GI pharm - E3

Question 1

go back and review

Answer 1

constipation & diarrhea meds

Question 2

when treating gerd / PUD, what drugs increase protective factors

Answer 2

antacids
sucralfate

Question 3

when treating gerd / PUD, what drugs decrease aggressive factors

Answer 3

H.pylori treatment
H2 blockers
PPIs

Question 3

how to treat H.pylori

Answer 3

several abx + gastric acid inhibitors
-need the combo therapy to minimize resistance & bc H.py thrives in acidic environments and abc hate acidic environments
-take abx for 10 to 14 days (bad adherences bc expensive & lots of pills)

Question 4

what class are cimedetidine & famotidine

Answer 4

H2 receptor antagonists

Question 5

H2 receptor MOA

Answer 5

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

Question 6

cimedetidine & famotidine indications

Answer 6

Gerd
PUD
Ulcer prophylaxis
Heartburn/dyspepsia

Question 7

cimedetidine & famotidine SE

Answer 7

well tolerated
-CNS effects in elderly
-Slight increased risk for pneumonia in elderly

Question 8

cimedetidine & famotidine nursing considerations

Answer 8

-give at least 1hr apart from antacids
-inhibits CYP 450 enzymes (newer does not so use famotidine when possible)
-give IV form slowly to avoid bradycardia

Question 9

cimedetidine & famotidine interactions

Answer 9

warfarin
phenytoin
theophylline

Question 10

cimedetidine & famotidine can be used to help prevent what

Answer 10

aspiration pneumonia

Question 11

what class are omoprazole, pantoprazole, & esomeprazole

Answer 11

proton pump inhibits (PPIs)

Question 12

PPIs MOA

Answer 12

Binds to proton pump and inhibits the hydrogen potassium ATPase enzyme system -> irreversibly inhibits the secretion of HCl which is the primary driver of gastric acid
more effective than H2RA

Question 13

omoprazole, pantoprazole, & esomeprazole indications

Answer 13

Short term treatment of PUD
GERD

Question 14

omoprazole, pantoprazole, & esomeprazole SE

Answer 14

Short term: relatively safe

Long term: increased risk for pneumonia, bone loss/ hip fx, & stomach cancer

Question 15

omoprazole, pantoprazole, & esomeprazole nursing considerations

Answer 15

try to only use for short term use

Question 16

what class is sucralfate

Answer 16

mucosal protectant

Question 17

mucosal protectant MOA

Answer 17

Drug is altered when exposed to gastric acid and becomes a thick, sticky gel that creates a protective barrier

Question 18

sucralfate indications

Answer 18

Duodenal ulcers
Gastric ulcers

Question 19

sucralfate SE

Answer 19

May cause constipation

Question 20

sucralfate nursing considerations

Answer 20

Always given PO

Decreased drug absorption so take 2 hrs before other meds

Question 21

major forms of antacids

Answer 21

amphojel
tums
milk of magnesia
Maalox
Mylanta

Question 22

amphojel base & SE

Answer 22

aluminum ; constipation

Question 23

tums base & SE

Answer 23

calcium ; constipation

Question 24

milk of magnesium base & SE

Answer 24

magnesium ; diarrhea

Question 25

Maalox and Mylanta base & SE

Answer 25

Al + Mg ; balanced

Question 26

antacids MOA

Answer 26

neutralizes acid by approximately 50%

Question 27

antacids indication

Answer 27

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

Question 28

antacids SE

Answer 28

Diarrhea or constipation Acid rebound (can eat tums all day but once stopped sx will come back so avoid triggers vs all med mgt)

Question 29

antacid nursing consideration

Answer 29

Alters gastric absorption when taken w/ other drugs (chelation) -> **separate from other meds by 1 to 2 hrs**

Question 30

what class is Ondansetron

Answer 30

serotonin blocker

Question 31

serotonin blocker MOA

Answer 31

Blocks serotonin receptors in the trigger zone in the brain and in the afferent vagal nerves in the stomach and small intestines

Question 32

Ondansetron indication

Answer 32

Nausea & vomiting

Question 33

Ondansetron SE

Answer 33

Mild HA Diarrhea Dizziness

Question 34

Ondansetron nursing consideration

Answer 34

**Monitor for serotonin syndrome** -> beware if pt is on SSRIs, SNRIs, TCAs, MAIs, buspirone, tramadol

Question 35

what class are Dimenhydrinate, Meclizine & Hydroxyzine

Answer 35

antihistamines

Question 36

antihistamines MOA

Answer 36

Blocks the release of histamine H1 receptors in the inner ear

Question 37

Dimenhydrinate, Meclizine & Hydroxyzine indications

Answer 37

Treatment of dizziness & nausea (**antiemetic & antivertigo associated w/ motion sickness**)

Question 38

Dimenhydrinate, Meclizine & Hydroxyzine SE

Answer 38

Sedation Drowsiness Dizziness **Anticholinergic effects**

Question 39

Dimenhydrinate, Meclizine & Hydroxyzine nursing considerations

Answer 39

**Fall risk** in elderly Hydroxyzine cannot be given IV

Question 40

what class is metoclopramide

Answer 40

dopamine antagonists

Question 41

dopamine antagonists

Answer 41

Blocks dopamine receptors, increases the tone of the lower esophageal sphincter (GERD), increases peristalsis in both the stomach & the intestines (diabetic gastroparesis)

Question 42

metoclopramide indication

Answer 42

N/v associated w/ chemo/radiation/opioids GI motility issues paralytic ileus

Question 43

metoclopramide SE

Answer 43

Sedation Severe: extrapyramidal symptoms, restlessness, neuroleptic malignant syndrome

Question 44

metoclopramide nursing considerations

Answer 44

extrapyramidal symptoms (drug induced movement disorders) usually occurs when given w/ antipsychotic meds

Question 45

extrapyramidal symptoms (ESP)

Answer 45

-Akathisia: may feel restless, tense, constant desire to move -acute dystonia: involuntary muscle contractions -parkinsonism -tardive dyskinesia (repeated abnormal facial movements) -neuroleptic malignant syndrome: life threatening, 1st sign is rigid muscle, fever & drowsiness and can lead to seizures

Question 46

what drug class is Diphenoxylate w/ atropine & Loperamide

Answer 46

antidiarrheal

Question 47

antidiarrheal MOA

Answer 47

Decrease intestinal peristalsis, reduce the intestinal effluent

Question 48

Diphenoxylate w/ atropine & Loperamide indication

Answer 48

diarrhea

Question 49

Diphenoxylate w/ atropine & Loperamide SE

Answer 49

drowsiness constipation

Question 50

Diphenoxylate w/ atropine & Loperamide nursing consideration

Answer 50

Dip + At can cause bradycardia & anticholinergic effects Fall risk and driving precautions

Question 51

what class is sulfasalazine

Answer 51

5-aminosalicylates

Question 52

5-aminosalicylates MOA

Answer 52

Sulfasalazine is a sulfonamide antibiotic that converts the intestine into 5- aminosalicyclic acid & sulphapyridine

Question 53

sulfasalazine indication

Answer 53

mild to moderation IBD

Question 54

sulfasalazine SE

Answer 54

Nausea Fever Rash H/a Hematologic disorders

Question 55

sulfasalazine nursing considerations

Answer 55

**Do not give to patients who are allergic to sulfa drugs or who have certain types of anemias** Not the best drug for patients with many diseases d/t lots of interactions

Question 56

what class is infliximab

Answer 56

Disease modifying antirheumatic drug (DMARD)

Question 57

Disease modifying antirheumatic drug (DMARD) MOA

Answer 57

Monoclonal antibody which neutralizes TNF alpha (inflammatory mediatory)

Question 58

infliximab indication

Answer 58

IBD

Question 59

infliximab SE

Answer 59

Immune suppression -> Infection, cancer, heart failure, infusions

Question 60

infliximab nursing considerations

Answer 60

Often require therapeutic drug monitoring and biomarker monitoring for inflammation (CRP) **Needs lots of prescreening: vaccines, tifers, TB screen**