pharm 4 set 1

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pharm 4 set 1
2013-10-29 15:14:37

pharm 4
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  1. most prominent cause for ulcers?
    H. pylori
  2. 4 defensive factors against ulcers
    • GI mucus
    • Bicarbonate= from epithelial cells of stomach
    • ¬† = neutralize acids
    • Blood flow
    • Prostiglandins= promote vasodilation, stimulate secretions of mucus and bicarb, suppress gastric acid secretion
  3. Diet therapy for ulcers
    • traditional ulcer bland diet not effective
    • avoiding caffeine not effective

    • eat 5-6 small meals daily
    • Avoid NSAIDS and ASA
  4. Antibiotics
    • eradicate H. pylori
    • **use 2-3 at a time to avoid resistance

    SE= n/v/diarrhea
  5. Histamine2 receptor blockers (type of med?)

    H2 receptors
    • anti-acid secretion drug
    • = reduce volume and acidity of secretions

    recept= parietal cells of stomach
  6. Cimetidine / Tagament
    • H2 receptor blocker
    • -CNS effects= confusion, hallucinations
    • -reduced labido, impotence
    • -hematological effects

    Today's Tagament is better than the first one
  7. Ranitidine / Zantac

    Famotidine / Pepcid

    Nizatadine / Axid
    • All H2 receptor blockers
    • All can cause HypoTN if given IVpush, MUST be pushed very slowly

    Pepcid needs to be diluted
  8. What can result from long term H2 receptor blockers?
    Pneumonia b/c Dec. acid means Inc. bacteria growth
  9. Proton pump inhibitors
    • most effective acid suppresion b/c it shuts everything down
    • prevents basal and stimulated acid production

    • Cancer risk with long term use
    • along with pneumonia, fractures, rebound hypersecretions, and for C-Diff
  10. Rabeprazole / Aciphex
    • PPI
    • used with Zollinger-Ellison Syndrome gastrin secreting tumor, until tumor removed
  11. Sucralfate / Carafate
    other anti-ulcer drug

    • Inert-provides viscous protective barrier b/w acid and epithelium
    • May impede absorption of some drugs
  12. Misoprostal / cytotec-prostaglandin analog
    was DOC before H2 and PPI's

    • NSAID ulcer prophylaxis and Tx
    • Serves as a prostaglandin replacement b/s NSAIDs stop prost's

    PPI are as effected and better tolerated though
  13. Antacids
    • Alkaline cmps that neutralize
    • Stimulate production of prostaglandins
    • Do not provide physical barrier
    • poorly absorbed

    Provide symptomatic relief for GERD
  14. Acid Neutralizing Capacity

    Mg vs Al
    higher ANC is better

    more Mg has SE of Diarreha

    more Al has SE of constipation
  15. Pirezepine / Gastrozapine
    • Anti-cholinergic drug
    • Outside the US

    selective blocker for muscarinic receps that promote acid secretion
  16. Laxatives

    • to ease of stimulate defecation
    • -soften
    • -increase stool volume
    • -hasten fecal passage
    • -facilitate evacuation

    • uses:
    • to decrease need to strain
    • -cardiac and HTN problems
    • -geriatrics/para and quadrpalegia
    • -->to compensate for poor muscle tone
  17. laxative effects
    L= mild leisurely results

    C= Fast, intense effects
  18. **group 1 laxative**
    • watery stool in 2-6 hours
    • Osmotics, Castor oil, Electrolyte solutions

    used to clean bowels before surgery
  19. **group 2 laxatives**
    • Semi-fluid stools in 6-12 hours
    • Osmotics, stimulants

    used for general constipation
  20. **group 3 laxatives**
    • Soft stool in 1-3 DAYS
    • Bulk, surfactant, lactulose

  21. Bulk forming
    • group 3
    • Like dietary fiber
    • Stretch of intestinal wall stimulates peristalsis
    • Absorbs water to soften stool
  22. Surfactant
    • group 3
    • Lower surface tension - greater water absorption
  23. Stimulant
    • Stimulate instestinal motility
    • Inc. water and electorlyte in intestinal lumen
  24. Osmotics
    • Laxative Salts
    • Draw water into the gut
    • Poorly absorbed systemically, but high doses can cause problems for cardiac pt.s
  25. Mineral Oil
    • lubricant
    • taken orally but caused issues like asperation pneumonia, oil deposits on liver, and anal leakage (yum!)
  26. Lactulose
    • made of fructose and galactose
    • Enhances intestinal excretion of ammonia

    used for liver failure pt.s to help rid ammonia in stool
  27. antienimics
    target the CTZ (chemoreceptor trigger zone)
  28. Serotonin Receptor Antagonist
    Anti-emetic drugs

    Supress Chemo induced nausea and vomiting
  29. Ondansetron / Zofran
    • Serotonin receptor antagonist (anti-emetic)
    • Block CTZ and vagus nerve

    SE= headache, dizziness, diarrhea
  30. Aprepitant / Emend
    • Substance P / Neurokin Antagonist
    • Blocks substance p / neurokin
    • -moderate affect alone BUT, can Enhance response of other antiemetics

    prevent acute and delays n/v
  31. glucocorticoids and emetics
    • suppress emesis caused by cancer chemo
    • don't know how it works, but given IV during chemo Tx
  32. Methylpredisolone / Solumedrol

    Dexamethasone / Decadron
    glucocorticoids used for anti-emetic
  33. Dopamine antagonist
    • used as anti-emetic
    • blocks dopamine receptors in CTZ
  34. Metoclopramide / Reglan
    dopamine antagonist used as anti-emetic

    • Inc. actions of gut
    • =>moves contents down instead of up
  35. Scopolamine
    Muscarinic antagonist (anti-cholinergic) used for Motion sickness

    suppresses nerve traffic in ear

    SE= blurred vision, sleepy, urine retention (transdermal)
  36. Dimenhydrinate / Dramamine

    Promethazine / Phenergan
    • Antihistamines in motion sickness¬†
    • blockade of cholinergic and H1 receptors
  37. Diphenoxylate / Lomotil

    Loperamide / Immodium
    Opioid used as anti-diarrhea

    • Dec. intest motility
    • Dec. secretion of fluid in sm. bowel
    • Inc. fluid and Na+ absorption
  38. Alosetron / Lotronex
    IBS-diarrhea for women ONLY

    blocks serotonin receptors
  39. Tegaserod / Zelnorm
    • was for women with IBS-constipation
  40. Lubiprostone / Amitiza
    IBS-constipation in women

    Blocks Chloride channels in gut
  41. Crohn's
    Ulcerative Colitis
    C= inflamm through mucosa and intest. wall

    UC= inflamm through mucosa ONLY
  42. 4 things used for Inflamm Bowel Disease
    • Aminosalicylates
    • Glucocoritcoids
    • Immunosupressants
    • Immunomodulators
  43. Aminosalicylates
    Suppresses prostaglandin synthesis and migration of inflamm cells

    where we start with IBD

    SE= nausea, fever, rash arthralgias
  44. Sufasalazine / Azulfidine

    Mesalamine / Asacol & Pentasa
    Aminosalicylates used for IBD
  45. Dexamethazone / Decadron

    Buesonide / Entocort
    Glucocorticoids used for anti-inflamm action of IBD

    • For acute symptoms only
    • avoid adrenal suppression b/c it is short acting
  46. Azathioprine
    • Immunosupressant for IBD
    • Not approved for IBD but used for long term suppression
    • takes up to 6 months to see effects
    • INhibits B and T-cells proliferation
    • Anti-inflamm effects
  47. Cyclosporine
    stronger and faster that Azathioprine

    Suppress T-cells and anti-inflamm process

    for acute symptoms
  48. Infliximab / Remicade

    • Inactivates TNF-a
    • => a primary inflamm mediator
  49. Metoclopromide / Reglan
    • Prokinetic Agent
    • -increase tone and motility in IBD

    • Suppresses dopa and serotonin receptors in CTZ
    • *Inc. motility by enhancing action of ACh
    • *Sedation and diarrhea countered with antihistamines

    (used in pt with tube feeding and sluggish gut)
  50. Pancreatic Enzymes
    • given to pt.s w/o enzymes with EVERY meal
    • ->obstruction of pancreas, pancreatitis, pancreatectomy

    secreted into duodenum to break down fats
  51. Chenodial / Chenix
    • used for gallstones
    • reduces hepatic production of cholesterol
    • facilitates dissolving stones
  52. Ursodial / Actigall
    gallstone med

    • 2nd gen of Chenix
    • Less SE's