PHARM 3 (GI)

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MeganM
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269897
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PHARM 3 (GI)
Updated:
2014-04-19 22:28:04
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Pharm
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Pharm 3 - GI
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  1. Drugs that block the release of HCl in stomach in response to gastrin. When are they given?
    • Histamine H2 antagonist
    • with food or one hr after antacid
  2. Interacts with gastric acids at the chemical level to neutralize them.  When are they given?
    • antacids
    • usually AFTER meals
  3. Drugs that suppress secretion of HCl into the stomach lumen. When are they given?
    • Proton Pump Inhibitors
    • BEFORE meals
  4. Drugs that reduce gastric motility.
    Anticholinergics
  5. Drugs that coat any injured area in the stomach to prevent further injury from acid.
    Mucosal barrier protectants
  6. When are Mucosal protectants given?
    BEFORE meals
  7. "tidines"
    H2 receptor antagonists
  8. What are the "tidine" drugs used for?
    • PUD
    • GERD
    • Reflux esophagitis
    • prevention of aspiration pneumonia
    • prevention of stress ulcers in critically ill (as combo therapy to treat H. pylori)
  9. When are Prostaglandins given?
    WITH meals
  10. Prototype for anti-ulcer drugs.
    Cimetidine
  11. Prototype for  antacids.
    AIOH and MgOH
  12. Prototype for  PPIs.
    Omeprazole
  13. Prototype for Mucosal protectants.
    Sucralfate
  14. Prototype for prostaglandin analogs.
    Misoprostol
  15. Avoid ____ use within one hour of po administration of H2 receptor antagonists.
    antacid
  16. What does aluminum toxicity cause (from antacids)?
    Neuro dysfunctions (dementia)
  17. "prazoles"
    Protein pump inhibitor
  18. What are PPIs indicated for?
    • Short term treatment of gastric ulcers
    • active duodenal ulcers & peptic ulcers (H.pylori)
    • erosive esophagitis
    • GERD
    • hypersecretory states
  19. Most common side effect to be aware of with PPIs.
    hyperglycemia
  20. How should Pantoprazole be administered via IV?
    • filtered
    • over 15 minutes
  21. What should you avoid eating with use of tetracycline?
    dairy (binds to Ca++ and decreases action)
  22. What med can gray teeth particularly in kids?
    tetracycline
  23. _______ is used for treating PUD due to long term NSAID or corticosteroid use.
    • misoprostol (Cytotec)  
    • (a mucosal protective agent)
  24. When is misoprostol (Cytotec) contraindicated?
    • pregnant (causes spontaneous abortion!!)
    • lactating
    • allergic to prostaglandins
  25. "Buttpaste" for your gut - works to form a protective acid resistant shield in ulcer crater.
    Sucralfate (Carafate)
  26. When should Carafate be administered (regarding meals)?
    • 1 hr before meals or 2 hrs after
    • 2 hrs after other PO meds
    • not within 2 hrs of antacids
  27. Sucralfate (Carafate) can result in ________ in renally compromised clients.
    aluminum toxicity
  28. When should Cytotec be taken?
    on empty stomach and not within 30 min before or after meals
  29. What is the purpose of a laxative vs a cathartic?
    • Laxative: production of soft, formed stool over ONE or MORE DAYS
    • Cathartic: RAPID, intense fluid evacuation of bowel
  30. Antidiarrheals include what 3 things?
    • opioid-related drugs
    • kaolin
    • pectin
  31. Mech of axn for opioid-related laxatives.
    decreases peristalsis in the intestines
  32. Do not give ______ to a pt with C. diff?
    • antidiarrheals (or anything that slows GI motility)
    • -wanna let it flush out!
  33. How do osmotic laxatives work? What is the most common one?
    • pull water into lumen of gut
    • Milk of Magnesia
  34. Osmotic Laxatives.
    • Glycerin (Glycerol)
    • Lactulose (kirstalose)
    • Polyethylene glycol (Miralax)
    • Saline compounds
  35. How do bulk-forming laxatives work?
    Absorb water
  36. Bulk-forming laxatives.
    • methylcellulose (Citrucel)
    • psyllium (Metamucil)
    • Polycarbophil
  37. Dietary fiber and related bulk-forming laxatives are used to?
    • treat simple constipation
    • aid pts recovering from acute MIs, cerebral aneurysms, or eye surgery (avoid Valsalva maneuver)
    • pts w/ IBS or diverticulosis
  38. How do surfactant (emolient) laxatives work (stool softeners)?
    • lowers surface tension 
    • facilitates water penetration
  39. What kind of laxative is given to a pt with hypoactive bowel sounds or with constipation?
    stimulant laxatives
  40. Major antiflatulant drug currently used.
    Simethicone
  41. How do Phenothiazines work?
    block vomiting center in medulla
  42. Two phenothiazine drugs (domapine antagonists; blk vomiting ctr in medulla).
    • prochloraperazine (Compazine)
    • promethazine (Phenergan)
  43. What is the main adverse effect with high doses of Reglan?
    EPS symptoms (extrapyramidal effects; psuedoparkinsons)
  44. What are emetic drugs used for?
    to induce vomiting in a person who has ingested toxic substances
  45. Emetic drug of choice.
    Syrup of Ipecac
  46. What are digestion aids used for?
    • inactive vagal stimulus
    • pts with bypassed duodenum
  47. Do not take pancreatic enzymes with ______ because______.
    • hot foods
    • heat deactivates them
  48. Most commonly used adsorbent drug.
    activated charcoal
  49. What is Ursodiol-Actigall used for and mech of axn?
    Dissolves gallstones (recur when med stopped)
  50. What is mech of axn Chenodiol (Chenex)?
    reduces cholesterol content of gallstones
  51. Mech of axn of Cholestyramine (Questran) and what it's used for.
    • ginds bile salts to hasten excretion thru feces 
    • used for severe pruritus
  52. What's important to teach the pt taking sulfa drugs?
    • drink lots of water!
    • (need to flush kidneys because they will crystalize in the kidney if they are dehydrated)
  53. What main s/s should you look for with immunosuppressives (methotrexate, cyclosporine, mercaptopurine, imuran)?
    • bone marrow toxicity 
    • (which means decreased or inhibation of bld cell production; "-penias")
  54. Magnesium compounds, especially in higher doses, often cause _______.
    diarrhea
  55. ______ and _______ compounds may cause ________.
    constipation
  56. Sodium compounds may cause ________.
    flatulence
  57. Symptoms of ______ include dysphagia, dyspepsia, nausea, belching, heartburn, and chest pain.
    GERD
  58. The proton pump is activated by __________.
    food intake
  59. When should you administer a PPI?
    20-30 min before the first major meal of the day to allow peak serum levels to coincide with when the max levels of pumps are activated
  60. When are proton pumps less active?
    • at night
    • in fasting state
    • between meals
  61. Blood dyscrasias, especially thrombocytopenia and neutropenia, have been reported with long-term use of ______.
    ranitidine (Zantac)
  62. Periodic ______ should be performed with pts taking ranitidine (Zantac).
    blood counts
  63. Concurrent use of ________ and _______ poses a risk for aluminum toxicity.
    • aluminum salts 
    • sucralfate
  64. ______ and ______ are used routinely to relieve symptoms of GERD.
    • H2-receptor antagonists
    • PPIs
  65. What type of foods contribute to or increase GERD?
    • acidic foods (such as tomatoes)
    • high fat foods
  66. ________ may provide temporary relief of GERD but should not be used in pts with ____________.
    • Sodium bicarbonate
    • HEART FAILURE
  67. Antacids act within ___  to _____ minutes.
    10-15
  68. If indigestion is not relieved with an antacid, what may it indicate?
    a heart attack
  69. A _____ is recommended as an adjunct treatment of H. pylori to suppress both acid and H. pylori.
    PPI
  70. _______ is a common cause of PUD.
    H. pylori
  71. _________ is a histamine H2-receptor antagonist that inhibits histamine binding to parietal cells and reduces acid secretion.
    Ranitidine (Zantac)
  72. PPIs inhibit _____,  ______, ______, located on the surface of parietal cells.
    • H+
    • K+
    • -ATPase
  73. Diphenoxylate with atropine is given for _______.
    diarrhea
  74. Although _______ with _____ may decrease abdominal cramping and gas as a result of slowed peristalsis, it is not the main therapeutic effect desired.
    diphenoxylate with atropine
  75. One adverse effect of sulfasalazine (Azulfidine) is ________ and possible symptoms include?
    • blood dyscrasias
    • fever, bruising, sore throat
  76. __________ is a phenothiazine and can cause EPS resembling Parkinson's (aka dystonias).
    Prochlorperazine
  77. The enzymes in _______ come from pork.
    pancrelipase
  78. If a pt is allergic to or has religious restrictions on pork, the drug ______ is contraindicated.
    pancrelipase
  79. Because magnesium hydroxide (milk of mag) will stimulate _______, it is important that the nurse assess for ________ before giving the drug.
    • peristalsis
    • bowel sounds
  80. When should magnesium hydroxide (milk of mag) be held and the HCP notified?
    If a blockage or ileus is suspected.
  81. Why is it important to explore possible causes for diarrhea before making a recommendation?
    if diarrhea is caused by an infection, slowing motility may allow the infection to increase
  82. __________, including bismuth, are contraindicated in children younger than 19.  Why?
    • Salicylates
    • increased risk for Reye's syndrome
  83. What's important to teach pts about Psyllium?
    • It must be mixed in at least 8 oz of liquid
    • if not, it can become a gelatinous mass in the esophagus
  84. ________  activates Cl- channels in the intestinal luminal cells, altering stool consistency & promoting regular BMs.
    Lubiprostone
  85. What is the goal of therapy with Lubiprostone?
    • to normalize peristalsis;
    • NOT inhibit it
  86. Typical therapeutic response to psyllium (time).
    24-48 hrs
  87. Saline laxatives usually produce the desired effect within __- ___ hrs.
    6-12
  88. A ________ laxative works in 1-6 hrs.
    Saline cathartic
  89. Which oral laxative works immediately?
    none!
  90. Sulfasalazine may color the urine what color?
    orange-yellow
  91. ________ can cause crystalluria and one side effect is headache & should be discontinued if headache occurs.
    Sulfasalazine
  92. ________ usually occurs with Sulfasalazine but does not require treatment.
    Dizziness
  93. What's significant about PPI's and the enzyme?
    They inhibit the enzyme that secretes HCl, which is irreversible, and a new enzyme must be made - so the drug works for a while, even after a pt stops taking it.
  94. When is an anticholinergic contraindicated?
    • BPH
    • glaucoma
    • Paralytic ileus
    • MI
    • (4D's)
  95. What is pirenzepine (Gastrozepine)?
    • anticholinergic
    • slows GI motility
  96. What is misoprostol (Cytotec) and what is it used to treat?
    • prostaglandin analog
    • treats PUD due to long term NSAID or corticosteroid use
    • protects against peptic ulcers caused by NSAIDS (reduces secretion of HCl, increases production of gastric mucus)
  97. When should a pt take Cytotec?
    • empty stomach
    • NOT within 30 min B4 or after food
  98. Carafate protects the mucosa for how long?
    up to 6 hrs
  99. If giving/prescribing Cytotec to a female, what should you do first?
    • Have her take a pregnancy test 
    • (drug will cause spontaneous abortion)
  100. What happens to PO drugs in a pt if they have just been given Carafate?
    • they will be absorbed in the intestine rather tan the stomach
    • b/c Carafate protects stomach with a "paste-like" substance for up to 6 hrs
  101. How long should you wait to get pregnant after stopping Cytotec?
    stay on birth control for at least ONE MONTH
  102. ______ is an analog to Demerol.
    Imodium
  103. Antidote to Diphenoxylate with Atropine (Lomotil) OD?
    naloxone (reverse respiratory depression)
  104. Used to treat chronic diarrhea.
    Loperamide
  105. Used to treat acute, nonspecific diarrhea.
    Immodium
  106. Type of antidiarrheal agent given for severe diarrhea associated with cancer/tumors.
    Ocreotide acetate (Sandostatin)
  107. Most common OSMOTIC laxative.
    Milk of Magnesia (pulls water into lumen, does NOT affect GI motility)
  108. Why not give M.o.M. to renal failure pts?
    They will get toxic b/c can't get rid of Mg++
  109. What kind of laxative is given to pts who have had an acute MI or eye surgery and why?
    • Drug of choice is Emmolient laxatives, but can also give fiber/bulk-forming
    • to avoid straining with Valsalva maneuver (which will lower HR & BP, increase intraocular pressure)
  110. What kind of laxative is good for someone with a neuro problem or who has been on narcotics for a long time?
    stimulant laxatives
  111. Antiflatulant major drug currently used.
    Simethicone
  112. What is an adsorbent drug? Most common?
    • antidote for ingestion of toxins
    • activated charcoal
  113. What is Sulfasalazine (Azulfidine) given for? What else is given with it and why?
    • to treat ulcerative colitis
    • iron and folate - (deficiency occurs)

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