Pharm Exam 2 GI Drugs:

Question 1

Aluminum antacids:

Answer 1

*Have constipating effects

*Often used with magnesium to counteract constipation

*Often recommended for patients with renal disease (more easily excreted)

*Examples

*Aluminum carbonate: Basaljel

*Hydroxide salt: AlternaGEL

*Combination products (aluminum and magnesium): Gaviscon, Maalox, Mylanta, Di-Gel

Question 2

Magnesium antacids:

Answer 2

*Commonly cause diarrhea; usually used with other drugs to counteract this effect

*Dangerous when used with renal failure; the failing kidney cannot excrete extra magnesium, resulting in accumulation

*Examples

*Hydroxide salt: magnesium hydroxide (Milk of Magnesia)

*Carbonate salt: Gaviscon (also a combination product)

*Combination products such as Maalox, Mylanta (aluminum and magnesium)

Question 3

Calcium antacids:

Answer 3

*Many forms but carbonate is most common

*May cause constipation, kidney stones

*Also not recommended for patients with renal disease—may accumulate to toxic levels

*Long duration of acid action—may cause increased gastric acid secretion (hyperacidity rebound)

*Often advertised as an extra source of dietary calcium

*Example: Tums (calcium carbonate)

Question 4

Sodium bicarbonate:

Answer 4

*Highly soluble

*Buffers the acidic properties of HCl

*Quick onset but short duration

*May cause metabolic alkalosis

*Sodium content may cause problems in patients with heart failure (HF), hypertension, or renal insufficiency.

Question 5

What is Antacid?

Answer 5

*Basic compounds used to neutralize stomach acid

*Salts of aluminum, magnesium, calcium, and/or sodium

*Many aluminum- and calcium-based formulations also include magnesium, which not only contributes to the acid-neutralizing capacity but also counteracts the constipating effects of aluminum and calcium

*Magnesium-based – Milk of Magnesia

*Calcium-based - Tums

Aluminum Hydroxide (Amphojel); Magnesium-based – Milk of Magnesium

Calcium-based - Tums

Question 6

Antacids Mechanism of Action:

Answer 6

*Help to neutralize acid secretions

*Promote gastric mucosal defense mechanisms

*Stimulate secretion of:

–Mucus: protective barrier against HCl

–Bicarbonate: helps buffer acidic properties of HCl

–Prostaglandins: prevent activation of proton pump

Question 7

Antiacid: Aluminum Hydroxide (Amphojel)- Mechanism of action

Answer 7

Neutralize gastric acid.

Question 8

Pregnancy category and indications of Antiacid: Aluminum Hydroxide (Amphojel)

Answer 8

Pregnancy category: Risk vs. Benefit (C?)

Indications: Peptic ulcer disease, Gastrointestinal reflux disease (GERD), Gastritis

Question 9

Contraidnications and Interactions of Antiacid: Aluminum Hydroxide (Amphojel)

Answer 9

Contraindications: Severe abdominal pain of unknown origin, Gastric Obstructions

Interactions: Interferes with absorption of many drugs including: tetracyclines,

Question 10

Side effects and advers effects of Antiacid: Aluminum Hydroxide (Amphojel)

Answer 10

Side effects: Constipation (aluminum and calcium antacids), Diarrhea (magnesium antacids)

Adverse effects: Hypophosphatemia

Question 11

Nursing considerations of Antiacid: Aluminum Hydroxide (Amphojel):

Answer 11

–Make sure clients chew tablets thoroughly and follow with at least 8 oz of water

–Do not give within 1 to 2 hr of administering drugs that interact with antacids.

–Increase fluid and fiber intake.

–Increase activity and exercise.

–Report abdominal pain.

–Report severe diarrhea (Mg-based).

–Patients with HF or hypertension should not use antacids with high sodium content.

Question 11

What are the laxative types?

Answer 11

Bulk-forming, surfactant, stimulant, and osmotic laxatives.

Question 12

Bulk-forming laxatives: Name, action, and indication.

Answer 12

–Psyllium (Metamucil)

Action: Function similarly to dietary fiber: swell with water to form a gel to soften fecal mass and increase stool size (bulk).

Indications: Temporary treatment of constipation; diverticulosis; irritable bowel syndrome; Stool regulation for diarrhea and with fecal ostomies.

Question 13

Bulk-forming laxatives: Contraindications and Adverse Effects

Answer 13

Contraindications: Esophageal or gastrointestinal obstruction, Narrowing of intestinal lumen, Fecal impaction, Dysphagia, Nausea, Vomiting, Appendicitis, Undiagnosed abdominal pain

Adverse effects are minimal

–Esophageal obstruction with minimal fluid intake. Drink with water if you do not want to CHOKE!

Interactions: Decreases absorption of orally ingested medications

Question 14

Surfactant laxatives: Name, Actions and Indications

Answer 14

Docusate sodium (Colace)

Action: Facilitates mixture of Stool Fat and Water

Indications: Constipation; Prevention of fecal impaction, straining during defecation, painful elimination of hard stools

Question 15

Surfactant laxatives: Contraidnications, Adverse effects, and Interactions

Answer 15

Contraindications: Gastrointestinal obstruction, Fecal impaction, Nausea, Vomiting, Undiagnosed abdominal pain, concurrent use of mineral oil

Adverse effects:

Diarrhea, Throat irritation, rashes

Interactions: Do not admin within 2 hours of other laxatives. Esp. mineral oil.