-
most prominent cause for ulcers?
H. pylori
-
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
-
Diet therapy for ulcers
- traditional ulcer bland diet not effective
- avoiding caffeine not effective
- eat 5-6 small meals daily
- Avoid NSAIDS and ASA
-
Antibiotics
- eradicate H. pylori
- **use 2-3 at a time to avoid resistance
SE= n/v/diarrhea
-
Histamine2 receptor blockers (type of med?)
H2 receptors
- anti-acid secretion drug
- = reduce volume and acidity of secretions
recept= parietal cells of stomach
-
Cimetidine / Tagament
- H2 receptor blocker
- -CNS effects= confusion, hallucinations
- -reduced labido, impotence
- -hematological effects
Today's Tagament is better than the first one
-
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
-
What can result from long term H2 receptor blockers?
Pneumonia b/c Dec. acid means Inc. bacteria growth
-
Proton pump inhibitors
- most effective acid suppresion b/c it shuts everything down
- prevents basal and stimulated acid production
- IRREVERSIBLE
- Cancer risk with long term use
- along with pneumonia, fractures, rebound hypersecretions, and for C-Diff
-
Rabeprazole / Aciphex
- PPI
- used with Zollinger-Ellison Syndrome gastrin secreting tumor, until tumor removed
-
Sucralfate / Carafate
other anti-ulcer drug
- Inert-provides viscous protective barrier b/w acid and epithelium
- May impede absorption of some drugs
-
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
-
Antacids
- Alkaline cmps that neutralize
- Stimulate production of prostaglandins
- Do not provide physical barrier
- poorly absorbed
Provide symptomatic relief for GERD
-
Acid Neutralizing Capacity
Mg vs Al
higher ANC is better
more Mg has SE of Diarreha
more Al has SE of constipation
-
Pirezepine / Gastrozapine
- Anti-cholinergic drug
- Outside the US
selective blocker for muscarinic receps that promote acid secretion
-
Laxatives
uses
- 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
-
laxative effects
vs.
catharsis
L= mild leisurely results
C= Fast, intense effects
-
**group 1 laxative**
- watery stool in 2-6 hours
- Osmotics, Castor oil, Electrolyte solutions
used to clean bowels before surgery
-
**group 2 laxatives**
- Semi-fluid stools in 6-12 hours
- Osmotics, stimulants
used for general constipation
-
**group 3 laxatives**
- Soft stool in 1-3 DAYS
- Bulk, surfactant, lactulose
preventative
-
Bulk forming
- group 3
- Like dietary fiber
- Stretch of intestinal wall stimulates peristalsis
- Absorbs water to soften stool
-
Surfactant
- group 3
- Lower surface tension - greater water absorption
-
Stimulant
- Stimulate instestinal motility
- Inc. water and electorlyte in intestinal lumen
-
Osmotics
- Laxative Salts
- Draw water into the gut
- Poorly absorbed systemically, but high doses can cause problems for cardiac pt.s
-
Mineral Oil
- lubricant
- taken orally but caused issues like asperation pneumonia, oil deposits on liver, and anal leakage (yum!)
-
Lactulose
- made of fructose and galactose
- Enhances intestinal excretion of ammonia
used for liver failure pt.s to help rid ammonia in stool
-
antienimics
target the CTZ (chemoreceptor trigger zone)
-
Serotonin Receptor Antagonist
Anti-emetic drugs
Supress Chemo induced nausea and vomiting
-
Ondansetron / Zofran
- Serotonin receptor antagonist (anti-emetic)
- Block CTZ and vagus nerve
SE= headache, dizziness, diarrhea
-
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
-
glucocorticoids and emetics
- suppress emesis caused by cancer chemo
- don't know how it works, but given IV during chemo Tx
-
Methylpredisolone / Solumedrol
Dexamethasone / Decadron
glucocorticoids used for anti-emetic
-
Dopamine antagonist
- used as anti-emetic
- blocks dopamine receptors in CTZ
-
Metoclopramide / Reglan
dopamine antagonist used as anti-emetic
- Inc. actions of gut
- =>moves contents down instead of up
-
Scopolamine
Muscarinic antagonist (anti-cholinergic) used for Motion sickness
suppresses nerve traffic in ear
SE= blurred vision, sleepy, urine retention (transdermal)
-
Dimenhydrinate / Dramamine
Promethazine / Phenergan
- Antihistamines in motion sickness
- blockade of cholinergic and H1 receptors
-
Diphenoxylate / Lomotil
Loperamide / Immodium
Opioid used as anti-diarrhea
- Dec. intest motility
- Dec. secretion of fluid in sm. bowel
- Inc. fluid and Na+ absorption
-
Alosetron / Lotronex
IBS-diarrhea for women ONLY
blocks serotonin receptors
-
Tegaserod / Zelnorm
- OFF THE MARKET NOW
- was for women with IBS-constipation
-
Lubiprostone / Amitiza
IBS-constipation in women
Blocks Chloride channels in gut
-
Crohn's
vs
Ulcerative Colitis
C= inflamm through mucosa and intest. wall
UC= inflamm through mucosa ONLY
-
4 things used for Inflamm Bowel Disease
- Aminosalicylates
- Glucocoritcoids
- Immunosupressants
- Immunomodulators
-
Aminosalicylates
Suppresses prostaglandin synthesis and migration of inflamm cells
where we start with IBD
SE= nausea, fever, rash arthralgias
-
Sufasalazine / Azulfidine
Mesalamine / Asacol & Pentasa
Aminosalicylates used for IBD
-
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
-
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
-
Cyclosporine
stronger and faster that Azathioprine
Suppress T-cells and anti-inflamm process
for acute symptoms
-
Infliximab / Remicade
Immunomodulator
- Inactivates TNF-a
- => a primary inflamm mediator
-
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)
-
Pancreatic Enzymes
- given to pt.s w/o enzymes with EVERY meal
- ->obstruction of pancreas, pancreatitis, pancreatectomy
secreted into duodenum to break down fats
-
Chenodial / Chenix
- used for gallstones
- reduces hepatic production of cholesterol
- facilitates dissolving stones
-
Ursodial / Actigall
gallstone med
- 2nd gen of Chenix
- Less SE's
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