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1 Pharmacology > GI - Ulcers, GERD, H. Pylori > Flashcards

GI - Ulcers, GERD, H. Pylori Flashcards

1
Q

6 categories to treat peptic ulcers

A 
1 histamine H2 antag
2 PPI
3 mucosal protectants
4 antacids
5 prostaglandin E analog
6 antibiotics (H. Pylori)
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2
Q

histamine H2 antagonist

indications

A
  • gastric duodenal ulcers
  • H. Pylori
  • heartburns
  • dyspepsia
  • GERD
  • aspiration pneumonitis
  • hypersecretory disorders like Zollinger-Ellison syndrome
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3
Q

histamine H2 antagonist

3 drug names

A 
1 cimetidine (prototype)
2 nizatidine 
3 famotidine (Pepcid)
  • ends in -tidine
  • ranitidine is pulled fr shelves bc carcinogenic
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4
Q

*histamine H2 antagonist

MOA

A

-blocks H2 receptors on parietal cells>
reduces gastric acid production>
increases pH (more basic)

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5
Q

cimetidine

A/E

A
  • CNS effect (agitation, confusion)
  • cimetidine>blocked androgen receptors (s/s decr libido, gynecomastia, impotence, PNA)
  • dizzy, headaches
  • more rare: aplastic anemia
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6
Q

*histamine H2 antagonist

RN/teaching

A
  • avoid smoking (leads to decr perfusion> delayed healing)
  • avoid ETOH + NSAIDs (burning)
  • incr in FIBER
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7
Q

*histamine H2 antagonist

administration + interactions

A
  • admin: 30-60 mins before eating to prevent heartburn, + at bedtime
    intrx: warfarin incr bleeding; phenytoin incr effect
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8
Q

histamine H2 antagonist

contraindications

A

porphyria

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9
Q

[PPI]

Tx

A
  • short-term Tx of ulcers, GERD, + erosive esophagitis

- last resort bc most intense

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10
Q

PPI

drug names

A

1 pantoprazole
2 omeprazole
3 lansoprazole
4 esomeprazole

***all end w -PRAZOLE

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11
Q

PPI

prototype

A

omeprazole

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12
Q

PPI

MOA

A

-stop parietal cells fr secreting H+ which combines w Cl-

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13
Q

*PPI

A/E

A

**Osteoporosis and fractures (long term use)
**incr risk for pneumonia (use w caution for COPD)
•Headache (IV), diarrhea, nausea, vomiting, thrombophlebitis
•Rebound acid hypersecretion (taper slowly when discontinuing to prevent)

PORHO: Pneumonia, Osteop, Rebound, Hypersecretn, hypO-Mg

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14
Q

PPI

CI

A

*lactation
•Excess PPI can cause C.Dif
•incr risk of pneumonia

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15
Q

with omeprazole (type of PPI), monitor intaractions w…

A

digoxin, phenytoin, warfarin (Coumadin)

-do not give w atazanavir, ketoconazole, itraconazole (leads to decr absorp)

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16
Q

Mucosal Protectants

Tx for

A

acute duodenal ulcers

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17
Q

Mucosal Protectants

drug names

A

sucralfate

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18
Q

*Mucosal Protectants

MOA

A
  • chem rxn w HCl that creates a gel that coats ulcers

- creates a barrier bw stomach + gastric secretion

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19
Q

*Mucosal Protectants

administration

A
  • empty stomach
  • *1 hr before 3 meals + 1 before bedtime
  • -empty stomach
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20
Q

Mucosal Protectants

A/E

A

**constipation (incr fluid + fiber activity to prevent)
GI discomfort
Indigestion

**monitor for GI bleeding

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21
Q

Mucosal Protectants

CI

A
  • caution w patients w renal failure, diabetes, + dysphagia
  • antacids
  • prevents ABSORPTION of many drugs
22
Q

*Mucosal Protectants

interactions

A

•coumadin + tetracycline need to be 1hr apart

  • take other drugs 2 hrs before
  • incr absorption of fluoroquinolone abx, digoxin, warfarin, diazepam (Valium)
  • antacids reduce therapeutic effects
23
Q

Antacids

Tx

A
  • PUD
  • stress-induced ulcers
  • relief of manifestation of GERD
24
Q

Antacids

drug names

A

1 Al hydroxide (prototype)
2 Mg hydroxide (milk of magnesia)
3 Ca carbonate (Tums)(prototype)
(all have alkaline chem names!!!)

25
Q

Antacids

MOA

A

alkaline +buffer acid

-neutralize pH to promote wound healing + further

26
Q

*Antacids

administration

A
  • *take atleast 1 hr before or after most other meds (esp warfarin)
  • orally
  • up to QID
  • chew thoroughly followed by 8oz water
27
Q

Antacids

A/E

A
  • electrolyte imbalance + alkalosis
  • constipation (Ca+Al)
  • hypercalcemia (Ca)(s/s constptn, anorexia, n/v, confusn)
  • fluid retentn (Na)
  • toxicity(Mg)(esp w impaired kdn fnxn + ESRD)(s/s diarrhea)
28
Q

Antacids

CI

A
  • *acute ABD pain of unknown cause
  • impaird kidn funx must avoid Mg (toxicity + hyperMg)
  • —monitor for CNS deprssn
  • GI perforation or obstruction
29
Q

Antacids

indications

A

ulcers, GERD, CRD

—incr Ca, decr Phos

30
Q

Prostaglandin E analog

Tx

A
  • gastric ulcers fr long-term use of NSAIDs

- induce labor (Cat X)

31
Q

Prostaglandin E analog

drug name

A

misoprostol

32
Q

Prostaglandin E analog

MOA

A

1 decr acid secrtn
2 incr the secrtn of bicarb
3 protective mucosal layer
4 promotes vasodilation to maintain bld flow + incr healing

33
Q

Prostaglandin E analog

admin

A
  • oral
  • QID (w each meal + b4 bed)
  • take on day 2/3 of period (catgry X!!!!!!)
34
Q

Prostaglandin E analog

A/E

A
  • diarrhea

- miscarriage, spotting, dysmenorrhea, painful periods (ctgry X!!!!!)

35
Q

*Prostaglandin E analog

RN/teaching

A
  • Pregnancy Risk X
  • check for pregnancy test
  • can be given during labor to open the cervix
36
Q

Antibiotics for PUD/H. Pylori

Tx

A

H.Pylori infection

37
Q

*Antibiotics for PUD

admin

A

admin in combination of 3-4 total abx for 14 days
-to prevent resistance

*prophylactic proBiotics - Saccharomyces Boulardii

38
Q

**types of abx for H. Pylori

A

1 clarithromycin
2 amoxicillin
3 metronidazole
4 tetracycline

39
Q

Abx for H. Pylori is commonly combined w/

A
  • PPI
  • H2
  • bismuth subsalicylate
40
Q

PPI

admin

A
  • take once per day

- 30 mins prior to eating in AM

41
Q

PPI

RN/teaching

A
  • incr vit D + Ca
  • monitor B12 levels
  • taper to discontinue
  • for long term use get baseline Mg levels + teach patient to report s/s of hypo-Mg (s/s tremors, muscle cramps, seizures)
42
Q

Laxatives are used prophylactically for

A
  • bedridden (immobile, drugs, gravity)
  • have neuro issues
  • before/after surgery
  • before diagnostic
43
Q

Types of Laxatives

A

1 bulk-forming
2 surfactant lax
3 stimulant lax
4 osmotic lax

44
Q

bulk-forming lax

drug name + MOA

A

psyllium husk (Metamucil)

-contains fiber, absorbs water

45
Q

*bulk-forming lax

RN/teaching

A
  • need to drink water (8ox+++)
  • slow acting
  • for chronic conditions
46
Q

surfactant lax

drug name + MOA

A

docusate sodium
““stool softener””
-lowers surface tension so water + fats can penetrate
-made defecation more comf

47
Q

stimulant lax

drug + MOA

A

bisacodyl, senna, DSS

incr peristalsis by irritating bowel mucosa

48
Q

stimulant lax

RN/teaching

A
  • watch for hypokalemia

* no milk w/in 1 hr of bisacodyl (can cause burning sensation)

49
Q

osmotic lax

drug + MOA

A

Mg hydroxide, Mag citrate, Na Phosphate

-draws water into mass of stool, stretched muscles, incr peristalsis

50
Q

osmotic lax

indication

A
  • bowel prep,
  • PEG
  • lactulose
  • sorbitol
  • ion exchange resins - kayexalate
51
Q

probiotic for H.Pylori abx

A

Saccharomyces Boulardii

1 Pharmacology (33 decks)

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