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Proton Pump Inhibitor, supressant of acid secretion, gastric and duodenal ulcers and GERD.
Mechanism of action for Prilosec
It blocks the final common pathway of gastric acid production, omeprazole can inhibit basal and stimulated acid release
S/S for Prilosec
- Headache, diarrhea, N/V (minor effects)
- Gastric cancer- hyper gastric secretion of gastrin.
- Hip fracture- high dose increases the risk of osteoporosis and fractures, reducing acid secretion may decrease absoprtion of calcium.
What does Gastrin do?
stimulates hyperplasia in gastric epi cells whose growth may ultimately result in gastric garcinoid tumor.
-supressess emisis (vomiting) by blocking receptors for dopamine serotonin in the CTZ (Chemoreceptor zone)
Increases upper GI motility by enhancing the actions of acetylcholine
S/S of Reglan metaclopramide
can suppress post op nausea and vomiting as well as emesis caused by anti cancer drugs, opioid toxins and radiation therapy.
High dose therapy sedation and diarrhea are common.
What do dopamine antagonists do?
increases gastrointestinal tone and motility antispasmodics
analog of prostaglandin E, protects against NSAID induced ulcers by stimulating secretion of mucous and bicarbonate, maintaining submucosal bloodflow and suppressing secretion of gastric acid- treats peptic ulcers. PUD is the most common.
S/S of Cytotec
Dont take when pregnant!! Prostaglandins stimulate uterine contraction.
antisecretory agent, H2 antagonists
this drug is approved for treatment and prevention of duodenal ulcers, gastric ulcers, GERD and hypersecretory states (Zollinger-Ellison Syndrome)
take 1 hour ac with glass of water
does not suppress metabolism of other drugs
Difference in direct and indirect acting stimuli for ondansetron Zofran
direct acting stimuly include signals from the cerebral cortex (anticipation or fear), signals from sensory organs (upsetting sights, noxious odors, or pain) and signals from the vastibular apparatus of the inner ear)
- indirect actin stimuli first activate the chemoreceptor trigger zone which in turn activates the vomiting center. Activation occus in 2 ways:
- -signals from the stomach and small intestine (along vagal afferents)
- -by direct action of emetogenic compounds- anticancer drugs, opioids, ipecac
used to prevent nausea and vomiting associated with radiotherapy and anesthesia; more effective when combines with dexamethasone
Benefits derive from blocking type 3 serotonin receptors (5-HT3 receptors)
S/S of ondansetron - Zofran
common: headache, diarrhea, dizziness
achieves higher blood levels then omeprazole and somewhat lasts longer.
can be used for prophylaxis if NSAID-induced ulcers
most common adverse effects of Nexium esoemeprazole
headache and diarrhea may cause: nausea, flatulence, abdominal pain and dry mouth/ pose a risk of osteoporosis and fractures, may increase a risk for pneumonia if gastric pH is elevated.
What is calcium carbonate and what are the S/S?
- alkaline compounds neutralize stomach acid: PUD and GERD; rapid acting, effects are of long duration.
adverse effects: constipation
calcium carbonate releases carbon dioxide in the stomach which can cause flatulence and belching.
bismuth Pepto Bismol
act topically to disrupt the cell wall of H. Pylori causing lysis and death, cn cause black color on tongue and black stools, patient should be forewarned, black stool may interpretate gastric bleedinng, long term use for neurologic injury.
antibiotic for protozoal infections. could be used for patients with crohns disease.
S/S for Flagyl metronidazole
- common: nausea, vomiting
- RXN can occur: Disufiram can occus if taken with alcohol; should not be taken when pregnant. long term use can cause peripheral neuropathy.
Lomotil diphenoxylate (plus atrophine)
opioids, antidiarrheal agents
Lonox, Logen, Lomanate
used only for diarrhea, no effect of CNS, but can have typical morphine like rxn's when taken by high doses, taken orally, insoluble to water, cannot be abused by parental routes.
docusate sodium, penetrates small intestine and colon, all doses taken with full glass of water
inhibits fluid absorption
stimulate secretion of water and electrolytes into the intestinal lumen
BOTH surgactant action softens stool by facilitating penetration of water, also causes secreation of water and electrolytes into intestine.
Phenothiazine and EPS -prochlorperazine
suppresses emesis by blocking dopamine receptors in the ctz
side effects: extrayramidal rxn, antibholinergenic effects, hypotension and sedation
promote fluid evactuation of bowel
effect is relatively fast and intense
- proton pump inhibitor
- like omeprazole
indications are duodenal ulcers, gastric ulcers, GERD and hypersecretory states
- PO or IV, most common effect:
- orally: diarrhea, headache and dizziness
- IV: diarrhea, headache, nausea, dyspepsia
- Inj site: thrombophlebitis and abscess may increase risk for pneumonia.
- By stimulating choinergenic receptors in the eye, it produces two direct effects:
- -Miosis- constriction of the pupil secondary to contraction of the iris sphincter
- -contraction of the ciliary muscle- an action that focuses the lens for near vision
IOP reduced indirectly
S/S of Pilocarpine
Contraction of the ciliary muscle focuses the lens for near vision
sustaines contraction of the ciliary muscle causes retinal detachment
constriction of the pupil
visual acuity caused by contraction of the iris sphincter
local irritation, eye pain and brow ache
antihistamines (nonsedating) intranasal and nasal spray
blocks the release of histamine and other mediators from mast cells
complain of a bitter taste. both drugs are indicated for allergic rhinitis in adults and children over 12 years. 2 sprays in each nostril, twice dails, somnolence develops in an increased amount of users
S/S of Azelastine
mild sedation and should not be comined with alcohol
headache, drowsiness, pharyngitis, dry mouth, nose and throat, nausea, vomiting, and bowel changes.
Beta 2 androgenic agonists, used in asthma patients, MDI (90 mcg/puff), solution for nebulizer, 2 puffs every 4-6 hours, dosing is 3-4 times a day, long term control
Ipratropium bromide (anticholinergenic agent) (atrovent)
muscarinic antagonist, indications, allergic rhinitis, asthma and common cold.
does not decrease sneezing, nasal congestion or postnasal drip
nasal spray, 12 yr and older, 2-3 times a day
common effects from Ipratropium bromide
nasal dying and irritation, relieves bronchospasm, COPD, promotes bronchodilation, drug may raise IOP in glaucoma patients, patients with peanut allergy and soya protein should avoid, available in: MDI (combivent and solution for nebulation) Duoneb
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