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Pharmacotherapeutics > Week 13 GI meds > Flashcards

Week 13 GI meds Flashcards

1
Q

What are the underlying causes of GI disorders?

A
  • dietary excess
  • stress
  • hiatal hernia
  • esophageal reflux
  • adverse drug effects
  • peptic ulcer disease
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2
Q

What effects do drugs have on GI secretions?

A
  • decrease GI secretory activity
  • block the action of GI secretions
  • Form protective covering on the GI lining to prevent erosion from GI secretions
  • Replace missing GI enzymes that the GI tract or ancillary gland and organs can no longer produce
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3
Q

What can effect the GI secretions?

A

May be caused by

- caffeine, alcohol, fatty foods

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4
Q

What is the stomach pH suppose to be?

A

Stomach pH 1-4

  • kill bacteria
  • medications are meant to be absorbed in that pH
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5
Q

What is peptic ulcer disease?

A
  • Erosions in the lining of the stomach and adjacent areas of the GI tract
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6
Q

What symptoms occur in peptic ulcer disease?

A

Gnawing, burning pain, often occurring after meals

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7
Q

What is often the cause of peptic ulcer disease?

A

Bacterial infection by Helicobacter pylori bacteria

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8
Q

How do you test for helibacter pylori bacteria?

A
  • serum test for antibodies for H. pylori

- treated with antibiotics (other medications help with pain and promote healing of the ulcer)

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9
Q

What kinds of drugs are used in treatment of ulcers?

A
  • Histamine-2 (H2) Antagonist
  • Antacids
  • Proton Pump Inhibitors
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10
Q

What do Histamine-2 (H2) Antagonist do?

A

Block the release of hydrochloric acid in response to gastrin

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11
Q

What do antacids do?

A

neutralize acids

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12
Q

What do proton pump inhibitors do?

A

suppress the secretions of hydrochloric acid into the lumen of the stomach

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13
Q

What is the action of Histamine-2 (H2) antagonist?

A
  • Selectively block histamine-2 receptor sites

- This blocking leads to a reduction in gastric acid secretion and reduction in overall pepsin production

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14
Q

What are Histamine-2 (H2) antagonists indicated for?

A
  • Short term treatment active duodenal ulcers, or benign gastric ulcer
  • treatment of pathological hypersecretory conditions such as Zollinger-Elison syndrome
  • Prophylaxis for stress induced ulcers and acute upper GI bleeding in critical patients
  • Treatment of erosive gastroesophageal reflux
  • Relief of symptoms of heartburn, acid indigestion, and sour stomach (OTC)
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15
Q

What is Cimetidine?

A

Histamine-2 (H2) Antagonist

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16
Q

What is the prototype for Histamine-2 (H2) Antagonist?

A

cimetidine

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17
Q

What are the pharmacokinetics of Histamine-2 (H3) Antagonists (Cimetidine)?

A
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18
Q

What are the contraindications and cautions of Histamine-2 (H3) Antagonists (Cimetidine)?

A 
CONTRAINDICATIONS
known allergy
CAUTIONS
- pregnancy and lactation
- hepatic and renal dysfunciton
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19
Q

What are the adverse effects of Histamine 2 (H2) antagonists (Cimetidine)?

A
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20
Q

What are the drug interactions for Histamine 2 (H2) antagonist (Cimetidine)?

A

Warfarin, phenytoin, beta blockers, alcohol, quinidine, lidocaine, theophylline, chloroquine, benzodiazepines, nifedipine, pentoxifylline, tricyclics, procainamide, and carbamazepine

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21
Q

What important teaching will the nurse provide t the patient taking Histamin-2 Antagonists?

A
  • What other meds are you taking (MAIN CONCERN- interactions with other medications)
  • test first before driving because of dizziness and confusion
  • treat peptic ulcer disease, GERD, heartburn, indigestion
  • Adjunct therapy with GI bleeds
  • Less effective in smokers
  • Inform men about gynecomastia
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22
Q

Define gynecomastia.

A

enlargement of male breasts

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23
Q

What is the action of antacids?

A
  • Neutralize stomach acid by direct chemical reaction
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24
Q

What are the indications for antacids?

A
  • Symptomatic relief of upset stomach associated with hyperacidity, as well as hyperactivity
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25
Q

What are the contraindications and cautions of antacids?

A 
CONTRAINDICATIONS
- Known allergy
CAUTIONS
- Condition that can be exacerbated by electrolyte imbalances
- GI obstruction
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26
Q

What are the adverse effects of antacids?

A
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27
Q

What are the drug interactions of antacids?

A

affect the absorption of many other PO drugs

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28
Q

What is the prototype for antacids?

A

sodium bicarbonate

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29
Q

Mr. Jones says he has used OTC aluminium hydroxine/magnesium hydroxide antacid (Maalox) for many yrears to treat his indigestion but it is no longer working. He asked for recommendation of another antacid.
What should the nurse say?

A
  • could be other underlying disorders so should see your doctor (could have malignancy, ulcer, etc)
  • rebound acidity
  • reduces acidity reduces pain
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30
Q

What can aluminum and Ca cause?

A

constipation

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31
Q

What helps to neutralize the effect of aluminum and Ca?

A

magnesium

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32
Q

What is the action of Proton pump inhibitors?

A

Acts at specific secretory surface receptors to prevent the final step of acid production and thereby decrease the level of acid in the stomach

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33
Q

What are the indications for proton pump inhibitors?

A
  • Short-term treatment of active duodenal ulcers, GERD, erosive esophagitis, and benign active gastric disease
  • Long-term treatment of pathological hypersecretory conditions
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34
Q

What are the pharmacokinetics of Proton Pump Inhibitors?

A
  • Acid labile, rapidly absorbed in the GI tract

- Metabolized in the liver and excreted in the urine

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35
Q

What do proton pump inhibitors end in?

A

-zole

(prototype omeprazole)

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36
Q

What are the contraindications and cautions of proton pump inhibitors (omeprazole)?

A

CONTRAINDICATION
- Allergy
CAUTION
- Pregnancy or lactation

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37
Q

What are the adverse effects of proton pump inhibitors (omeprazole)?

A
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38
Q

What is asthenia?

A

abnormal physical weakness or lack of energy

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39
Q

What is apathy?

A

lack of interest

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40
Q

What must the nurse think about when working with a patient on proton pump inhibitors (omeprazole)?

A
  • Decreases Ca so worry of it leading to ostoeperosis or bone loss
  • Also alters normal flora (more likely to be effected by c. difacile)
  • elevate the head to help with acid (try not to eat before bed, etc)
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41
Q

What teaching is required for patients on proton pump inhibitors (omeprazole)?

A

Teaching

  • know what drugs they are on (severe interactions with benzodiazepine and anticoagulants)
  • how to avoid
  • don’t crush or chew (have to take it whole)
  • take before or with a meal for best results
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42
Q

What are the actions of drugs used to affect motor activity of the GI tract?

A
  • Speed up or IMPROVE MOVEMENT of intestinal contents when movement becomes slow or sluggish (constipation)
  • INCREASE TONE of the GI tract and stimulate motility throughout the system
  • DECREASE MOVEMENT along the GI tract when rapid movement decreases the time for absorption of nutrients (diarrhea)
43
Q

What types of meds decrease motility as a side effect?

A
  • Ca and aluminum containing antacids

- opioids

44
Q

Name 3 types of laxatives.

A

CHEMICAL STIMULANTS
- Chemically irritate the lining of the GI tract
BULK STIMULANTS
- Cause the fecal matter to increase in bulk
LUBRICANTS
- Help the intestinal contents move more smoothly

45
Q

When would chemical stimulants be used?

A
  • prior to diagnostic procedures or surgery

- remove ingested poisons from the lower GI; adjunct in anthelmintic

46
Q

When are bulk stimulants used?

A
  • safe short term relief of occasional constipation (mainly fibre)
  • prevent straining
  • to remove ingested poisons of lower GI
  • adjunct to anthelmintic therapy
47
Q

When are lubricants indicated for treatment?

A
  • help with healing of ulcers
  • safe short term relief of occasional constipation (mainly fibre)
  • prevent straining
  • to remove ingested poisons of lower GI
  • adjunct to anthelmintic therapy
48
Q

What are BULK STIMULANTS

A
  • Cause the fecal matter to increase in bulk
49
Q

What are CHEMICAL STIMULANTS?

A
  • Chemically irritate the lining of the GI tract
50
Q

What are LUBRICANTS

A
  • Help the intestinal contents move more smoothly
51
Q

What are some examples of chemical stimulants?

A
  • Cascara (Generic): Reliable agent that leads to intestinal evacuation
  • Senna (Senokot): Reliable drug, similar to cascara (OTC)
  • Castor Oil (Neoloid): Old standby for thorough evacuation
    of the intestine
  • Bisacodyl (Dulcolax): Very popular OTC laxative
52
Q

What is the prototype of chemical stimulants?

A

caster oil (Neoloid)

53
Q

What are some examples of BULK STIMULANTS

A
54
Q

What is Psyllium (Metamucil) also marketed for?

A

Also marketing to lower cholesterol; contains fibre (psyllium); works by being high in fibre and draws in water thus increasing the bulk of the stool (which stimulates stretch receptors)

55
Q

What are some types of lubricating laxatives?

A

Docusate (Colace)

56
Q

What routes can Colace be given in?

A

rectal or oral

57
Q

What are the actions of laxatives?

A

Work in 3 ways:

  • Direct chemical stimulation of the GI tract
  • Production of bulk or increased fluid in the lumen
  • Lubrication of the intestinal bolus to promote passage through the GI tract
58
Q

What are laxatives indicated for?

A
59
Q

What are the pharmacokinetics of laxatives?

A
  • Only minimally absorbed and exert their therapeutic effect

directly in the GI tract

60
Q

What are the contraindications and cautions?

A

CONTRAINDICATIONS
- acute abdominal disorders (obstructions, surgery, abdominal pain)
CAUTIONS
- pregnancy and lactation

61
Q

What are the adverse effect of laxatives?

A
  • GI effects - Diarrhea, abdominal cramping, and nausea
  • CNS effects – Dizziness, headache, and weakness
  • CV effects – Sweating, palpitations, flushing, and fainting
  • Cathartic dependency
62
Q

What is cathartic dependance?

A

when a person requires a laxative to have a BM

63
Q

What are the drug to drug interactions of laxatives?

A

Some interfere with the timing or process of absorption

64
Q

Stressed, poor diet, and antacids used. Complains of constipation. What teaching will the nurse provide? Which laxative? What teaching?

A

Which laxative?
- fibre (bulk forming); few side effects, very safe, produces normal stools (take with lots of water)
What teaching?
- antacid could be contributing
- recommend exercise, fibre, stress, lots of water (at least a full glass of water; can cause a bolus of metamucil in the esophagus)
-for short term use and can cause dependance (contributes to loss of bowel tone)

65
Q

What are some types of gastrointestinal stimulants?

A

Dexpanthenol (Ilopan)
- Increases acetylcholine levels and stimulates the
parasympathetic system
Metoclopramide (Reglan)
- Blocks dopamine receptors and makes the GI cells more
sensitive to acetylcholine
- Leads to increased GI activity and rapid movement of food through the upper GI tract

66
Q

What are the actions of GI stimulants?

A
  • Stimulate parasympathetic activity within the GI tract

- Increase GI secretions and motility

67
Q

What are the indications of GI stimulants?

A
  • Rapid movement of GI contents is desirable
68
Q

What are the pharmacokinetics of GI stimulants?

A
69
Q

What are the contraindications and cautions of GI stimulants?

A 
Contraindications 
- Allergy
- GI obstruction
Caution
-Pregnancy & lactation
70
Q

What are the adverse effects of GI stimulants?

A
  • N&V
  • diarrhea
  • intestinal spasms
  • cramping
  • decreased blood pressure and heart rate
  • weakness and fatigue
71
Q

What are the drug interactions of GI stimulants?

A
  • Digoxin
  • Cyclosporine
  • Alcohol
72
Q

What is the prototype of GI stimulants?

A

Metoclopramide

73
Q

What routes can metoclopramide be taken?

A

PO, IM, IV

74
Q

What is metolopramide?

A

GI stimulants

75
Q

What is metoclopramide indicated for?

A
  • Relief of acute or chronic diabetic gastroparesis (partial paralysis of the stomach)
  • GERD patients that cannot have tradition treatment
  • Prevention of postoperative or chemotherapy N&V
  • Facilitates small bowel intubation
  • Promotion of intestinal transit of barium
  • stimulation of gastric emptying
76
Q

What are antidiarrheal drugs?

A

stop diarrhea

77
Q

What is the action of antidiarrheal drugs?

A

Slow the motility of the GI tract through direct action on the lining of the GI tract

78
Q

What are some types of antidiarrheal drugs?

A
  • Bismuth Subsalicylate (Pepto-Bismol)
  • Loperamide (Imodium)
  • Opium derivatives (Paregoric)
79
Q

What is acute diarrhea?

A
  • usually caused from a virus or something

- very old and very young may need treatment (pedialite for children)

80
Q

What is chronic diarrhea?

A
  • tumours
  • crohns, collitis, IBS
  • cystic collitis
81
Q

Which antidiarrheal drug would be best for travellers diarrhea?

A

Bismuth subsalicylate (Pepto-Bismol)

82
Q

When do you want to avoid the use of antidiarrheal drugs?

A

when you have an infectious diarrhea

83
Q

What does Bismuth Subsalicylate do?

A

Coats the lining of the GI tract and soothes irritation stimulating local reflexes to cause excessive GI activity and diarrhea

84
Q

What does Loperamide do?

A

Has a direct effect on the muscle layers of the GI tract; slows peristalsis and allows increased time for absorption of fluid and electrolytes

85
Q

What do Opium derivatives (Paregoric) do?

A

Stimulate spasm within the GI tract, stop peristalsis and diarrhea

86
Q

What are the actions of antidiarrheal meds?

A
  • Slow the motility of the GI tract through direct action on the
    lining of the GI tract
87
Q

What are the indications for antidiarrheal drugs?

A
  • Relief of symptoms of acute or chronic diarrhea
  • Reduction of volume of discharge from ileostomies
  • Prevention and treatment of traveler’s diarrhea
88
Q

What are the pharmacokinetics of antidiarrheal drugs?

A

varies depending on drug

89
Q

What are the contraindications and cautions of antidiarrheal drugs?

A 
Contraindications
- Allergy
Cautions
- Pregnancy and lactation
- History of GI obstruction
- History of acute abdominal condition
- Diarrhea due to poisoning
90
Q

What are the adverse effects of antidiarrheal meds?

A
  • Constipation (most common)
  • Abdominal distension
  • Abdominal discomfort
  • Nausea
  • Dry mouth
  • Toxic megacolon
  • Fatigue
  • Weakness
  • Dizziness
91
Q

What are the drug interactions with antidiarrheal meds?

A

depends on the drug

92
Q

What is the prototype for antidiarrheal meds?

A

loperamide (imodium)

93
Q

What routes can you take loperamide?

A

PO

94
Q

What is the most common uncomfortable complaint of patients?

A
  • N&V
95
Q

What is vomiting?

A

a complex reflex reaction to various stimuli

96
Q

What causes N&V?

A
  • motion sickness
  • pregnancy
  • over eating
  • infections
  • medications (common one is opioids)
  • stress
97
Q

What are emetics?

A
  • cause vomiting
98
Q

What are anti emetics?

A
  • decrease or prevent vomiting (central or locally acting)
99
Q

What is dimenhydrinate?

A

an antihistamine antiemetic (aka Gravol)

100
Q

What is important to teach people taking dimenhydrinate?

A
  • don’t take with alcohol
  • don’t drive due to drowsiness
  • can cause orthostatic hypotension
101
Q

Can you give gravol to children?

A

NO

can use pedialite

102
Q

What is the action of anticholinergics/antihistamines?

A

Anticholinergics that act as antihistamines and block the transmission of impulses to the CTZ

103
Q

When are anticholinergics/antihistamines indicated?

A

prevention and treatment of N&V

104
Q

What are the adverse effects of anticholinergics/antihistamines?

A
  • Drowsiness
  • Confusion
  • Dry mouth
  • Anorexia
  • Urinary frequency

Pharmacotherapeutics (7 decks)

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