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2020 Pharmacology I > PME Gastrointestinal Tract > Flashcards

PME Gastrointestinal Tract Flashcards

1
Q

Name the six classes of drugs used to treat peptic ulcers.

A
  • Histamine2-receptor antagonists
  • Proton pump inhibitors
  • Mucosal protectants
  • Antacids
  • Prostaglandin E analogs
  • Antibiotics
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2
Q

peptic ulcer

A
  • erosive lesion in the stomach or duodenum
  • caused by imbalance of gastric acid and mucus secretion
  • common cause: Helicobacter pylori infection
  • severe lesions involve several layers of the stomach and can cause bleeding or perforation
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3
Q

What are histamine2-receptor antagonists used to treat?

A
  • gastric and duodenal ulcers
  • heartburn, dyspepsia
  • erosive esophagitis
  • gastrointestinal reflux disease (GERD)
  • aspiration pneumonitis
  • hypersecretory disorders such as Zollinger-Ellison syndrome (gastrin) and systemic mastocytosis (histamine)
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4
Q

dyspepsia

A
  • indigestion, often chronic or persistent
  • sometimes related to the ingestion of food and may be a side effect of many meds
  • symptoms can include
    • fullness
    • eructation
    • bloating
    • nausea
    • loss of appetite
    • upper abdominal pain
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5
Q

eructation

A
  • producing gas from the stomach
  • belching
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6
Q

Name three histamine2-receptor antagonists.

A
  • prototype: ranitidine hydrochloride (Zantac)
  • cimetidine (Tagamet)
  • famotidine (Pepcid)
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7
Q

How do histamine2-receptor antagonists work?

A
  • by blocking the receptors on parietal cells in the stomach responsible for secretion of stomach acid
  • decrease stomach acid content
  • increase pH of stomach contents
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8
Q

Name some side effects of cimetidine (Tagamet) and ranitidine hydrochloride (Zantac).

A
  • cimetidine only: impotence, reduced libido
  • CNS effects (more common with cimetidine)
    • lethargy
    • depression
    • restlessness
    • seizures
  • both can cause
    • nausea
    • vomiting
    • diarrhea
    • constipation
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9
Q

What are the appropriate interventions for side effects from cimetidine or ranitidine hydrochloride?

A
  • impotence or reduced libido: switch to ranitidine
  • CNS effects: switch to ranitidine
  • other: monitor for and report severe vomiting or diarrhea
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10
Q

How can histamine2-receptor antagonists be administered?

A
  • orally
    • with or without food
    • Make sure pts dissolve effervescent tablets in water; do not chew, swallow whole, or allow to dissolve on tongue
  • IM
  • IV
    • slowly to avoid bradycardia
  • other considerations
    • do not give antacids within 1 hr of admin; potential decreased absorption
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11
Q

instructions for pts taking histamine2-receptor antagonists

A
  • report any:
    • changes in sex drive or function
    • lethargy, depression, restlessness, or seizures
    • vomiting or diarrhea
    • signs of GI bleed
  • drink plenty of fluids
  • try antacids to reduce symptoms, but not within 1 hr of taking drug
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12
Q

contraindications for histamine2-receptor antagonists

A
  • children younger than 12yo
  • acute porphyria
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13
Q

histamine2-receptor antagonists precautions

A
  • older age
  • kidney or liver dysfunction
  • phenylketonuria
  • COPD
  • high risk for infection (long-term use can decrease WBC count)
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14
Q

phenylketonuria (PKU)

A
  • congenital autosomal recessive disease that can cause irreversible neurological damage in infancy if it is not promptly detected
  • enzyme deficiency that prevents the metabolism of the amino acid phenylalanine to tyrosine
  • amino acid and its by-products build up in CNS
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15
Q

What drugs do ranitidine and cimetidine decrease absorption of?

A
  • ketoconazole
  • itraconazole (Sporanox)
  • some cephalosporins
  • delavirdine (Rescriptor)
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16
Q

What drugs’ concentrations are increased by cimetidine?

A
  • warfarin (Coumadin): blood thinner; longer clotting time
  • phenytoin (Dilantin): seizure med; toxicity with dangerous neurological side effects
  • lidocaine (Xylocaine)
  • theophylline (Theolair): brochodilator; overstimulation of heart, lungs, CNS
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17
Q

What decreases absorption of ranitidine and cimetidine?

A

antacids

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18
Q

What are proton pump inhibitors used to treat?

A
  • Gastric and duodenal ulcers
  • Prolonged dyspepsia
  • Gastrointestinal reflux disease (GERD)
  • Erosive esophagitis
  • Hypersecretory disorders such as Zollinger-Ellison syndrome, systemic mastocytosis
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19
Q

Name four proton pump inhibitors.

A
  • prototype: omeprazole (Prilosec)
  • pantoprazole (Protonix)
  • lansoprazole (Prevacid)
  • esomeprazole (Nexium)
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20
Q

How do proton pump inhibitors work?

A
  • inhibit hydrogen, potassium-ATPase enzyme system in parietal cells
  • suppresses gastric acid production
    • basal rate
    • production secondary to food
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21
Q

side effects of proton pump inhibitors

A
  • long-term use: bone loss
  • nausea
  • vomiting
  • diarrhea
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22
Q

proton pump inhibitor interventions for side effects

A
  • lowest effective dose for shortest time
  • monitor for bone loss with regular bone density scans
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23
Q

How are proton pump inhibitors administered?

A
  • once daily before the first meal
  • do not chew, break, or crush omeprazole delayed-release capsules
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24
Q

pt instructions for taking proton pump inhibitors

A
  • weight-bearing exercise daily
  • get adequate vitamin D and calcium
  • report vomiting or diarrhea
  • drink plenty of clear fluids
  • take antacids to minimize symptoms initially
  • report signs of obvious or occult GI bleed (coffee-grounds emesis)
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25
Q

contraindications of proton pump inhibitors

A
  • children younger than 12 yr
  • hypersensitivity
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26
Q

precautions for use of proton pump inhibitors

A
  • liver dysfunction
  • metabolic or respiratory alkalosis
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27
Q

What drugs do proton pump inhibitors decrease absorption of?

A
  • atazanavir (Reyataz)
  • ketoconazole (Nizoral)
  • itraconazole (Sporanox)
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28
Q

What can decrease absorption of proton pump inhibitors?

A

food

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29
Q

What supplements can decrease levels of proton pump inhibitors?

A
  • ginkgo biloba
  • St. John’s wort
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30
Q

Levels of what drugs increase when administered with proton pump inhibitors?

A
  • warfarin (Coumadin)
  • phenytoin (Dilantin)
  • diazepam (Valium)
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31
Q

What are mucosal protectants used to treat?

A

acute duodenal ulcers

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32
Q

mucosal protectant prototype drug

A

sucralfate (Carafate)

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33
Q

How does sucralfate work?

A
  • chemical reaction in stomach creates gel
  • coats ulcers
  • creates a barrier between the stomach lining and gastric secretions
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34
Q

side effects of sucralfate

A
  • Constipation
  • Nausea
  • Diarrhea
  • Dyspepsia
35
Q

interventions for pts taking sucralfate

A
  • monitor bowel function
  • administer stool softeners as needed
36
Q

administration of sucralfate

A
  • orally on an empty stomach.
  • four times a day: 1 hr AC and HS
  • do not give antacids within 30 to 60 min
  • do not give within 2 hr of administering
    • fluoroquinolone antibiotics
    • warfarin (Coumadin)
    • phenytoin (Dilantin)
    • theophylline (Theolair)
    • digoxin (Lanoxin)
    • tetracycline
    • diazepam (Valium)
37
Q

instructions for pts taking sucralfate

A
  • Increase fluid and fiber.
  • Increase activity and exercise.
  • Drink plenty of clear fluids.
  • Report worsening diarrhea.
  • Try antacids to help minimize symptoms, but not within 30 min of taking the drug.
  • Report signs of obvious or occult GI bleeding, such as coffee-ground emesis.
38
Q

contraindications for sucralfate

A
  • children
  • hypersensitivity
39
Q

precautions for sucralfate

A
  • chronic renal failure, dialysis
  • renal dysfunction
40
Q

What drugs does sucralfate decrease absorption of? What decreases effectiveness of sucralfate?

A
  • decreases absorption of
    • fluoroquinolone antibiotics
    • tetracycline
    • digoxin (Lanoxin)
    • warfarin (Coumadin)
    • phenytoin (Dilantin)
    • theophylline (Theolair)
    • diazepam (Valium)
  • antacids decrease therapeutic effect
41
Q

What are antacids used to treat?

A
  • peptic ulcer disease
  • GERD
42
Q

Name three types of antacids and four individual antacids.

A
  • types
    • aluminum-based
    • magnesium-based
    • calcium-based
  • antacids
    • prototype: aluminum hydroxide (Amphojel)
    • magnesium hydroxide (milk of magnesia)
    • calcium carbonate (Tums)
    • magnesium and aluminum hydroxide (Magaldrate)
43
Q

how antacids work

A

antacids are alkaline compounds that neutralize gastric acid

44
Q

side effects of antacids

A
  • constipation (aluminum and calcium antacids)
  • diarrhea (magnesium antacids)
  • hypophosphatemia, hypomagnesemia: aluminum-based antacids bind phosphate, decreasing its absorption
  • antacids with opposing side effects often taken together to minimize issues
45
Q

interventions for antacid side effects

A
  • monitor bowel function
  • stool softeners for calcium- and aluminum-based antacids
  • aluminum-based: monitor phosphorus and magnesium levels
46
Q

administering antacids

A
  • orally up to four times a day
  • tablets: chew thoroughly, then drink 4 oz milk or water
  • liquids: drink water after
  • do not give within 2 hr of drugs that interact
47
Q

pt instructions for antacids

A
  • calcium- or aluminum-based
    • increase activity and exercise
    • increase fluid and fiber intake
  • aluminum-based: report s/s of hypophosphatemia or hypomagnesemia
    • muscle weakness
    • muscle cramps
    • difficulty swallowing
    • tremors
  • magnesium-based: immediately report abdomincal cramps or diarrhea
  • all: monitor for signs of obvious or occult GI bleed
48
Q

contraindications for antacids

A
  • any: GI perforation or obstruction
  • aluminum-based: hypophosphatemia
49
Q

precautions for antacids

A
  • abdominal pain
  • renal dysfunction
  • dehydration
  • fluid restriction
  • reduced bowel motility
50
Q

What are some common drugs whose absorption is decreased by antacids? How do we avoid interaction?

A
  • drugs affect
    • warfarin (Coumadin)
    • digoxin (Lanoxin)
    • phenytoin (Dilantin)
    • tetracycline
    • isoniazid (INH)
    • cimetidine (Tagamet)
    • NSAIDs
    • ciprofloxacin (Cipro)
  • avoid interaction by not administering antacids within 2 hr of any other drug
51
Q

What are prostaglandin E analogs used for?

A

prevention of gastric ulcers in long-term use of NSAIDs

52
Q

Name some antibiotics used to treat peptic ulcer disease.

A
  • amoxicillin
  • bismuth
  • clarithromycin
  • metronidazole
  • tetracycline
  • tinidazole
53
Q

prostaglandin E analog prototype drug

A

misoprostol (Cytotec)

54
Q

How does endogenous prostaglandin work?

A
  • Decreases gastric acid secretion
  • Increases secretion of bicarbonate (a base)
  • Increases secretion of protective mucus
  • Increases vasodilation of submucosal blood flow in gastric wall
55
Q

Name the common side effects for mysoprostol (Cytotec).

A
  • in general
    • diarrhea
    • abdominal pain
    • nausea
    • dyspepsia
  • in women
    • spotting
    • dysmenorrhea
    • uterine cramps
56
Q

What should we monitor for in pts taking mysoprostol (Cytotec)?

A
  • all pts: severe diarrhea and abdominal pain
  • in women: excessive menstrual pain or midcycle bleeding
57
Q

adminstering mysoprostol

A
  • orally four times a day, with meals and HS while the patient is on NSAID therapy

confirm nonpregnant state before initiating drug therapy, as this drug can cause spontaneous abortion.

Make sure women of childbearing age use effective contraception during drug therapy.

58
Q

A health care professional should question the use of misoprostol (Cytotec) for a patient who has which of the following?

  • seizure disorder
  • rheumatoid arthritis
  • positive pregnancy test
  • heart failure
A

positive pregnancy test

59
Q

A health care professional is about to administer ondansetron (Zofran) to a patient who is receiving chemotherapy. Which of the following actions should the health care professional take? (Select all that apply.)

  • infuse 30 min prior to chemo
  • admin when pt reports nausea
  • infuse slowly over 15 min
  • admin immediately following chemo
  • repeat dose 4 hr after chemo
A
  • infuse 30 min prior to chemo
  • infuse slowly over 15 min
  • repeat dose 4 hr after chemo
60
Q

A health care professional should question the use of metoclopramide (Reglan) for a pt who is taking which of the following?

  • digoxin (Lanoxin)
  • warfarin (Coumadin)
  • fluvoxamine (Luvox)
  • allopurinol (Zyloprim)
A

digoxin (Lanoxin)

61
Q

When talking with a pt about taking omeprazole (Prilosec) to treat a duodenal ulcer, the health care professional should include which of the following instructions?

  • take with food
  • swallow capsules whole
  • dissolve in water
  • take at bedtime
A

swallow whole

62
Q

An HCP is caring for a pt who is about to begin taking azathioprine (Imuran) to treat inflammatory bowel disease. The HCP should tell the pt to report which of the following adverse effects? (Select all that apply.)

  • impotence
  • bruising
  • jaundice
  • sore throat
  • nausea
A
  • bruising
  • jaundice
  • sore throat
  • nausea
63
Q

An HCP is reviewing the medical record of a pt who is to begin taking ranitidine (Zantac). Which of the following meds interacts with ranitidine?

  • phenobarbital sodium (Luminal)
  • ketoconazole
  • lisinopril (Prinivil)
  • hydrochlorothiazide (HydroDIURIL)
A

ketoconazole

64
Q

An HCP is caring for a pt who is about to begin dimenhydrinate to prevent motion sickness. Which of the following instructions should the HCP include? (Select all that apply.)

  • sit upright for 30 min after
  • avoid antacids when taking
  • take 30-60 min before activities that trigger nausea
  • avoid activities that require alertness
  • increase fluid and fiber intake
A
  • take 30-60 min before activities
  • avoid activities that require alertness
  • increase fluid and fiber intake
65
Q

When talking with a pt about taking psyllium (Metamucil) to treat constipation, the HCP should include which of the following instructions? (Select all that apply.)

  • expect results in 6-12 hrs
  • urinate ever 4 hrs
  • take with at least 8 oz of fluid
  • avoid activities that require alertness
  • increase fluid and fiber intake
A
  • take with 8 oz fluid
  • increase fluid and fiber intake
66
Q

An HCP is caring for a pt who has recently had an MI and is about to start docusate sodium (Colace). The HCP should explain that the drug will have which of the following therapeutic effects?

  • reduces inflammation
  • reduces gastric acid
  • prevents diarrhea
  • prevents straining
A

prevents straining

67
Q

An HCP is assessing a pt who was given ondansetron (Zofran) IV 1 hr ago. Which of the following is an adverse effect of this drug?

  • dizziness
  • rash
  • tardive dyskinesia
  • abdominal cramping
A

dizziness

68
Q

Which of the following drugs requires pts to meet specific risk-management criteria and sign a treatment agreement before the HCP can administer it?

  • lubiprostone (Amitiza)
  • azathioprine (Imuran)
  • sulfasalazine (Azulfidine)
  • alosetron (Lotronex)
A

alosetron (Lotronex)

69
Q

An HCP is caring for a pt who is about to begin ranitidine (Zantac) to treat GERD. The HCP should tell the pt to take precautions when taking which of the following OTC drugs?

  • ginkgo biloba
  • antidiarrheals
  • St. John’s wort
  • antacids
A

antacids

70
Q

A PCP should use caution when prescribing bisacodyl (Dulcolax) to a pt with

  • anorexia nervosa
  • myelosuppression
  • hypomagnesemia
  • diabetes mellitus
A

anorexia nervosa

71
Q

An HCP is caring for a pt who is about to begin alosetron (Lotronex) to treat IBS. The HCP should tell the pt to report which of the following adverse effects?

  • headache
  • drowsiness
  • abdominal pain
  • sore throat
A

abdominal pain

72
Q

When talking with a pt about taking loperamide (Imodium), the HCP should include which of the following instructions?

  • dissolve powder in 8 oz of water
  • have diphenhydramine available
  • avoid activities that require alertness
  • take 30 min before activities that trigger nausea
A

avoid activities that require alertness

73
Q

When talking with a pt about taking metoclopramide (Reglan) to treat GERD, the HCP should include which of the following instructions?

  • take once daily in the morning
  • stop taking if drowiness develops
  • chew gum or suck on hard candy
  • take acetaminophen for headaches
A

chew gum or suck on hard candy

74
Q

When giving sulfasalazine (Azulfidine) to a pt, the HCP should check which of the following to help identify an adverse effect of the drug? (Select all that apply.)

  • LOC
  • skin integrity
  • temp
  • UOP
  • CBC
A
  • skin integrity
  • temp
  • CBC
75
Q

A PCP should use caution prescribing sulfasalazine (Azulfidine) for a pt who has

  • pancreatitis
  • aspirin sensitivity
  • bronchitis
  • GERD
A

aspirin sensitivity

76
Q

An HCP is caring for an older adult pt who is about to begin cimetidine (Tagamet) for a duodenal ulcer. The HCP should tell the pt to report which of the following adverse reactions?

  • lethargy
  • cellulitis
  • dry mouth
  • myalgia
A

lethargy

77
Q

An HCP should conclude that alosetron (Lotronex) therapy is effective when a pt who is taking it reports which of the following?

  • one formed stool per day
  • urination without burning
  • no nausea or vomiting
  • less GI reflux
A

one formed stool per day

78
Q

An HCP is caring for a pt who takes phenytoin (Dilantin) for a seizure disorder and is about to begin sucralfate (Carafate) therapy to treat a duodenal ulcer. The HCP should tell the pt to take the drugs at least 2 hr apart because

A

sucralfate interferes with absorption of phenytoin

79
Q

An HCP should question the use of diphenoxylate/atropine (Lomotil) for a pt who has which of the following?

  • inflammatory bowel disease
  • thrombophlebitis
  • agranulocytosis
  • immunization with a live virus
A

inflammatory bowel disease

80
Q

A PCP who is considering the pharmacologic options ofr a pt with PUD should understand that which of the following requires monitoring of the pt’s phosphorus levels?

  • omeprazole (Prilosec)
  • aluminum hydroxide (Amphojel)
  • sucralfate (Carafate)
  • ranitidine (Zantac)
A

aluminum hydroxide (Amphojel)

81
Q

An HCP should question the use of dimenhydrinate for a pt who has which of the following disorders?

  • hyperthyroidism
  • angle-closure glaucoma
  • hypertension
  • diabetes mellitus
A

angle-closure glaucoma

82
Q

When talking with a pt about taking lubiprostone (Amitiza), the HCP should tell the pt not to take the drug if he has which of the following?

  • nausea
  • diarrhea
  • urinary retention
  • sore throat
A

diarrhea

83
Q
A

2020 Pharmacology I (21 decks)

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