1. PUD symptoms
    • Nausea and epigastric pain that is worse at night and after eating
    • decreased H & H
  2. Prevpac
    • Antibiotic pack for PUD
    • Amoxicillin+Clarithromycin+PPI
    • 14 days
    • Check for penicillin allergy
  3. Normal Hematocrit & Hemoglobin
    • Hb-
    • males= 14-18
    • Females= 12-16
    • Ht- 3x Hb
  4. Antibiotic Drug combo for PUD
    (not Prevpac)

    No alcohol(metro), Sunscreen, no children, no pregnant bitches, empty stomach (tetra)
  5. Cimetidine (Tagament)
    • H2 blocker
    • decrease gastric acid secretions

    ADRS: gynecomastia, impotence, CNS-confusion, hallucinations, sedation, excitation

    • Drug Interactions:
    • Warfarin- Increase- bleeding
    • Phenytoin(Dilantin)-Increase-toxicity=nystagmus, ataxia
    • Theo-Dur-Increase-jittery, seizures, arrythmias
  6. Newer H2 blockers
    • End in -tidine
    • Ranitidine (Zantac)
    • Famotidine (Pepcid)
    • Nizatidine (Axid)

    • fewer side effects
    • fewer drug interations
    • overall better
  7. Omeprazole (Prilosec)
    • PPI prototype
    • Block enzyme needed to produce gastric acid
    • Adrs rare in short course (4-8 wks)
  8. Newer PPIs
    • End in "Prazole"
    • Lansoprazole (Prevacid)
    • Rabeprazole (Aciphex)
    • Pantoprazole (Protonix)
    • Esomeprazole (Nexium)
  9. Misoprostol (cytotec)
    • Increases Prostoglandins- decreases acid and increases mucous
    • Prevents ulcers, stimulates contractions (Cat. X no preggers!!)

    ADRS: diarrhea, abdominal pain, spotting, dysmenorrhea
  10. Antacid Classifications
    • Al compounds
    • Mg comounds
    • Al and Mg compounds
    • Ca compounds
    • Na compounds

    • neutralize  stomach acid
    • take 1 hour apart from other meds-decreases absorption
    • take1 and 3 hours pc
  11. Aluminum compounds
    • Antacids
    • AlternaGEL
    • Amphojel

    ADRS: constipation
  12. Magnesium Compounds
    Antacids: Milk of Mg

    ADR: diarrhea, CNS depression
  13. Al and Mg Compounds
    Antacids: Maalox, Mylanta

    ADRS: no GI effects
  14. Calcium Compounds
    Antacids: Ca carbonate (Tums)

    ADRS: aid rebound, belching/gas
  15. Sodium Compounds 
    Antacid- Sodium Bicarbonate

    ADRS: Sodium loading (avoid in HTN and Heart Failure)
  16. Sucralfate (Carafate)
    • stomach "bandaid"
    • barrier against acid and pepsin for PUD
    • needs acidic environment to work

    ADRs: rare b/c not absorbed

    dont take antacids with (2 hours apart)
  17. Indications for Laxatives
    • bowel prep
    • poisonings
    • Pregnancy (except stimulants)
    • Constipation
    • MI-no strain
    • Painful anorectal conditions
  18. Contraindications for Laxatives
    • Constipation due poor diet (except bulk)
    • to maintain regularity
    • Undiagnosed abdominal pain
    • Certain GI diseases
    • obstruction (listen for bowel sounds)
  19. Osmotic Laxatives
    "saline" laxatives- made of salt or Mg-draws in H20

    MOM, Fleet Phosphosoda

    ADRS: dehydration, N/V, dizzy/fainting

    • NO Mg for renal
    • NO Na for HTN and CHF
  20. Polyethylene Glycol-electrolyte Laxatives
    Colyte, Golytely

    non-absorbant osmotic agent and mix of K/Na salts

    No loss of water or electrolytes- use in dehyrdrated and renal/cardio pt

    Give with large vol of water
  21. Stimulant Laxatives
    Bisacodyl (Dulcolax, Correctol), Senna (Senokot), Castor Oil

    Increases H20 and electrolytes into inestines 

    Interations: Milk and Antacids

    ADRs: stomach cramps
  22. Bulk Forming Laxatives
    Metamucil, Citrucel

    like fiber-used for regularity (diarrhea and constipation)

    may contain dextrose (avoid in diabetic)

    give with lots of water to avoid obstruction
  23. Surfactants
    • "Stool softeners"-easier to go
    • Docusate Sodium (Colace)

    lowers surface tension so water can pentrate feces

    • Avoid in HTN and CHF
    • cant give for opiod constipation
  24. Antiemetic classes
    • Serotonin antagonist
    • Dopamine antagonist
    • Glucocorticoids "steroids"
    • Cannabinoids
    • Anticholinergics (antihistamines)
    • Benzos
  25. Serotonin Antagonist
    • Ondansetron (Zofran)
    • antiemetic- most effective

    ADRs: HA, diarrhea, dizziness
  26. Dopamine Antagonist
    • Antiemtics
    • Prochorperazine (compazine), Promethazine (Phenergan)

    ADRS: EPS, sedation, antichilinergic effects, hypotension, movement disorders, hallucinations
  27. Glucocorticoids "steroids"
    • Antiemtic- end in "one"
    • Methylprednisolone (Solumedrol)
    • Dexamethasone (Decadron)

    Combined with other antiemetics for chemo emesis

    ADRs: long term= andrenal insufficiency
  28. Cannabinoids
    • antiemtic-chemo pts, appetite- aids
    • Dronabinol (Marinol)- weed

    ADRS: dry mucous membranes, hungry, lethargy, euphoria, increase HR, decrease BP

    caution in cardio pts and psych disorders
  29. Anticholinergics
    • Antiemetics- for motion sickness
    • Scopolamine- patch, PO, SQ
    • Dimenhydrinate (Dramamine)- PO

    ADRs: no pee, no see, no shit, no spit, sedation (dramamine)

  30. Benzos
    • No direct antiemtic
    • Lorazepam (Ativan)

    causes antergrade amnesia, sedation
  31. Antidiarrheals
    • Opiods- Diphenoxylate/Atropine (Lomotil), Loperamide (Imodium)
    • ADRs: morphine like in overdose

    Bulk Forming- Metamucil, Citrucal
  32. Metoclopramide (Reglan)
    • blocks seratonin and dopamine
    • increases peristalsis, reduces N/V, supresses Gerd, treats diabetic gastroparesis

    ADRs: sedation, diarrhea, EPS (increase in kids)

    Contraindications: GI obstruction, hemmorrhage, perforation
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