cancer, heart failure, infusion reactions, neutropenia

NUR 326: exam 3 (14 decks)

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