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Where does peptic ulcer disease occur?
Areas exposed to HCL acid and pepsin
What is GERD
gastro-esophageal reflux disease
What are causes of ulcers?
- H. Pylori
- Gastric acid: acetylcholine, histamine II
- Pepsin (pH < 3)
- H. Pylori
What protects the cells?
- dilution of HCL acid
- tight esophageal sphincter
- cytoprotective prostaglandins
What are the different types of Anti-Ulcer Meds?
- Ulcer adherent
- Histamine 2 Receptor Blockers
- Proton Pump Inhibitors
- H. Pylori Agents
What is the prototype for Antacids?
Aluminum and Magnesium: Maalox, Mylanta, Gelusel, Di-Gell
When do you give antacids?
- 1hr after meals
- 2hrs after other meds
What is the prototype for ulcer adherent?
What are the ADE for sucralafate (carafate)
- metallic taste
- dry mouth
What is an issue with having a patient take sucralafate (carafate)?
- difficult schedule to keep (1 hr after/before bed, 4-8 weeks)
- Pt non-compliance
What is the prototype for Histamine 2 Receptor Blocking Agents?
What does H2 cause?
Increased gastric acid production
What is the MoA of Cimetidine (Tagamet)?
H2 receptor blocker to inhibit gastric acid production
When can you give Cimetidine (Tagamet)?
- any time W/O regard to meals
- 2 hrs apart from antacids
What are some ADE of cimetidine (Tagamet)
How long can you take antacids?
- a few weeks
- NOT a few years
What is the prototype for Proton Pump Inhibitors? (PPI)
What are the common ADE of Omeprazole (Prilosec)
What is the MoA of Omeprazole (Prilosec)?
prevent or stop the "pumping" or release of gastric acid
What are long term ADE for Omeprazole (Prilosec)
- increased risk for bone loss and C.Diff
- Decreased absorption of nutrients and meds
Does Sucralfate (Carafate) change pH in stomach?
How is sucralfate (Carafate) excreted?
with fecal matter
What are some nursing assessments for Histamine 2 receptors blocking agents?
- renal function
- liver function
- other medication interferance (there's alot)
- pregnancy, lactating
How long is it recommended to take Omeprazole (Prilosec)
What is a prevpak treating?
Hy. Pylori agents
What is in the prevak?
- 1 lansoprazel (Prevacid)
- 2 amoxicillin
- 1 (Clarithromycin (Biaxin))
mild effects w the formation of soft stool
Define Cathartic (GI Tract)
strong effect w/ elimination of liquid or semi-liquid stool
What is an example of bulk forming laxative and cathartic?
What is the action of bulk forming laxatives and cathartics
adds bulk to increase peristalsis
What is the action of Surfactant (stool softeners)
What is the action of Saline cathartic?
Increases osmotic peristalsis
What is the action of irritant or stimulant cathartics?
irritates the GI mucosa > increases peristalsis
What is the action of lubricant laxatives?
What are examples of Saline Cathartic?
- milk of magnesia
What are contraindicatiosn for laxatives and cathartics
- Abd pain of unknown origin
- Bowel Perforation
- GI obstruction
Name some causes of Diarrhea
- excessive use of laxatives
- intestinal infection
- highly spice foods
- lack of digestive enzymes
- Inflammatory bowel disease
- drug therapy
- Intestinal Cancer
What are nonspecific therapies for Diarrheals?
What are some types of opiate derivatives for nonspecific therapy?
What are some misc diarrheals for nonspecific therapy
When is specific therapy for diarrheals used?
Means that there's a specific problem that has to be taken care of
What are 2 types of specific therapy for anti-diarrheals?
- Digestive Enzymes
What should you do prior to giving an anti-emetic?
assess for bowel sounds
What are the 4 types of anti-emetics?
- Serotonin Receptor Antagonist