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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
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Interacts with gastric acids at the chemical level to neutralize them. When are they given?
- antacids
- 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.
Anticholinergics
-
Drugs that coat any injured area in the stomach to prevent further injury from acid.
Mucosal barrier protectants
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When are Mucosal protectants given?
BEFORE meals
-
"tidines"
H2 receptor antagonists
-
What are the "tidine" drugs used for?
- PUD
- GERD
- Reflux esophagitis
- prevention of aspiration pneumonia
- prevention of stress ulcers in critically ill (as combo therapy to treat H. pylori)
-
When are Prostaglandins given?
WITH meals
-
Prototype for anti-ulcer drugs.
Cimetidine
-
Prototype for antacids.
AIOH and MgOH
-
Prototype for PPIs.
Omeprazole
-
Prototype for Mucosal protectants.
Sucralfate
-
Prototype for prostaglandin analogs.
Misoprostol
-
Avoid ____ use within one hour of po administration of H2 receptor antagonists.
antacid
-
What does aluminum toxicity cause (from antacids)?
Neuro dysfunctions (dementia)
-
"prazoles"
Protein pump inhibitor
-
What are PPIs indicated for?
- Short term treatment of gastric ulcers
- active duodenal ulcers & peptic ulcers (H.pylori)
- erosive esophagitis
- GERD
- hypersecretory states
-
Most common side effect to be aware of with PPIs.
hyperglycemia
-
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?
tetracycline
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_______ 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!!)
- lactating
- allergic to prostaglandins
-
"Buttpaste" for your gut - works to form a protective acid resistant shield in ulcer crater.
Sucralfate (Carafate)
-
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.
aluminum toxicity
-
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
- kaolin
- pectin
-
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
-
Osmotic Laxatives.
- Glycerin (Glycerol)
- Lactulose (kirstalose)
- Polyethylene glycol (Miralax)
- Saline compounds
-
How do bulk-forming laxatives work?
Absorb water
-
Bulk-forming laxatives.
- methylcellulose (Citrucel)
- psyllium (Metamucil)
- Polycarbophil
-
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?
stimulant laxatives
-
Major antiflatulant drug currently used.
Simethicone
-
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.
activated charcoal
-
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 _______.
diarrhea
-
______ and _______ compounds may cause ________.
constipation
-
Sodium compounds may cause ________.
flatulence
-
Symptoms of ______ include dysphagia, dyspepsia, nausea, belching, heartburn, and chest pain.
GERD
-
The proton pump is activated by __________.
food intake
-
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 ______.
ranitidine (Zantac)
-
Periodic ______ should be performed with pts taking ranitidine (Zantac).
blood counts
-
Concurrent use of ________ and _______ poses a risk for aluminum toxicity.
- aluminum salts
- sucralfate
-
______ and ______ are used routinely to relieve symptoms of GERD.
- H2-receptor antagonists
- PPIs
-
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.
10-15
-
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.
PPI
-
_______ is a common cause of PUD.
H. pylori
-
_________ is a histamine H2-receptor antagonist that inhibits histamine binding to parietal cells and reduces acid secretion.
Ranitidine (Zantac)
-
PPIs inhibit _____, ______, ______, located on the surface of parietal cells.
-
Diphenoxylate with atropine is given for _______.
diarrhea
-
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).
Prochlorperazine
-
The enzymes in _______ come from pork.
pancrelipase
-
If a pt is allergic to or has religious restrictions on pork, the drug ______ is contraindicated.
pancrelipase
-
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?
- Salicylates
- 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.
Lubiprostone
-
What is the goal of therapy with Lubiprostone?
- to normalize peristalsis;
- NOT inhibit it
-
Typical therapeutic response to psyllium (time).
24-48 hrs
-
Saline laxatives usually produce the desired effect within __- ___ hrs.
6-12
-
A ________ laxative works in 1-6 hrs.
Saline cathartic
-
Which oral laxative works immediately?
none!
-
Sulfasalazine may color the urine what color?
orange-yellow
-
________ can cause crystalluria and one side effect is headache & should be discontinued if headache occurs.
Sulfasalazine
-
________ usually occurs with Sulfasalazine but does not require treatment.
Dizziness
-
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?
- BPH
- glaucoma
- Paralytic ileus
- MI
- (4D's)
-
What is pirenzepine (Gastrozepine)?
- anticholinergic
- 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.
Imodium
-
Antidote to Diphenoxylate with Atropine (Lomotil) OD?
naloxone (reverse respiratory depression)
-
Used to treat chronic diarrhea.
Loperamide
-
Used to treat acute, nonspecific diarrhea.
Immodium
-
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?
stimulant laxatives
-
Antiflatulant major drug currently used.
Simethicone
-
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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