pharm 4 set 1

H. pylori

• 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

• traditional ulcer bland diet not effective
• avoiding caffeine not effective

• eat 5-6 small meals daily
• Avoid NSAIDS and ASA

• eradicate H. pylori
• **use 2-3 at a time to avoid resistance

SE= n/v/diarrhea

• anti-acid secretion drug
• = reduce volume and acidity of secretions

recept= parietal cells of stomach

• H2 receptor blocker
• -CNS effects= confusion, hallucinations
• -reduced labido, impotence
• -hematological effects

Today's Tagament is better than the first one

• All H2 receptor blockers
• All can cause HypoTN if given IVpush, MUST be pushed very slowly

Pepcid needs to be diluted

Pneumonia b/c Dec. acid means Inc. bacteria growth

• 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

• PPI
• used with Zollinger-Ellison Syndrome gastrin secreting tumor, until tumor removed

other anti-ulcer drug

• Inert-provides viscous protective barrier b/w acid and epithelium
• May impede absorption of some drugs

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

• Alkaline cmps that neutralize
• Stimulate production of prostaglandins
• Do not provide physical barrier
• poorly absorbed

Provide symptomatic relief for GERD

higher ANC is better

more Mg has SE of Diarreha

more Al has SE of constipation

• Anti-cholinergic drug
• Outside the US

selective blocker for muscarinic receps that promote acid secretion

• 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

L= mild leisurely results

C= Fast, intense effects

• watery stool in 2-6 hours
• Osmotics, Castor oil, Electrolyte solutions

used to clean bowels before surgery

• Semi-fluid stools in 6-12 hours
• Osmotics, stimulants

used for general constipation

• Soft stool in 1-3 DAYS
• Bulk, surfactant, lactulose

preventative

• group 3
• Like dietary fiber
• Stretch of intestinal wall stimulates peristalsis
• Absorbs water to soften stool

• group 3
• Lower surface tension - greater water absorption

• Stimulate instestinal motility
• Inc. water and electorlyte in intestinal lumen

• Laxative Salts
• Draw water into the gut
• Poorly absorbed systemically, but high doses can cause problems for cardiac pt.s

• lubricant
• taken orally but caused issues like asperation pneumonia, oil deposits on liver, and anal leakage (yum!)

• made of fructose and galactose
• Enhances intestinal excretion of ammonia

used for liver failure pt.s to help rid ammonia in stool

target the CTZ (chemoreceptor trigger zone)

Anti-emetic drugs

Supress Chemo induced nausea and vomiting

• Serotonin receptor antagonist (anti-emetic)
• Block CTZ and vagus nerve

SE= headache, dizziness, diarrhea

• Substance P / Neurokin Antagonist
• Blocks substance p / neurokin
• -moderate affect alone BUT, can Enhance response of other antiemetics

prevent acute and delays n/v

• suppress emesis caused by cancer chemo
• don't know how it works, but given IV during chemo Tx

glucocorticoids used for anti-emetic

• used as anti-emetic
• blocks dopamine receptors in CTZ

dopamine antagonist used as anti-emetic

• Inc. actions of gut
• =>moves contents down instead of up

Muscarinic antagonist (anti-cholinergic) used for Motion sickness

suppresses nerve traffic in ear

SE= blurred vision, sleepy, urine retention (transdermal)

• Antihistamines in motion sickness 
• blockade of cholinergic and H1 receptors

Opioid used as anti-diarrhea

• Dec. intest motility
• Dec. secretion of fluid in sm. bowel
• Inc. fluid and Na+ absorption

IBS-diarrhea for women ONLY

blocks serotonin receptors

• OFF THE MARKET NOW
• was for women with IBS-constipation

IBS-constipation in women

Blocks Chloride channels in gut

C= inflamm through mucosa and intest. wall

UC= inflamm through mucosa ONLY

• Aminosalicylates
• Glucocoritcoids
• Immunosupressants
• Immunomodulators

Suppresses prostaglandin synthesis and migration of inflamm cells

where we start with IBD

SE= nausea, fever, rash arthralgias

Aminosalicylates used for IBD

Glucocorticoids used for anti-inflamm action of IBD

• For acute symptoms only
• avoid adrenal suppression b/c it is short acting

• 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

stronger and faster that Azathioprine

Suppress T-cells and anti-inflamm process

for acute symptoms

Immunomodulator

• Inactivates TNF-a
• => a primary inflamm mediator

• 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)

• given to pt.s w/o enzymes with EVERY meal
• ->obstruction of pancreas, pancreatitis, pancreatectomy

secreted into duodenum to break down fats

• used for gallstones
• reduces hepatic production of cholesterol
• facilitates dissolving stones

gallstone med

• 2nd gen of Chenix
• Less SE's