pharm II meds
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pharm II meds
pharm II nursing n306 drexel
what digestive enzyme is activated by HCl to form pepsin?
what is dyspepsia?
what is the LES? its significance to GERD?
lower esophogeal sphincter.
when it does not properly close, GERD & reflux occurs
what are the aggressive (
) factors of ulcers?
H. pylori infection
3 types of cells found in the stomach lining?
chief (form pepsinogen - which HCl converts to pepsin)
mucous (from Goblet cells; form protective secretions)
parietal (makes HCl for acidic pH)
what are the defensive (
factors of ulcers?
5 classes of drugs used to treat
peptic ulcer disease
combo antisecretory agents & mucosal protectants
what combo of drug classes are given to treat H. pylori?
2 to 3 antibiotics PLUS an antisecretory agent
what abx has side effects of an unpleasant, "metallic" taste?
what abx works best in a neutral pH? what is it given with to achieve this?
amoxicillin. antacids are given to make stomach more alkaline
what abx has side effects of a black tongue & stools?
bismuth (Pepto Bismol)
what abx has a high resistance and is usually only given in conjunction with other abx?
what abx is not recommended for use in children < 8! yrs of age? why?
tetracycline. can stain adult set of teeth
what are the two types of antisecretory agents usually given to treat H. pylori?
histamine-2 receptor antagonist
proton pump inhibitor
describe the treatment of H. pylori, and why compliance is difficult to obtain
H2 receptor antagonist/proton pump inhibitor
(an antisecretory agent).
course must be followed for
compliance is difficult due to side effects, or feeling better and stopping too soon. strict, multi-dose days.
is important for patients to know the infx WILL NOT GO AWAY until full course is taken.
what is cimetidine (Tagamet)? therapeutic uses? mechanism of action? side effects?
prototype for histamine-2 receptor antagonists
: GERD, PUD, dyspepsia, Z-E syndrome,
prevention of aspiration pneumonia
action: inhibits h2 receptor; results in decreased secretions
: antiadronergic & CNS effects (confusion in elderly)
can cross the blood-brain barrier (also into BM & placenta)
what is ranitidine (Zantac)? therapeutic uses? mechanism of action? side effects? interactions?
: h2 receptor antagonist (
more potent than cimetidine)
: GERD, PUD, Z-E syndrome, dyspepsia
: inhibits h2 receptor; decreases secretions
: does not cross blood-brain barrier as easily as cimetidine, no antiadronergic effects
: antacids can decrease absorption
: antisecretory (h2 receptor antagonist)
does not inhibit liver enzymes
what is omeprazole (Prilosec)? uses? action? side effects? nursing considerations?
prototype agent of
proton pump inhibitors
: GERD, PUD, Z-E syndrome, dyspepsia
: inhibits proton formation; less gastric acid; less stomach acid secretions
: N/V/D, headache
needs to be taken before meals. can NOT crush.
can h2 receptor antagonists and proton pump inhibitors both be given together?
yes due to
different mechanisms of action
. if secretions are severely acidic and only one med is ineffective, both can be used together
other proton pump inhibitors?
lansoprazole (Prevacid) - IV
pantoprazole (Protonix) - IV
esmoprazole (Nexium) - IV
what is sucralfate (Carafate)? action? uses? nursing indications? interactions?
chemical "band aid" that lines the stomach and covers the ulcer.
used for PUD
does NOT decrease acid secretions
if cannot be swallowed as a pill orally, can be dissolved and made into a "slurpee"
: should not be given at same time as other meds due to coating of stomach lining
what is misoprostol (Cytotec)? action? uses? side effects? nursing indications?
antisecretory agent that ALSO enhances mucosal defenses
synthetic form of prostaglandin E
NSAID-related gastric ulcers. does
prevent NSAID-related duodenal ulcers
: diarrhea, abd pain, spotting/dysmenorrhea
category X. known teratogenic.
women should be educated about increased contraception during use
should be taken
general antacids - uses? action? dosage? nursing considerations?
: MoM, aluminum hydroxide, calcium carbonate, sodium bicarbonate
: symptom mgmt of GERD, PUD, dyspepsia
: raises the stomach pH to make it less acidic; composed of inorganic salts
: given around 7x a day. 1 & 3 hours after each meal and at bedtime.
education is important for pts to maintain daily schedule. should be given 2 hrs after other oral meds to avoid any interactions.
at what pH level are antacids given? why?
when the stomach pH is <5, antacids are given to
(pepsin is activated normally to stimulate HCl and break down foods, making stomach acidic)
how is the potency of antacids measured?
ANC - acid neutralizing capacity. measures the potency and strength of antacids
milk of magnesia? nursing indications? side effects?
should not be given to renal patients
side effects: diarrhea
aluminum hydroxide (Amphogel, Alternagel)? side effects?
okay to give to renal patients
side effects: constipation
calcium carbonate (Tums)? side effects?
- taking too many can make symptoms worse
: constipation, eructation from CO2 production
sodium bicarbonate? nursing implications?
not the choice antacid used for PUD.
caution in pt's at risk for sodium overload - hx of HTN, heart failure
aluminum + magnesium (Maalox)?
combination of two salts with reverse SE (constipation and diarrhea) balances them out.
what type of antacid has the highest ANC?