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