PHARM 3 (GI)
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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
Interacts with gastric acids at the chemical level to neutralize them. When are they given?
- usually AFTER meals
Drugs that suppress secretion of HCl into the stomach lumen. When are they given?
- Proton Pump Inhibitors
- BEFORE meals
Drugs that reduce gastric motility.
Drugs that coat any injured area in the stomach to prevent further injury from acid.
Mucosal barrier protectants
When are Mucosal protectants given?
H2 receptor antagonists
What are the "tidine" drugs used for?
- Reflux esophagitis
- prevention of aspiration pneumonia
- prevention of stress ulcers in critically ill (as combo therapy to treat H. pylori)
When are Prostaglandins given?
Prototype for anti-ulcer drugs.
Prototype for antacids.
AIOH and MgOH
Prototype for PPIs.
Prototype for Mucosal protectants.
Prototype for prostaglandin analogs.
Avoid ____ use within one hour of po administration of H2 receptor antagonists.
What does aluminum toxicity cause (from antacids)?
Neuro dysfunctions (dementia)
Protein pump inhibitor
What are PPIs indicated for?
- Short term treatment of gastric ulcers
- active duodenal ulcers & peptic ulcers (H.pylori)
- erosive esophagitis
- hypersecretory states
Most common side effect to be aware of with PPIs.
How should Pantoprazole be administered via IV?
What should you avoid eating with use of tetracycline?
dairy (binds to Ca++ and decreases action)
What med can gray teeth particularly in kids?
_______ is used for treating PUD due to long term NSAID or corticosteroid use.
- misoprostol (Cytotec)
- (a mucosal protective agent)
When is misoprostol (Cytotec) contraindicated?
- pregnant (causes spontaneous abortion!!)
- allergic to prostaglandins
"Buttpaste" for your gut - works to form a protective acid resistant shield in ulcer crater.
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
Sucralfate (Carafate) can result in ________ in renally compromised clients.
When should Cytotec be taken?
on empty stomach and not within 30 min before or after meals
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
Antidiarrheals include what 3 things?
- opioid-related drugs
Mech of axn for opioid-related laxatives.
decreases peristalsis in the intestines
Do not give ______ to a pt with C. diff?
- antidiarrheals (or anything that slows GI motility)
- -wanna let it flush out!
How do osmotic laxatives work? What is the most common one?
- pull water into lumen of gut
- Milk of Magnesia
- Glycerin (Glycerol)
- Lactulose (kirstalose)
- Polyethylene glycol (Miralax)
- Saline compounds
How do bulk-forming laxatives work?
- methylcellulose (Citrucel)
- psyllium (Metamucil)
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
How do surfactant (emolient) laxatives work (stool softeners)?
- lowers surface tension
- facilitates water penetration
What kind of laxative is given to a pt with hypoactive bowel sounds or with constipation?
Major antiflatulant drug currently used.
How do Phenothiazines work?
block vomiting center in medulla
Two phenothiazine drugs (domapine antagonists; blk vomiting ctr in medulla).
- prochloraperazine (Compazine)
- promethazine (Phenergan)
What is the main adverse effect with high doses of Reglan?
EPS symptoms (extrapyramidal effects; psuedoparkinsons)
What are emetic drugs used for?
to induce vomiting in a person who has ingested toxic substances
Emetic drug of choice.
Syrup of Ipecac
What are digestion aids used for?
- inactive vagal stimulus
- pts with bypassed duodenum
Do not take pancreatic enzymes with ______ because______.
- hot foods
- heat deactivates them
Most commonly used adsorbent drug.
What is Ursodiol-Actigall used for and mech of axn?
Dissolves gallstones (recur when med stopped)
What is mech of axn Chenodiol (Chenex)?
reduces cholesterol content of gallstones
Mech of axn of Cholestyramine (Questran) and what it's used for.
- ginds bile salts to hasten excretion thru feces
- used for severe pruritus
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)
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")
Magnesium compounds, especially in higher doses, often cause _______.
______ and _______ compounds may cause ________.
Sodium compounds may cause ________.
Symptoms of ______ include dysphagia, dyspepsia, nausea, belching, heartburn, and chest pain.
The proton pump is activated by __________.
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
When are proton pumps less active?
- at night
- in fasting state
- between meals
Blood dyscrasias, especially thrombocytopenia and neutropenia, have been reported with long-term use of ______.
Periodic ______ should be performed with pts taking ranitidine (Zantac).
Concurrent use of ________ and _______ poses a risk for aluminum toxicity.
- aluminum salts
______ and ______ are used routinely to relieve symptoms of GERD.
- H2-receptor antagonists
What type of foods contribute to or increase GERD?
- acidic foods (such as tomatoes)
- high fat foods
________ may provide temporary relief of GERD but should not be used in pts with ____________.
- Sodium bicarbonate
- HEART FAILURE
Antacids act within ___ to _____ minutes.
If indigestion is not relieved with an antacid, what may it indicate?
a heart attack
A _____ is recommended as an adjunct treatment of H. pylori to suppress both acid and H. pylori.
_______ is a common cause of PUD.
_________ is a histamine H2-receptor antagonist that inhibits histamine binding to parietal cells and reduces acid secretion.
PPIs inhibit _____, ______, ______, located on the surface of parietal cells.
Diphenoxylate with atropine is given for _______.
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
One adverse effect of sulfasalazine (Azulfidine) is ________ and possible symptoms include?
- blood dyscrasias
- fever, bruising, sore throat
__________ is a phenothiazine and can cause EPS resembling Parkinson's (aka dystonias).
The enzymes in _______ come from pork.
If a pt is allergic to or has religious restrictions on pork, the drug ______ is contraindicated.
Because magnesium hydroxide (milk of mag) will stimulate _______, it is important that the nurse assess for ________ before giving the drug.
When should magnesium hydroxide (milk of mag) be held and the HCP notified?
If a blockage or ileus is suspected.
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
__________, including bismuth, are contraindicated in children younger than 19. Why?
- increased risk for Reye's syndrome
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
________ activates Cl- channels in the intestinal luminal cells, altering stool consistency & promoting regular BMs.
What is the goal of therapy with Lubiprostone?
- to normalize peristalsis;
- NOT inhibit it
Typical therapeutic response to psyllium (time).
Saline laxatives usually produce the desired effect within __- ___ hrs.
A ________ laxative works in 1-6 hrs.
Which oral laxative works immediately?
Sulfasalazine may color the urine what color?
________ can cause crystalluria and one side effect is headache & should be discontinued if headache occurs.
________ usually occurs with Sulfasalazine but does not require treatment.
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.
When is an anticholinergic contraindicated?
- Paralytic ileus
What is pirenzepine (Gastrozepine)?
- slows GI motility
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)
When should a pt take Cytotec?
- empty stomach
- NOT within 30 min B4 or after food
Carafate protects the mucosa for how long?
up to 6 hrs
If giving/prescribing Cytotec to a female, what should you do first?
- Have her take a pregnancy test
- (drug will cause spontaneous abortion)
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
How long should you wait to get pregnant after stopping Cytotec?
stay on birth control for at least ONE MONTH
______ is an analog to Demerol.
Antidote to Diphenoxylate with Atropine (Lomotil) OD?
naloxone (reverse respiratory depression)
Used to treat chronic diarrhea.
Used to treat acute, nonspecific diarrhea.
Type of antidiarrheal agent given for severe diarrhea associated with cancer/tumors.
Ocreotide acetate (Sandostatin)
Most common OSMOTIC laxative.
Milk of Magnesia (pulls water into lumen, does NOT affect GI motility)
Why not give M.o.M. to renal failure pts?
They will get toxic b/c can't get rid of Mg++
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)
What kind of laxative is good for someone with a neuro problem or who has been on narcotics for a long time?
Antiflatulant major drug currently used.
What is an adsorbent drug? Most common?
- antidote for ingestion of toxins
- activated charcoal
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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