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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
antacids: SE
diarrhea or constipation acid rebound (can help, once you stop symptoms return)
26
antacids: interactions
chelation (connect with other drugs and do not let body digest) altered gastric absorption of many drugs ---- separate dugs by 1-2 hours
27
antiemetics
nasuea serotonin blockers antihistamines anticholinergics dopamine antagonists prokinetics
28
serotonin blockers
ondansetron
29
serotonin blocker/ondansetron MOA
blocks serotonin receptors in trigger zone in brain and in afferent vagal nerves in stomach and SI
30
serotonin blocker/ondansetron: indication/route
treat N/V (esp chemo/radiation induced) PO/IV
31
serotonin blocker/ondansetron: SE/interactions
common --> mild: HA, diarrhea, dizzy serious: serotonin syndrome ** be aware of other drugs that affect serotonin syndrome (SSRIs, SNRIs, TCAs, MAIs, buspirone, tramadol)
32
antihistamines
dimenhydrinate meclizine hydroxyzine
33
antihistamines MOA
blocks the release of histamine H1 receptors in inner ear
34
antihistamines: indications
dizziness and nausea antiemetic and antivertigo associated with motion sickness
35
antihistamines SE
sedation, drowsiness, dizziness, and anticholinergic effect -- fall risk
36
dopamine antagonists
pro kinetic agent metoclopramide
37
dopamine antagonists/metoclopramide MOA
blocks dopamine receptors increases tone of lower esophageal sphincter (GERD) increases peristalsis in stomach and intestine (diabetic gastroparesis)
38
dopamine antagonists/metoclopramide: indications
N/V (chemo/radiation/opioid) GI motility issues paralytic ileus (ex: cystic fibrosis)
39
dopamine antagonists/metoclopramide: SE
severe: extrapyramidal symptoms (EPS) restlessness neuroleptic malignant syndrome (high fever, sweating, unstable BP)
40
extrapyramidal symptoms
akathisia - restless, tense, constant desire to move acute dystonia - involuntary muscle contractions *parkinsonism *tardive dyskinesia *neuroleptic malignant syndrome
41
drug therapy for diarrhea
diphenoxylate with atropine loperamide
42
diphenoxylate with atropine loperamide MOA
decrease intestinal peristalsis reduce intestinal effluent
43
diphenoxylate with atropine loperamide SE
drowsiness + constipation fall and driving precautions -- esp with other CNS Depressants anticholinergic effects of the atropine SERIOUS: cardiac arrest/arrythmias
44
IBD drug therapy
sulfasalazine infliximab
45
5-aminosalicylates + MOA
sulfasalazine sulfonamide antibiotic that converts the intestine into 5-aminosalicyclic acid AND sulphapyridine
46
sulfasalazine/5-aminosalicylates indications
mild to moderate IBD
47
sulfasalazine SE
nausea, fever, rash, HA, hematologic disorders
48
who should not receive sulfasalazine?
patients who are allergic to SULFA drugs or have certain types of anemia *caution for use for pt with many diseases
49
sulphapyridine
no therapeutic effect for IBD and bc of its SE, some patients prefer mesalamine alone (part of sulphasalazine)
50
disease modifying anti rheumatic drug (DMARD)
infliximab monoclonal ATB which neutralizes TNF-alpha (inflammatory mediator)
51
infliximab indications
IBD + a lot more
52
infliximab SE
IMMUNE SUPPRESSION infection, cancer, heart failure, infusion reactions, neutropenia

NUR 326: exam 3 (14 decks)

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