GI pharm Flashcards
what is the side effects associated with aluminum as an antacid?
constipation
what is the side effects associated with calcium as an antacid?
constipation
what is the side effects associated with magnesium as an antacid?
diarrhea
what is the side effects associated with aluminum + magnesium as an antacid?
not constipation or diarrhea - just a balanced approach
what are two examples or antacids that are aluminum + magnesium?
Maalox, Mylanta
why is it ideal to use a combination approach to treat h. pylori?
to minimize resistance and because h. pylori loves an acidic environment but we can’t get antibiotics to work in a highly acidic environment
what class is cimetidine / famotidine?
H2 receptor antagonist
what class is omeprazole / pantoprazole / esomeprazole?
PPI
what class is sucralfate?
mucosal protectant
what class is ondanestron?
serotonin blocker
what class is dimenhydramine, meclizine, and hydrozyzine?
antihistamines
what class is metoclopromide?
dopamine antagonists / prokinetic agent
what class is sulfasalazine?
5-aminosalicylate
what class is infliximab?
disease modifying anti-rheumatic drug (DMARD)
what is the MOA of H2 receptor antagonists?
blocks H2 receptors in the stomach, which reduces acid secretion by 60-70%, which increases gastric pH
what are the indications for H2 receptor antagonists?
PUD, GERD, prophylaxis, heartburn/dyspepsia
what are the side effects for H2 receptor antagonists?
generally well tolerated - except in elderly, then can have CNS alteration and an increased risk of pneumonia
what is the route for H2 receptor antagonists?
IV and PO
how long should you wait in between giving a H2 receptor antagonist and an antacid?
~ 1 hours
are H2 receptor antagonists CYP inhibitors or agonists?
inhibitors
what 3 medications can H2 receptor antagonists increase the levels for?
warfarin, phenytoin, theophylline
if pushed too fast what can H2 receptor antagonists cause?
bradycardia
what is the MOA of PPIs?
inhibiting the proton pump by binding directly to it, this irreversibly inhibits the HCl secretion
what are PPIs used for?
short term treatment of GERD and PUD (if long term usually are rx)
what are the short term and long term side effects of PPIs?
short term - generally nothing
long term - increased risk of pneumonia, bone loss / hip fracture, stomach cancer
are H2 receptor antagonists or PPIs generally more effective?
PPI
what is the MOA of mucosal protectants?
they change into a thick gel when in contact with gastric acid - this provides a barrier to the stomach
what are mucosal protectants used for?
ulcers
what are the side effects of mucosal protectants?
generally nothing, maybe some constipation
how are mucosal protectants taken?
PO
when should you take mucosal protectants in relation to other meds?
~ 2 hours before (it decreases the absorption of other drugs because it coats the stomach)
what are the side effects of antacids?
diarrhea / constipation, rebound acid
why do antacids need to be spaced out from other drugs?
they generally have a chelating effect which pulls the drugs out of the system and causes them to not be absorbed as well
what is the MOA of ondansetron?
blocks serotonin receptors in the brain and in afferent vagal nerves in the stomach and intestines to decrease N/V
what are the side effects of serotonin blockers?
headache, diarrhea, dizziness, serotonin syndrome
how is ondansetron given?
PO , IV
what medications must a nurse know about before giving ondansetron?
SSRI, SNRI, MAOI, TCA, buspirone, tramadol
antihistamines increase fall risk - true or false?
true
what is the MOA of metoclopramide?
blocks dopamine receptors which increase the tone of the LES while also increasing peristalsis
what are the side effects of metoclopramide?
sedation, extrapyramidal symptoms (dystonia, pseudoparkinsonism, akathisia (inability to remain still), tardive dyskinesia, restlessness, neuroleptic malignant syndrome (fever, altered LOC, muscle rigidity, and autonomic dysfunction)
what population of people are more at risk of developing EPS with metoclopramide?
those taking anti-psychotic medications
what are the side effects of diphenoxylate with atropine or loperamide?
drowsiness, constipation
anticholinergic
bradycardia
cardiac arrest / arrhythmia
what are the side effects for sulfasalazine?
fever, nausea, rash, HA, hematologic disorders
what groups of patients does the nurse need to be cautious giving sulfasalazine to?
anemia, lots of comorbidities
what is the MOA of infliximab?
monoclonal antibodies neutralize TNF alpha which causes a decreased inflammatory response
what is infliximab used for?
IBD
what are the side effects for infliximab?
immunosuppression
cancer, HF, infusion reactions
what monitoring needs to be done while taking infliximab?
therapeutic dose monitoring and CRP
