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Pathophysiology And Pharmacology 2 - notre dame > Wk2 > Flashcards

Wk2 Flashcards

1
Q

Pharmacokinetic properties (LADME)

A

Liberation: disintegration, dispersal, dissolution
Absorption: how’s it absorbed
Distribution: how does it spread through the body
Metabolism: is it turned chemically inside the body
Excretion: how is it eliminated form the body

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2
Q

Describe administration of medication the systemic effect

A

Most drugs given orally
Some changed by GI tract
Drugs absorbed by GIT pass through portal system to liver
Only once passed through liver can drug be distributed in systemic circulation
All this is known as oral bioavailability - titrating drugs bc differs form pt to pt

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3
Q

What are pharmacodynamics

A 
The biochemical and physiological effects of drugs in the body 
Drug response
Drug concentration vs effect
Cellular response
Modify cell function
Competitive (reversed)
No competitive (can't be reversed)
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4
Q

Information about the GI tract

A

Major endocrine systems of the body
Acid secreted by parietal cells
Maintains stomach acid at pH 1-4
Acid secretion stimulated by large, dfatty meals, excessive amounts of alcohol, emotional stress

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5
Q

What is the enteric nervous system

A

2 major nerve plexuses in wall of GIT

Sub mucosal and Myenteric

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6
Q

Meds to control gastric secretion

A

Antacids, histamine H2, proton pump

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7
Q

Meds to control motility

A

Purgatives, antidiarrhoeals, antispasmodics

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8
Q

Meds to control vomiting

A

Emetic, antiemetic

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9
Q

What are antacids

A

Don’t prevent overproduction of acid , neutralise acid once it’s in the stomach
Weak bases
Combine with HCL to raise pH
PH more than 4 = inactive pepsin (digestive protease enzyme released by chief cells that function to degrade food protein into peptides)

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10
Q

Types of antacids

A

Aluminium salts: constipation effects
Sodium bicarbonate: highly soluble, quick onset, short duration, issues with heart failure, renal issues, hypertension
Magnesium salts: laxative effects, dangerous in renal failure (accumulation of MG)
Calcium salts: may cause constipation
Siemthicone: reduce bloating, decrease surface tension of gas bubbles causing them to combine

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11
Q

Nursing considerations in use of antacids

A

May inactivate other drugs
Alteration of pH causes reduced drug absorption
Administer other drugs 2 hrs before or after

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12
Q

What is pharmacokinetics

A 
Explores what the body does to the drug
Mechanisms of absorption/distribution
Rate of onset
Action of drug
Duration
Effects
Route of excretion
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13
Q

What are H2 antagonists

A

Histamine is a potent stimulant agent for acid production in the stomach
Acid secretion increased by H2 -receptor activation.
H2 Antagonists block the actions of histamine & reduce acid production
Reduce acid secretion

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14
Q

what are the side effect and nursing considerations of H2 antagonists

A
  • Diarrhoea, constipation, headaches, dizziness
  • Rarely hypotension, liver problems, clotting disorders
  • Can interact with other drugs & reduce absorption
  • Assess for allergies and impaired renal or liver function.
  • Take 1 hour before or after antacids
  • Ranitidine may be given intravenously; follow administration guidelinesH2 antagonists may be administered with or without food
  • Assess effectiveness of medications relief from sysmptoms
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15
Q

Examples of H2 antagonists

A

Zantac (Ranitidine)
Tazac (Nizatidine)
Tagamet (Cimetidine)
Pepcid (Famotidine)

Gastric ulcer: 20% = H2 antagonist
Duodenal ulcer: 80% = H2 antagonist with or without h.pylori

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16
Q

what are PPI’s

A

The Proton Pump inhibitors block the release of acid
The parietal cells release hydrogen ions during HCl production.
• Hydrogen ion are referred to a “protons”
Parietal cells use an enzyme system “Proton pump” to manufacture & release acid into the stomach
The Proton Pump inhibitors block the release of acid
The parietal cells release hydrogen ions during HCl production.
• Hydrogen ion are referred to a “protons”
Parietal cells use an enzyme system “Proton pump” to manufacture & release acid into the stomach

17
Q

Side effects and nursing considerations for PPI’s

A

• Assess for allergies and history of liver disease
• Pantoprazole is the only proton pump inhibitor available for parenteral administration
– can be used for patients who are unable to take oral medications
• May increase serum levels of diazepam, phenytoin, and cause increased chance for bleeding with warfarin
• Omeprazole: B4 meals, whole, with antacids, short term

18
Q

Examples of PPI’s

A 
Omeprazole (Somac), Pantoprazole
Losec
Nexium
Prilosec
Lansoprazole

– Short term treatment of active duodenal and benign gastric ulcers
– Maintenance therapy peptic ulcers, oesophigitis, gastric reflux

19
Q

Examples of antacids

A

• Mylanta
(aluminum and magnesium)
• Quick-eze (calcium and magnesium carbonate)
• Gaviscon (simethicone)

20
Q

What are antiemetics

A

used to prevent vomitingCentral neural regulation located in 2 separate medulla units (vomiting centre in the medulla which can be stimulated from GI tract via vagus nerve and chemoreceptor trigger zone (CTZ). CTZ sensitive to chemical stimuli and main site of many druges to prevent emesis
Main neurotransmitters that control vomiting include acteycholine, histamine, dopamine, serotonin and opioid and 5HT

21
Q

What are the different types of antiemetics

A

Antimuscarinic: Used only for prevention or treatment of motion sickness, Action: thought to be on muscarinic receptors associated with the vestibular apparatus

Antihistamines: have antimuscarinic activity + antihistamine effects, Block histamine H1 receptors in vestibular apparatus (inner ear).
Also have additional sedative and anticholinergic properties that enhance antiemetic activity

Dopamine atagonists: Thought to bind to D2 receptors in the chemoreceptor trigger zone & vomiting centre

Serotonin 5-HT3 receptor antagonists: Central and peripheral 5-HT3 (Serotonin) receptor blockade in GI & CTZ centre

22
Q

Side effects and nursing considerations of antiemetics

A

Dry mouth, thirst, blurred vision, drowsiness, constipation, urinary retention, restlessness, fatigue

Dopamine antagonists used with caution
•	Impaired cardiovascular function
•	Glaucoma
•	liver disease
•	Seizure disorder
•	GI obstruction
23
Q

Examples of antiemetics

A

Antimuscarinic:
Kwells, travacalm

Antihistamines: Dimenhydrinate, Promethazine (Phenergen)

Dopamine atangonists: Metoclopramide (Maxalon)
Prochlorperazine (Stemetil)
• Domperidone (Motilium)

Serotonin: Ondansetron (Zofran) – Granisetron - expensive

24
Q

What are antidiarrhoeals

A

help bowel motility in order to prevent diarrhoea (Increase in volume, fluidity or frequency of bowel movements, relative to the usual pattern for the person)

25
Q

Different types of antidiarrhoeals

A

Adsorbents

Opiates - ↑ mixing movements & simultaneously ↓ peristaltic movements

Muscarinic receptor antagonists – seldom used as primary therapy because of their actions on other systems. Used in colicky pain but no effect on stool frequency or volume.

26
Q

Side effects and nursing considerations for antidiarrhoeals

A
  • Drowsiness, sedation, dizziness, lethargy
  • Nausea, vomiting, anorexia, constipation
  • Respiratory depression
  • Bradycardia, palpitations, hypotension
  • Urinary retention
  • Flushing, rash, urticaria
  • Obtain thorough history of bowel patterns
  • General state of health
  • Recent history of illness or dietary changes
  • Assess for allergies
  • Assess fluid volume status; intake and output
  • Prevent dehydration & electrolyte imbalance
  • Monitor for therapeutic effect
27
Q

Examples of antidiarrhoeals

A

Absorbent: bismuth subsalicylate (Pepto-Bismol), kaolin-pectin (Kaopectate), activated charcoal, attapulgite (Diareze)

Opiates: Codeine, morphine, Loperamide, Diphenoxylate

28
Q

What are purgatives

A 
Laxatives/aperients 
Treats constipation 
Accelerate the passage of food through the intestine
•	Anti-diarrhoea - ↓ movement
•	Anti-spasmodic - ↓ movement
29
Q

Different types of purgatives

A

bulk forming: Non-digestible and non-absorbable, form a viscous sol or gel => softening the faecal mass and ↑ bulk

emollient: Prevent straining, promote more water and fat in stool, take longer to act and Lubricate faecal material and intestine walls
osmotic: increases water content causing bowel distention, increased peristalsis and evacuation
stimulant: increases peristalsis

30
Q

side effects and nursing considerations of purgatives

A

• Obtain a thorough history
• Since all laxatives can cause electrolyte imbalances, assess fluid and electrolytes before initiating
• Monitor effects
• Patients experiencing nausea, vomiting, and/or abdominal pain: no laxatives
• Continuing problems: seek medical advice
• Encourage healthy, high-fiber diet and increased
fluid intake as alternative to laxative use
• Long-term use of laxatives often results in decreased bowel tone and may lead to dependency
• All laxative tablets should be swallowed whole
• not crushed or chewed, especially if enteric-coated

31
Q

Examples of purgatives

A

Bulk forming: Meta, Fybogel, Citrucel

Faecal softener: coloxyl, Colace, dulcelax

Osmotic: Osmolax, Carvso’s quick cleanse

Stimulant: castor oil, senna, cascara, bisacodyl

32
Q

Peptic ulcer treatment

A

Antacids: relieve symptoms
PPI: Binds to receptor and receptor can’t release HCl anymore
H2 antagonists
anticholinergic

Pathophysiology And Pharmacology 2 - notre dame (8 decks)

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