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N365: Pharmacology in Nursing > Week 13: GI Meds > Flashcards

Week 13: GI Meds Flashcards

1
Q

Prototype GI Meds

A

14:

Famotidine
Omeprazole
Sucralfate
AlOH and MgOH
Simethicone
Dimenhydrinate
Promethazine
Metoclopramide
Ondansetron
MgOH
Bisacodyl
Psyllium
Docusate
Loperamide

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2
Q

Famotidine (Pepcid) Classification

A

Antihistamine (H2 Blocking Agent)

different from H1 receptor blockers like true antihistamines

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3
Q

Action of Famotidine

A

Competitive antagonist acting on H2 receptors and mediates parietal cell acid production

Inhibits vagal stimulated gastrin enzyme release

*Basically blocks histamine action at parietal cells in the stomach to stop acid secretion

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4
Q

Routes for Famotidine

A

Oral or Parenteral

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5
Q

ADRs of Famotidine

A

UNCOMMON! (w/ short term use)

CONFUSION (Can see in older individuals since H2 is blocked)

PNEUMONIA

Other: HA, tiredness, constipation

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6
Q

Why is pneumonia a potential ADR of famotidine

A

because increasing gastric pH means organisms that are killed off normally can be aspirated

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7
Q

How often is famotidine given for GERD

A

20-40 mg TWICE DAILY

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8
Q

What does the suffix “-idine” mean

A

H2 blocker

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9
Q

Omeprazole (Prilosec) Classification

A

Proton Pump Inhibitor (PPI), gastric acid secretion suppressent

(Suppresses acid production)

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10
Q

Action of omeprazole

A

a “prodrug” converted to active form in parietal cells

active form inhibits H+K+-ATPase (enzyme producing gastric acid)

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11
Q

ADRs of omeprazole

A

Short Term Use (4-8 weeks): HA, NVD

Long Term: CHRONIC KIDNEY DISEASE, Dementia, Mg Deficiency, Pneumonia, Weakened Bones (Ca absorption)

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12
Q

What is considered to be one of the most effect acid secretion suppression drugs? What is the issue with it

A

Omeprazole

the issue is the ADRs increase with long term use such as chronic kidney disease

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13
Q

What is the most effective class of drugs for suppressing gastric acid secretion

A

PPIs (ex: omeprazole)

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14
Q

What does the suffix “-prazole” mean

A

PPI (ex: Omeprazole, Protonix is Pantoprazole)

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15
Q

What is important to know aboutb the tablet of Prilosec/omeprazole

A

it is enterically coated in a delayed release capsule so do not crush it

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16
Q

Sucralfate (Carafate) Classification

A

Anti Ulcer

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17
Q

What is unique about sucralfate

A

it is a unique drug with no other drug being like it

It “patches” the ulcerated area in the stomach mucosa

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18
Q

Action of sucralfate

A

exact mechanisms not fully defined

exerts LOCA ACTION - forms an ULCER ADHERENT COMPLEX (gooey sticky patch) at the ulcer site to protect it against further acid attack, pepsin, or bile salts

Also inhibits pepsin activity

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19
Q

Where does sucralfate act

A

acts locally (on the GI tract) not the bloodstream by patching the ulceration on mucosa

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20
Q

Sucralfate must be given…

A

on an empty stomach

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21
Q

What is important to know about the absorption and distribution of sucralfate

A

only 3-5% is absorbed since it has local low absorption

It is distributed on the GI tract and lasts about 5 hours

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22
Q

ADRs of Sucralfate

A

Most Common: CONSTIPATION

Other: Diarrhea, Nausea, Gastric Discomfort, Indigestion, Dry Mouth, Rash, Pruritis, Back Pain, Dizziness, Vertigo

*generally well tolerated)

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23
Q

Why can sucralfate not be given with an antacid within a half an hour period

A

because the stomach mucosa needs to be pH <4 for activation

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24
Q

sucralfate may interfere with what

A

absorption of fat soluble vitamins (blocks that mucosa)

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25
Q

Antacids

A

base salts that increase gastric pH

by doing so, they relieve symptoms of hyperacidity, GERD, and the pain of duodenal ulcers

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26
Q

AlOH & MgOH (Maalox) Classification

A

Antacid, Non sytemic

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27
Q

When do we give antacids

A

2 hours after other drugs to prevent interactions

Also given after meals WHEN ACID IS ALREADY PRODUCED

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28
Q

Action of AlOH & MgOH (Maalox)

A

local activity of neutralization of gastric acid by chemical reaction leading to higher pH

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29
Q

Absorption of AlOH & MgOH (Maalox)

A

it is not absorbed AT ALL

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30
Q

ADRs of AlOH & MgOH (Maalox)

A

Aluminum products cause constipation

Magnesium products cause diarrhea

Maalox attempts to balance these two effects out

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31
Q

What is important to know about taking other drugs alongsde AlOH & MgOH (Maalox)

A

the maalox can reduce absorption of drugs like tetracyclines, digoxin, iron, etc so they are all taken separately from antacids

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32
Q

Simethicone (Mylicon) Classification

A

anti flatulent

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33
Q

Action of simethicone

A

alters surface tension of gas bubles - they then coalesce and free the gas through belching or flatus

Disperses and prevents formation of mucus surrounded gas pockets in the GI tract so its easier for the body to expel these big bubbles

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34
Q

In essence what is simethicone doing

A

it is not PREVENTING gas from being made, it just is finding new ways of epelling it

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35
Q

ADRs of simethicone

A

VERY WELL TOLERATED

so mild it can be used on infants (can help with colic)

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36
Q

Route of simethicone

A

oral (80-120 mg qid)

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37
Q

Is simethicone often found in combination with anything else

A

its often found combined with other GI drugs like antacids

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38
Q

Why is simethicone the last drug you should take

A

because it works faster in dissolving than other drugs since its pink and chewable

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39
Q

dimenhydrinate (Dramamine) Classification

A

ANTIEMETIC, Anticholinergic, Antihistamine

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40
Q

What is dimenhydrinate often used for

A

PREVENTION of motion sickness

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41
Q

Action of dimenhydrinate

A

decreases GI motility and GI spasm (that usually causes vomiting) due to its anticholinergic action

Some H1 - antihistamine action affect neural labyrinth pathways by competing for receptor sites

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42
Q

ADRs of dimenhydrinate

A

ANTICHOLINERGIC SE - Dry mouth
Sedation
Blurred vision
Urinary Retention

(slow GI effect)

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43
Q

When should dimenhydrinate be taken

A

take .5-1 hour before activity like a car ride, boat ride, coaster, etc - it should be on board and working prior for prevention

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44
Q

dimenhydrinate is contraindicated when

A

if a patient has glaucoma as it increases intraocular pressure

45
Q

What is a problem that dimenhydrinate may mask

A

It can mask ototoxicity symptoms if the patient is on other drugs since it is chemically related to diphenhydramine (Benadryl)

46
Q

Promethazine (Phenergan) Classification

A

Antiemetic

(Phenothiazine family)

47
Q

What is the phenothiazine family structurally similar to

A

anti psychotic drugs

48
Q

Action of Promethazine

A

Acts on the CTZ (Chemorecetor trigger zone) / Vomiting center by interacting with dopaminergic receptors to suppress the response

49
Q

What is important to know about the absorption and route of promethazine

A

It is given oral NEVER IV

It has almost complete absorption

50
Q

why is promethazine never given IV

A

it can cause severe necrosis of tissues and blood vessels

51
Q

ADRs of promethazine

A
  1. PERIPHERAL ANTICHOLINERGIC EFFECTS (dry mouth, constipation, blurred vision, urinary retention)
  2. Sedation, Hypotension, Dystonia - unusual muscular activities
52
Q

Is promethazine effective for motion sickness

A

no

53
Q

Why is promethazine commonly given in conjunction to narcotic therapy

A

it has a synergistic effect for analgesia with narcotic and non narcotics

54
Q

Metoclopramide (Reglan) Classification

A

Antiemetic

55
Q

Action of Metoclopramide

A

Blocks dopaminergic receptors in CTZ/Vomit Center including antagonism of emesis

Stimulates AcH effect to enhance motility of smooth muscles from the esophagus to the small intestine

Accelerates gastric emptying and transit of intestinal contents from duodenum to ileocecal valve

56
Q

ADRs of Metoclopramide

A
  1. CNS - drowsiness, dizziness, ANXIETY, RESTLESSNESS
  2. Extrapyramidal symptoms esp with high IV doses (nystagmus, pill rolling, tongue movement)

GI - constipation, nausea, diarrhea, dry mouth

Endocrine - gynecomastia

57
Q

Metoclopramide is considered what kind of agent

A

a Pro Motility agent - it stimulates GI because of its AcH stimulating effect

58
Q

What does it mean for metoclopramide to be pro acetylcholine

A

it is a GI stimulant

it will boost motility while there is no NV like in diabetic gastroparesis (early satiety) and give pro motility effects before eating to prevent vomiting

59
Q

Why is it important to never mid metoclopramide (or phenergan) with a CNS depressant

A

metoclopramide has a sedative nature already

60
Q

When should metoclopramide be administered

A

30 minutes prior to meals

61
Q

Metoclopramide is highly effective with what sort of agents

A

highly emetic anti cancer agents

62
Q

When is metoclopramide contraindicated

A

in the presence of :

obstruction (pressure against the wall leading to perforation)

hemorrhage

perforation of the GI tract

63
Q

Ondansetron (Zofran) Classification

A

anti emetic / selectric serotonin receptor antagonist

64
Q

Action of ondansetron

A

selective serotonin 5HT3 receptor antagonist - NOT a dopamine receptor agonist like other anti-emetics

blocks stimulation of serotonin receptors in CTZ to prevent NV - not very well understood

65
Q

What drug has replaced Phenergan and Reglan

A

ondansetron (Zofran)

66
Q

Is odansetron for prevention only?

A

no- it mostly is for preventing NV but it can be given IV for vomitting episodes

67
Q

Routes of Absorption for odansetron

A

IV for episodes

oral for prevention

68
Q

Distribution of odansetron

A

widely distributed - including ending up in breast milk

However, 70-75% of it will be protein bound

69
Q

ADRs of odansetron

A

TRANSIENT BLURRED VISION (only IV form)

Other: Constipation, Rashes

70
Q

Doses of odansetron are based on …

A

weight

71
Q

Odansetron is especially effective with what unique NV situations

A

chemotherapy induced NV

post - op NV

anticipatory NV - smells or thoughs from chemo that trigger it

72
Q

When is odansetron given in reference to chemotherapy treatment

A

it is given 30 minutes prior

73
Q

What is the one kind of NV that odansetron cannot prevent

A

CINV - chemo induced NV which is a delayed form of vomiting from the chemo

Emend - another drug - does however

74
Q

Cathartic

A

Laxative

75
Q

Magnesium products cause

A

diarrhea

76
Q

Magnesium Hydroxide Mixture (MgOH) - Milk of Magnesia (MOM) Classification

A

Saline Cathartic (Laxative)

77
Q

Action of MgOH/MOM

A

In the stomach it reacts with HCl to form Magnesium Chloride which causes the laxative effect

Water will be retained in the bowel causing peristalsis - and this water is pulled from the intestinal lumen

78
Q

Absorption of MgOH/MOM

A

Almost none is absorbed - maybe only a small amount from the intestine

79
Q

Distribution and Onset of MgOH/MOM

A

onsert is .5-3 hours

SO THEY MUST HAVE ACCESS TO A BATHROOM

80
Q

ADRs of MgOH/MOM

A

Occasionally Diarrhea (mostly with more than 1 use a day)

MAY have absorption of ions and cause imbalance of Mg (only a problem with renal impairment as it accumulates)

81
Q

Can MgOH/MOM be used on children

A

yes it is a very mild saline laxative

82
Q

while MgOH/MOM is the mildest saline cathartic, what must be kept in mind while taking it

A

to avoid fluid imbalance, adminsiter with large amounts of water

caution in renal failure

83
Q

Polyethylene Glycol

A

Miralax

Used for chronic constipation - a nonabsorbable compound that retains water in the intestinal lumen like a saline cathartic like MOM/MgOH

However, takers 2-4 days potentially for a BM

84
Q

What is used prior to a colonoscopy

A

polyethylene glycol and electrolytes for bowel cleansing

85
Q

Is laxative dependence proven

A

it is not proven by researchers

86
Q

bisacodyl (Dulcolax) Classification

A

Cathartic, Stimulant (or contact)

87
Q

Action of Bisacodyl

A

stimulates peristalsis by 1 of 3 ways:

  1. Stimulating nerve plexus
  2. irritating mucosa
  3. direct action on smooth muscle

*Comes into contact with mucosa to cause peristalsis

88
Q

Route of Bisacodyl

A
  1. Rectal Suppository
  2. Enteric Coated Tablet (Oraal)
89
Q

ADRs of Bisacodyl

A
  1. Suppository MAY produce mild burning sensation in rectum (irritation of mucosa and its not pain)

Other: Intestinal Crampes, increased mucus secretion, diarrhea

90
Q

What is important to know about the oral form of bisacodyl

A

do not give oral tablet with antacid or milk and do not cut, crush, or chew the tablets (they are v small to prevent this)

91
Q

Psyllium (Metamucil) Classification

A

Laxative, Bulk Forming Agent

(it is a fiber supplement more than a cathartic - not a true cathartic)

92
Q

Action of psyllium

A

absorbs water (fiber), enlarging bulk of fecal mass

This mass mechanically stimulates the bowel and promotes formation of soft, water retaining gelatinous residue in the lower bowel in 12-72 hours

93
Q

How do fiber supplements like psyllium differ from true cathartics

A

fiber supplements dont work right away - they get you more regular

so they take time to work and keeps things moving through the GI tract and adds bulk

94
Q

Why does psyllium need to be drank immediately

A

it comes in a powder form that you mix in liquid and drink immediately

it thickens like oatmeal quick so you have to drink asap

also does have a capsule and wafer form

95
Q

ADRs of psyllium

A

RARE

96
Q

Sodium Docusate (Colace) Classification

A

emollient agent (stool softener)

97
Q

Action of Sodium Docusate

A

acts as a detergent and allows water and fatty substances to penetrate and mix well with fecal material

It is an emollient by mixing the water with stool to soften the mass, but does not cause bowel movement right away

98
Q

How does sodium docusate differ from cathartics and fiber supplements

A

it does not make you have to go, but rather when you do it is softer

99
Q

ADRs of sodium docusate

A

negligible, but occasional diarrhea

100
Q

What is a special caution with sodium docusate

A

may promote absorption of mineral oil (a fat) if given concurrently

101
Q

Loperamide (Imodium) Classification

A

antidiarrheal

102
Q

Action of loperamide

A

structurally similar to the opioid meperidine

So, it suppresses bowel motility and fluid secretion into the intestinal lumen by binding gut wall opioid receptors

this stops them from going

103
Q

What is a real life situation when loperamide may be helpful

A

when travelling incase of water induced diarrhea

104
Q

ADRs of loperamide

A
  1. CONSTIPATION

Other: Nausea, Abdominal Cramps, Dizziness, Drowsiness

105
Q

Black Box Warning of loperamide

A

TORSADES DE POINTES (only at higher than normal doses)

It is a very serious life threatening cardiac rhythm

106
Q

Why can torsades de points be a big problem with loperamide

A

because loperamide is available OTC and is not controlled

107
Q

Lotomil

A

an antidiarrheal similar to loperamide

it is diphenoxylate (opioid) plus atropine

The opioid will stop diarrhea but the atropine will discourage opioid abuse because the atropine will make you miserable before an opioid high

108
Q

You are helping a home care client schedule her medications. When would be the most appropriate to receive a proton pump inhibitor?

A. At Night
B. After fasting at least 2 hours
C. About 30 min before a meal
D. About 2-3 hours after eating

A

C. about 30 min before a meal

109
Q

Your patient is ordered to receive MgOH for post op constipation. What would you assess first?

A. BP
B. Bowel Sounds
C. The patient’s ambulatory status
D. Patients Mg Levels

A

C. The patients ambulatory status

(so when they do have to go they get there safely - bowel sounds are good but not the point)

N365: Pharmacology in Nursing (15 decks)

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