GI pharm - E3 Flashcards
go back and review
constipation & diarrhea meds
when treating gerd / PUD, what drugs increase protective factors
antacids
sucralfate
how to treat H.pylori
several abx + gastric acid inhibitors
-need the combo therapy to minimize resistance & bc H.py thrives in acidic environments and abx hate acidic environments
-take abx for 10 to 14 days (bad adherences bc expensive & lots of pills)
what class are cimedetidine & famotidine
H2 receptor antagonists
H2 receptor MOA
blocks H2 receptors in the stomach -> reduces gastric acid secretion by 60-70% and increases stomach pH
cimedetidine & famotidine indications
Gerd
PUD
Ulcer prophylaxis
Heartburn/dyspepsia
cimedetidine & famotidine SE
well tolerated
-CNS effects in elderly
-Slight increased risk for pneumonia in elderly
cimedetidine & famotidine nursing considerations
-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
cimedetidine & famotidine interactions
warfarin
phenytoin
theophylline
cimedetidine & famotidine can be used to help prevent what
aspiration pneumonia
what class are omoprazole, pantoprazole, & esomeprazole
proton pump inhibits (PPIs)
PPIs MOA
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
omoprazole, pantoprazole, & esomeprazole indications
Short term treatment of PUD
GERD
omoprazole, pantoprazole, & esomeprazole SE
Short term: relatively safe
Long term: increased risk for pneumonia, bone loss/ hip fx, & stomach cancer
omoprazole, pantoprazole, & esomeprazole nursing considerations
try to only use for short term use
what class is sucralfate
mucosal protectant
mucosal protectant MOA
Drug is altered when exposed to gastric acid and becomes a thick, sticky gel that creates a protective barrier
sucralfate indications
Duodenal ulcers
Gastric ulcers
sucralfate SE
May cause constipation
sucralfate nursing considerations
Always given PO
Decreased drug absorption so take 2 hrs before other meds
major forms of antacids
amphojel
tums
milk of magnesia
Maalox
Mylanta
amphojel base & SE
aluminum ; constipation
tums base & SE
calcium ; constipation
milk of magnesium base & SE
magnesium ; diarrhea
Maalox and Mylanta base & SE
Al + Mg ; balanced
antacids MOA
neutralizes acid by approximately 50%
antacids indication
PUD (healing)
GERD (symptoms)
Stress ulcers (prophylaxis)
antacids SE
Diarrhea or constipation
Acid rebound (can eat tums all day but once stopped sx will come back so avoid triggers vs all med mgt)
antacid nursing consideration
Alters gastric absorption when taken w/ other drugs (chelation) -> separate from other meds by 1 to 2 hrs
what class is Ondansetron
serotonin blocker
serotonin blocker MOA
Blocks serotonin receptors in the trigger zone in the brain and in the afferent vagal nerves in the stomach and small intestines
Ondansetron indication
Nausea & vomiting
Ondansetron SE
Mild HA
Diarrhea
Dizziness
Ondansetron nursing consideration
Monitor for serotonin syndrome -> beware if pt is on SSRIs, SNRIs, TCAs, MAIs, buspirone, tramadol
what class are Dimenhydrinate, Meclizine & Hydroxyzine
antihistamines
antihistamines MOA
Blocks the release of histamine H1 receptors in the inner ear
Dimenhydrinate, Meclizine & Hydroxyzine indications
Treatment of dizziness & nausea
(antiemetic & antivertigo associated w/ motion sickness)
Dimenhydrinate, Meclizine & Hydroxyzine SE
Sedation
Drowsiness
Dizziness
Anticholinergic effects
Dimenhydrinate, Meclizine & Hydroxyzine nursing considerations
Fall risk in elderly
Hydroxyzine cannot be given IV
what class is metoclopramide
dopamine antagonists
dopamine antagonists
Blocks dopamine receptors, increases the tone of the lower esophageal sphincter (GERD), increases peristalsis in both the stomach & the intestines (diabetic gastroparesis)
metoclopramide indication
N/v associated w/ chemo/radiation/opioids
GI motility issues
paralytic ileus
metoclopramide SE
Sedation
Severe: extrapyramidal symptoms, restlessness, neuroleptic malignant syndrome
metoclopramide nursing considerations
extrapyramidal symptoms (drug induced movement disorders) usually occurs when given w/ antipsychotic meds
extrapyramidal symptoms (ESP)
-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
what drug class is Diphenoxylate w/ atropine &
Loperamide
antidiarrheal
antidiarrheal MOA
Decrease intestinal peristalsis, reduce the intestinal effluent
Diphenoxylate w/ atropine & Loperamide indication
diarrhea
Diphenoxylate w/ atropine & Loperamide SE
drowsiness
constipation
Diphenoxylate w/ atropine & Loperamide nursing consideration
Dip + At can cause bradycardia & anticholinergic effects
Fall risk and driving precautions
what class is sulfasalazine
5-aminosalicylates
5-aminosalicylates MOA
Sulfasalazine is a sulfonamide antibiotic that converts the intestine into 5- aminosalicyclic acid & sulphapyridine
sulfasalazine indication
mild to moderation IBD
sulfasalazine SE
Nausea
Fever
Rash
H/a
Hematologic disorders
sulfasalazine nursing considerations
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
what class is infliximab
Disease modifying antirheumatic drug (DMARD)
Disease modifying antirheumatic drug (DMARD) MOA
Monoclonal antibody which neutralizes TNF alpha (inflammatory mediatory)
infliximab indication
IBD
infliximab SE
Immune suppression ->
Infection, cancer, heart failure, infusions
infliximab nursing considerations
Often require therapeutic drug monitoring and biomarker monitoring for inflammation (CRP)
Needs lots of prescreening: vaccines, tifers, TB screen
when treating gerd / PUD, what drugs decrease aggressive factors
H.pylori treatment
H2 blockers
PPIs
