GI - Ulcers, GERD, H. Pylori Flashcards
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)
histamine H2 antagonist
indications
- gastric duodenal ulcers
- H. Pylori
- heartburns
- dyspepsia
- GERD
- aspiration pneumonitis
- hypersecretory disorders like Zollinger-Ellison syndrome
histamine H2 antagonist
3 drug names
1 cimetidine (prototype) 2 nizatidine 3 famotidine (Pepcid)
- ends in -tidine
- ranitidine is pulled fr shelves bc carcinogenic
*histamine H2 antagonist
MOA
-blocks H2 receptors on parietal cells>
reduces gastric acid production>
increases pH (more basic)
cimetidine
A/E
- CNS effect (agitation, confusion)
- cimetidine>blocked androgen receptors (s/s decr libido, gynecomastia, impotence, PNA)
- dizzy, headaches
- more rare: aplastic anemia
*histamine H2 antagonist
RN/teaching
- avoid smoking (leads to decr perfusion> delayed healing)
- avoid ETOH + NSAIDs (burning)
- incr in FIBER
*histamine H2 antagonist
administration + interactions
- admin: 30-60 mins before eating to prevent heartburn, + at bedtime
intrx: warfarin incr bleeding; phenytoin incr effect
histamine H2 antagonist
contraindications
porphyria
[PPI]
Tx
- short-term Tx of ulcers, GERD, + erosive esophagitis
- last resort bc most intense
PPI
drug names
1 pantoprazole
2 omeprazole
3 lansoprazole
4 esomeprazole
***all end w -PRAZOLE
PPI
prototype
omeprazole
PPI
MOA
-stop parietal cells fr secreting H+ which combines w Cl-
*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
PPI
CI
*lactation
•Excess PPI can cause C.Dif
•incr risk of pneumonia
with omeprazole (type of PPI), monitor intaractions w…
digoxin, phenytoin, warfarin (Coumadin)
-do not give w atazanavir, ketoconazole, itraconazole (leads to decr absorp)
Mucosal Protectants
Tx for
acute duodenal ulcers
Mucosal Protectants
drug names
sucralfate
*Mucosal Protectants
MOA
- chem rxn w HCl that creates a gel that coats ulcers
- creates a barrier bw stomach + gastric secretion
*Mucosal Protectants
administration
- empty stomach
- *1 hr before 3 meals + 1 before bedtime
- -empty stomach
Mucosal Protectants
A/E
**constipation (incr fluid + fiber activity to prevent)
GI discomfort
Indigestion
**monitor for GI bleeding
Mucosal Protectants
CI
- 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
Tx
- 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
