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What are 3 gastric cells that are involved in gastric acid production?
parietal, chief, and mucous cells
what do parietal cells do?
produces and secretes HCL acid
What do chief cells do?
- Secretes pepsinogen
- converts pepsinogen into pepsin in the acidic gastric environment
What do mucous cells do?
- Secretes mucous
- Vital in maintaining the protective gastric mucosa lining
What is the mechanism of the action of antacids?
- used to neutralize gastric acid
- promotes gastric mucosal defenses
What are antacids made up of?
What are the reasons for Antacids?
- Treat symptoms of:
- Gastric Hyperacidity
What type of people should not take antacids?
Patients with renal insufficiency
What are the overall side effects of antacids?
- Mask symptoms of other disease
What is the side effect of antacids with magnesium?
What is the side effect of antacids with aluminum?
What is the side effect of antacids with Calcium?
- kidney stones
- rebound hyperacidity
What does antacids do when interacted with benzodiazepines, sulfonylureas, valproic acis?
Enhancment of these drugs
When should you take any other medications in regards to taking an antacid?
1-2 hours before or after an antacid
What are the types of Alumunium and magnesium antacids that are available?
What are the types of calcium antacids that are available?
What are the types of magnesuim antacids that are available?
Milk of Magnesia
What are they types of sodium bicarbonate antacids that are available?
What is the rule of thumb about mixing antacids with other drugs?
do not mix
What is the mechanism of action for H2R blockers?
Decreases HCL acid secretion by blocking the H2 receptor sites of the parietal cells
What are the indications of H2R blockers?
- Gastric Hypersecretory
- Upper GI bleeding
- Prophylactic to prevent stress ulcers in critically ill patients
What type of patients should not take H2R blockers?
Patients with liver and renal insuffiency
What are the side effects of H2R blockers?
- Hypotension (IV)
- Lethargy, Confusion/Disorientation
- Nausea, Diarrhea, Abdominal cramps
- Increased liver function tests, BUN, CREAT
What type of H2R blockers are available?
- Cimetidine (Tagament)
- Famotidine (Pepcid)
- Ranitidine (Zantac)
- Nizatidine (Axid)
What type of interaction does cimetidine (Tagament) have on theophylline, warfarin, lidocaine, phenytoin?
Increase there therapeutic effect.
What is the mechanism of action of proton pump inhibitors?
- Prevents H ion movement out of parietal cells
- Produces a temporary achlorhydric state
What is the indication for proton pump inhibitors?
- 1st line drug treatment for:
- Active gastric & duodenal ulcers
- Gastric hypersecretory
- NSAID induced ulcers
- Preventative for stress ulcers
- H. Pylori infections
What type of proton pump inhibitors blockers are available?
- Omeprazole (Prilosec)
- Pantoprazole (Protonix)
- Lansoprazole (Prevacid)
- Rabeprazole (Aciphex)
- Esomeprazole (Nexium)
When should you take proton pump inhibitors?
- Orally 30-60 mins before a meal
- Not with anyother meds
What type of interaction does proton pump inhibitors have on diazepam & phenytoin?
What type of interaction does proton pump inhibitors have on Warfarin?
Increases bleeding risk
What type of interaction does proton pump inhibitors have on Digoxin, Ampicillin, & Iron?
What type of medication is Sucralfate (Carafate)?
What are the indications for Sucralfate (Carafate)?
Used to treat stress ulcers & PUD
What are side effects to Sucralfate (Carafate)?
Constipation, nausea, and dry mouth
When should you give Sucralfate (Carafate)?
1 hour before a meal and at bedtime
What type of drug is Misoprostol (Cytotec) and what is it used for?
- Prevents induced ulcers caused by NSAIDS
What is side effects of Misoprostol (Cytotec)?
- GI upset
- vaginal bleeding
What type of patients should not get Misoprostol (Cytotec)?
Patients that are pregnant.
Which neurotransmitters stimulate nausea & vomiting?
- Acetylcholine (ACh)
- Dopamine (D2)
- Histamine (H1)
- Prostaglandins (PG)
- Serotonin (5-HT3)
What are the mechanism of action for anitemetics?
- Work at various points in the vomiting pathway to prevent the neurologic stimulus to vomit
- Relief of nausea & vomiting
What are the 6 types of antiemetics?
- 3.Neuroleptics (Phenothiazines)
- 5.Serotonin Blockers
What are the mechanism of action of anticholinergics?
- Bind to & block ACh receptors in the vestibular nuclei
- Blocks ACh receptors in the reticular formation
How do anticholinergics work to prevent nausea?
- Prevents nausea signals going to the CTZ & VC
- Dry GI secretions & decrease smooth muscle spasms
What type of anticholinergics drugs are avaliable?
What are side effects of anticholinergics?
What type of antihistamine (h1blockers) are avaliable?
- Meclizine (antivert) PO
- Dimenhydrinate (Dramamine)
- Diphenhydramine (Benadryl)
What are the indications for neuroleptics aka Phenothiazines?
Prevents nausea & vomiting by blocking dopamine receptors in the CTZ
What type of neuroleptics drugs are available?
- Prochlorperazine (Compazine)
- Promethazine (Phenergan)
What is the most common side effect of neuroleptics?
- Extrapyramidal Reaction-involuntary motor symptoms
- EKG changes-prolongs the QT interval (affects heart rate)
What type of extrapyramidal reation is motor restlessness?
What type of extrapyramidal reation is painful or forecful muscle contraction?
What type of extrapyramidal reation is involuntary contractions of the oral & facial muscles?
What is the mechanism of action of prokinetics?
Blocks dopamine receptors in the CTZ
How does prokinetics drugs work?
- Stimulates GI peristalsis
- Enhances gastric emptying
Metoclopramide (Reglan) is what type of drug?
How does Metoclopramide (Reglan) work?
- Increases GI mobility
- Decreases N&V
What type of patients should not get Metoclopramide (Reglan)?
- Patients with seizure precautions
- Patients with GI obstruction
- Patients with allergies to procaine & procainamide
What is the mechanism of action of serotonin blockers?
Blocks serotonin receptors in the GI tract, CTZ, and vomiting center
Ondansetron (Zofran) is what type of drug?