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

- short-term Tx of ulcers, GERD, + erosive esophagitis - last resort bc most intense

Mucosal Protectants CI

- caution w patients w renal failure, diabetes, + dysphagia - antacids - prevents ABSORPTION of many drugs

GI - Ulcers, GERD, H. Pylori Flashcards by jessica quintos

6 categories to treat peptic ulcers

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

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histamine H2 antagonist

indications

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

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histamine H2 antagonist

3 drug names

1 cimetidine (prototype)
2 nizatidine 
3 famotidine (Pepcid)

ends in -tidine
ranitidine is pulled fr shelves bc carcinogenic

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*histamine H2 antagonist

MOA

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

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cimetidine

A/E

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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*histamine H2 antagonist

RN/teaching

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

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*histamine H2 antagonist

administration + interactions

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

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histamine H2 antagonist

contraindications

porphyria

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[PPI]

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

- last resort bc most intense

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PPI

drug names

1 pantoprazole
2 omeprazole
3 lansoprazole
4 esomeprazole

***all end w -PRAZOLE

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PPI

prototype

omeprazole

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PPI

MOA

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

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*PPI

A/E

**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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PPI

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

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

digoxin, phenytoin, warfarin (Coumadin)

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

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Mucosal Protectants

Tx for

acute duodenal ulcers

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Mucosal Protectants

drug names

sucralfate

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*Mucosal Protectants

MOA

chem rxn w HCl that creates a gel that coats ulcers

- creates a barrier bw stomach + gastric secretion

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*Mucosal Protectants

administration

empty stomach
*1 hr before 3 meals + 1 before bedtime
-empty stomach

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Mucosal Protectants

A/E

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

**monitor for GI bleeding

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Mucosal Protectants

caution w patients w renal failure, diabetes, + dysphagia
antacids
prevents ABSORPTION of many drugs

*Mucosal Protectants

interactions

•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

Antacids

PUD
stress-induced ulcers
relief of manifestation of GERD

Antacids

drug names

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

Antacids | MOA

alkaline +buffer acid | -neutralize pH to promote wound healing + further

*Antacids | administration

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

Antacids | A/E

* 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)

Antacids | CI

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

Antacids | indications

ulcers, GERD, CRD | ---incr Ca, decr Phos

Prostaglandin E analog | Tx

- gastric ulcers fr long-term use of NSAIDs | - induce labor (Cat X)

Prostaglandin E analog | drug name

misoprostol

Prostaglandin E analog | MOA

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

Prostaglandin E analog | admin

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

Prostaglandin E analog | A/E

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

*Prostaglandin E analog | RN/teaching

* Pregnancy Risk X * check for pregnancy test * can be given during labor to open the cervix

Antibiotics for PUD/H. Pylori | Tx

H.Pylori infection

*Antibiotics for PUD | admin

admin in combination of 3-4 total abx for 14 days -to prevent resistance *prophylactic proBiotics - Saccharomyces Boulardii

**types of abx for H. Pylori

1 clarithromycin 2 amoxicillin 3 metronidazole 4 tetracycline

Abx for H. Pylori is commonly combined w/

- PPI - H2 - bismuth subsalicylate

PPI | admin

- take once per day | - 30 mins prior to eating in AM

PPI | RN/teaching

- 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)

Laxatives are used prophylactically for

- bedridden (immobile, drugs, gravity) - have neuro issues - before/after surgery - before diagnostic

Types of Laxatives

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

bulk-forming lax | drug name + MOA

psyllium husk (Metamucil) -contains fiber, absorbs water

*bulk-forming lax | RN/teaching

* need to drink water (8ox+++) - slow acting - for chronic conditions

surfactant lax | drug name + MOA

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

stimulant lax | drug + MOA

bisacodyl, senna, DSS incr peristalsis by irritating bowel mucosa

stimulant lax | RN/teaching

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

osmotic lax | drug + MOA

Mg hydroxide, Mag citrate, Na Phosphate -draws water into mass of stool, stretched muscles, incr peristalsis

osmotic lax | indication

- bowel prep, - PEG - lactulose - sorbitol - ion exchange resins - kayexalate

probiotic for H.Pylori abx

Saccharomyces Boulardii