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ABSN NUR 326 > Week 5: GI Pharmacology > Flashcards

Week 5: GI Pharmacology Flashcards

1
Q

What is the drug therapies for GERD and PUD?

A

H2 receptor antagonists
Proton pump inhibitors
Mucosal protectants
Antacids
Antiemetics

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2
Q

What is the main goal of antacids and sucralfate?

A

increase protective factors

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3
Q

What is the main goal of H2 blockers, proton pump inhibitors and the treatment of H. pylori ?

A

decrease aggressive factors

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4
Q

Treatment got H. pylori

A

several antibiotics and gastric acid inhibitor for 10-14days

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5
Q

Why do we do combination therapy when treating H. pylori?

A

to minimize resistance

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6
Q

Why is it difficult for patients to adhere to the treatment of H. pylori?

A

because it is expensive! $200 for 12 pills

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7
Q

What drugs are H2 receptor antagonists?

A

cimetidine, and famotidine

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8
Q

H2 receptor antagonists MOA

A

block H2 receptors in the stomach, which reduces gastric acid by 60-70% causing stomach pH to increase

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9
Q

Indications for H2 receptor antagonist

A

GERD, PUD, ulcer prophylaxis, heartburn/dyspepsia

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10
Q

S/E of H2 receptor antagonist

A

well tolerated, CNS effects in elderly and slight increase risk for pneumonia in elderly

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11
Q

Drug interactions with H2 receptor antagonists

A

INHIBITS CYP450 enzyme (older agents NOT pepcid)

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12
Q

Safety considerations for H2 receptor antagonist

A

can increase levels of warafrin, phenytoin, and theophylline

Give IV form slowly to avoid bradycardia

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13
Q

What drugs are proton pump inhibitors?

A

omeprazole, pantoprazole, esomeprazole magnesium

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14
Q

MOA of proton pump inhibitors

A

binds to proton pump inhibiting the proton pump which inhibits the secretion of HCl

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15
Q

Indications for taking proton pump inhibitors

A

short term treatment of PUD and GERD

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16
Q

S/E of proton pump inhibitors

A

short term- relatively safe
long term- increased risk dor pneumonia, bone loss/ hip x, and stomach cancer

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17
Q

What class is sucralfate?

A

Mucosal protectant

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18
Q

MOA of mucosal protectants

A

alters when exposed to gastric acid to a sticky thick gel, working as a protective barrier for the stomach

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19
Q

Indication for mucosal protectants

A

duodenal and gastric ulcers

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20
Q

S/E of sucralfate

A

nothing major, some constipation

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21
Q

Drug interactions with sucralfate

A

decreased drug absorption, take meds 2 hours AFTER taking sucralfate

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22
Q

What are the 4 major forms of antacids?

A
  1. Aluminum (amphojel)
  2. calcium (tums/calcium carbonate)
  3. Magnesium (Milk of magnesia)
  4. Aluminum + Magnesium (Maalox/Mylanta)
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23
Q

MOA for antacids

A

neutralize acid in the stomach by approximately 50%

e.g.
MgOH +HCl —-> MgCl +H2O

24
Q

Indications for antacids

A

PUD (healing), GERD (symptoms), stress ulcers (prophylaxis)

25
Q

S/E of antacids

A

diarrhea, constipation, and acid rebound

26
Q

drug interactions with antacids

A

chelation, altered gastric absorption of many drugs

27
Q

What are the 5 classes antiemetic (nausea) medications

A
  1. serotonin blockers
  2. antihistamines
  3. anticholinergics
  4. dopamine antagonists
  5. prokinetics
28
Q

What drugs are serotonin blockers?

A

ondansetron

29
Q

What is the MOA of a serotonin blocker

A

blocks serotonin receptors in the trigger zone in the b brain and in the afferent vagal nerves in the stomach and small intestine

serotonin causes nausea

30
Q

What are the indications for taking a serotonin blocker?

A

N/V, especially if chemo/radiation induced

31
Q

s/e of serotonin inhibitors

A

Common= mild headache, diarrhea, dizziness
severe= serotonin syndrome (so be aware of drugs that affect serotonin)

32
Q

What drugs effect serotonin? So must be careful with serotonin inhibitors

A

SSRI (citalopram), SNRIs (duloxetine), TCAs (amitriptyline), MAIs. buspirone, and tramadol

33
Q

What drugs are antihistamines?

A

dimenhydrinate, meclizine, and hydroxyzine

34
Q

MOA for antihistamines

A

blocks the release of histamine H1 receptors in the inner ear

35
Q

Indications for antihistamines

A

dizziness and nausea. usually associated with motion sickness

36
Q

S/E of antihistamines

A

sedation, drowsiness, dizziness and anticholinergic effects

FALL RISK

37
Q

What drugs are dopamine antagonist?

A

metoclopramide

38
Q

MOA of dopamine antagonists: prokinetic agent

A

blocks dopamine receptors increases the tone of the lower esophageal sphincter increasing peristalsis in both the stomach and duodenum

39
Q

Indications for dopamine antagonists: prokinetic agent

A

N?V associated with chemo/radiation/opioids, GI motility issues, and paralytic ileus

40
Q

S/E of dopamine antagonists

A

sedation, extrapyramidal symptoms, restlessness, neuroleptic malignant syndrome

41
Q

What are extrapyramidal symptoms?

A

-akathisia: may feel restless
-acute dystonia: involuntary muscle contractions
- parkinsonism
-tardive dyskinesia
-Neuroleptic malignant syndrome

42
Q

What are the antidiarrheal medications?

A

diphenoxylate with atropine, and loperamide

43
Q

what is the MOA for diphenoxylate with atropine, and loperamide

A

decrease intestinal peristalsis reducing the intestinal effluent

44
Q

S/E of diphenoxylate with atropine, and loperamide

A

drowsiness and constipation, fall and drive risk, anti-cholinergic effects of the atropine
SERIOUS: cardiac arrest/arrhythmias

45
Q

What drugs are in the class 5-aminosalicylates?

A

sulfasalazine

46
Q

Indications for taking sulfasalazine

A

mild to moderate IBD

47
Q

MOA of sulfasalazine

A

coverts the intestine into 5-aminsalicyclic acid and sulphapyridine

48
Q

Why do some with IBD prefer to take just mesalamine?

A

because sulphapyridine does nothing for IBD and has s/e that pt don’t like

49
Q

S/E of sulfasalazine

A

nausea, fever, rash, headache, hematologic disorders

50
Q

Who can NOT take sulfasalazine?

A

those with sulfa allergies and those with certain anemias

51
Q

What drug is a DMARD?

A

infliximab

52
Q

MOA for DMARDs

A

monoclonal antibody which neutralizes TNF-alpha

53
Q

Indications for taking DMARDs

A

There are lots but for this section IBD

54
Q

S/E of DMARDs

A

IMMUNE SUPPRESSION, infection, heart failure, infusion reactions, and neutropenia

55
Q

What is often required when taking DMARDs?

A

therapeutic drug monitoring and biomarker monitoring for inflammation

ABSN NUR 326 (10 decks)

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