1
Q
What are the defense mechanisms of PUD?
A
-mucus
-bicarbonate
-blood flow
-prostaglandins
goal: to protect epithelial lining
2
Q
What are the goals of drug therapy for PUD?
A
-alleviate symptoms
-promote healing of epithelial layer
-prevent complications
-prevent reoccurrence
3
Q
What are nonpharmacologic interventions of PUD?
A
-diet/ETOH/stress
-eating pattern
-smoking cessation
-NSAIDs alteration
all help BUT need drugs to completely eradicate
4
Q
What are pharmacologic agents for PUD?
A
-antibiotics (against H. pylori)
-anti-secretory agents
-mucosal protectants
-antacids
5
Q
Therapy for H. pylori
A
triple therapy:
-clarithromycin
-amoxicillin or metronidazole
-PPI
quadruple therapy:
-bismuth
-tetracycline
-PPI
6
Q
bismuth subsalicylate type
A
pepto bismol!
antacid, anti-diarrheal, anti-inflammatory, anti-secretory, mucosal protectant
7
Q
bismuth subsalicylate use
A
reduces diarrhea, PUD, GERD, H. pylori infection
8
Q
bismuth subsalicylate pharm action
A
-disrupts cell wall of H. pylori and adherence (antimicrobial agent)
-forms protective coating over stomach lining and ulcer
-stims produciton of mucus and bicarbonate (to neutralize stomach acid)
9
Q
bismuth subsalicylate complications
A
-constipation
-tongue and stool turn black
-tinnitus/ototoxic
10
Q
bismuth subsalicylate admin
A
PO
11
Q
bismuth subsalicylate contraindications
A
-allergy to salicylates
-suspected infectious diarrhea (C. diff)
-children recovering from recent viral illnesses
caution: patients on aspirin
12
Q
bismuth subsalicylate interactions
A
other salicylates (aspirin)
13
Q
bismuth subsalicylate interventions
A
-monitor for constipation
-monitor BMs
-abdominal assessment before and after admin
14
Q
bismuth subsalicylate client education
A
-report worsening of abdominal pain
-report GI bleed symptoms
-know it can cause constipation
-harmless discoloration of tongue and stool
15
Q
cimetidine type
A
anti-secretory, histamine H2 receptor blocker, antihistamine
16
Q
cimetidine use
A
-gastric ulcers
-duodenal ulcers
-GERD
-allergic reactions
-H. pylori infection
17
Q
cimetidine pharm action
A
-blocks histamine H2 receptors on parietal cells -> reduces secretions of HCl acid
17
Q
cimetidine admin
A
PO
17
Q
cimetidine complications
A
-anti-androgenic effects: impotence, reduced libido
-pneumonia
-confusion
-suppression of leukocytes and T cells
-aplastic anemia, agranulocytosis
-gynecomastia
-CNS depression (rare)
-chronic use: risk for vitamin B12 malabsorption and deficiency
18
Q
cimetidine contraindications
A
-previous reaction
caution: anemia, sensitivities
19
Q
cimetidine interactions
A
many: warfarin, beta-blockers, don’t give within 1 hour of antacids
20
Q
cimetidine interventions
A
abdominal assessment
21
Q
cimetidine client education
A
-avoid alcohol, smoking, aspirin, or NSAIDs
-report GI bleed
22
Q
omeprazole type
A
anti-secretory, PPI
23
omeprazole therapeutic use
-gastric ulcers
-duodenal ulcers
-erosive esophagitis
-GERD
-stress ulcer prophylaxis
24
omeprazole pharm action
target parietal cells, inhibiting hydrogen/potassium ATPase to decrease basal & gastric acid secretion
25
omeprazole admin
PO/IV in morning at 30-60 mins before food
do not crush
26
omeprazole complications
-headaches, abdominal pain, nausea, vomiting, diarrhea
-↑risk of osteoporosis, cancer, maybe dementia
-chronic use: risk for ↓ absorption of iron, calcium, magnesium, and vitamin B12 - parietal cells also produce intrinsic factor for B12 absorption
-rebound GERD
-bacterial overgrowth and C. diff infection, aspiration PNA (from altered pH of stomach)
-hypomagnesemia for pt taking med > 3 months
27
omeprazole contraindications
previous reaction
caution: pregnancy and lactation, liver or renal impairment
28
omeprazole interactions
-food ↓ absorption
-warfarin (may increase anticoagulant effect and risk of bleeding), St. John's Wort
29
omeprazole interventions
-lowest dose for shortest duration
-monitor for osteoporosis (especially low estrogen states)
-monitor magnesium level
30
omeprazole client education
-promote weight bearing exercises
-adequate vitamin D and calcium intake
-report severe vomiting or diarrhea and drink clear fluids
-monitor magnesium
31
sucralfate type
mucosal protectant
32
sucralfate therapeutic use
gastric and duodenal ulcers
33
sucralfate pharm action
-chemical rxn causing gel-like substance for barrier/protective covering over ulcer
-enhances healing of ulcers and repair of injured tissue
-stimulates prostaglandin production and traps bicarbonate to alkalize acids
34
sucralfate complications
-constipation
-GI obstruction
-may lead to hyperglycemia in patients w DM bc of drug formulation w sucrose
35
sucralfate admin
PO on empty stomach
QID (4x daily)
36
sucralfate contraindications
-current bowel obstruction
-previous allergic rxn to med
caution: dysphagia, renal or hepatic impairment
37
sucralfate interactions
don't take within 2 hours of antacids, warfarin, or fluroquinolones
38
sucralfate interventions
-monitor BMs
-abdominal assessment
-stool softeners for constipation
39
sucralfate client education
-increase fiber and fluids to prevent constipation
-report obstruction symptoms
40
aluminum hydroxide type
antacid (Tums)
41
aluminum hydroxide therapeutic use
-GERD
-PUD
-prevention of aspiration pneumonitis
42
aluminum hydroxide pharm action
-neutralizes gastric acid
-inactivates pepsin: activated in highly acidic environments
43
aluminum hydroxide admin
PO (max QID)
44
aluminum hydroxide complications
-constipation or diarrhea
-hypophosphatemia
-aluminum toxicity
45
aluminum hydroxide contraindications
-existing low phosphate or high aluminum levels
-CHF or renal failure (electrolyte abnormalities)
-severe abdominal pain w unknown origin (potential obstruction)
caution: many drug-drug interactions
46
aluminum hydroxide interactions
many, try to separate med admin 1 hr from taking antacid to decrease alterations in absorption
47
aluminum hydroxide interventions
-monitor BMs
-serum magnesium and phosphate levels
-consider how patients on antacids will absorb other meds w altered gastric pH (elevate HOB w eating & tube feeds)
48
aluminum hydroxide client education
-↑ fiber and fluids to prevent constipation
-report severe or worsening abdominal pain
49
What are the medications for constipation?
"Poop like a BOSS"
Bulk-forming laxatives
Osmotic laxatives
Surfactant laxatives/stool softeners
Stimulant laxatives
50
What affect does transit time in GI tract have on absorption?
-increased transit time in gut INCREASES absorption
-decreased transit time in gut DECREASES absorption
move too quickly = not enough time for absorption
51
Psyllium type
bulk-forming laxative
52
psyllium therapeutic use
-constipation
-diverticulosis
-IBS
-diarrhea
53
psyllium pharm action
nondigestible fiber that draws water into the intestine, making stool easier to pass and enlarging fecal volume (stretch) to stimulate peristalsis
54
psyllium admin
PO w full glass of water; works within 1-3 days of use
55
psyllium complications
-GI obstruction
-non-absorbable
56
psyllium contraindications
-bowel or esophageal obstruction (Hx or current)
cautions: none
57
psyllium interactions
check drug-drug when used w other meds
58
psyllium interventions
-monitor BMs and symptoms of obstruction
-retrosternal pain for esophageal obstruction
59
psyllium client education
-↑fluids, fiber, activity to prevent worsening or developing constipation
-report s/s obstruction
60
polyethylene glycol type
osmotic laxative (MiraLAX)
61
polyethylene glycol therapeutic use
constipation, bowel evacuation, prep for GI procedure
62
polyethylene glycol pharm action
has high conc. of salts or indigestible sugars/sugar alcohols (not well absorbed) to pull water into intestinal lumen -> stool is easier to pass and increases peristalsis
63
polyethylene glycol admin
PO (powder to mix) w full glass of water
not w milk
works in 2-12 hours
64
polyethylene glycol complications
-dehydration, diarrhea, electrolyte imbalances (hypermagnesemia, hyperphosphatemia, hypokalemia, hyponatremia)
-cardiac arrhythmias
65
polyethylene glycol contraindications
-GI obstruction or perforation
caution: CHF, renal failure
66
polyethylene glycol interactions
-antacids and milk (won't dissolve)
-diuretics: electrolyte imbalances
67
polyethylene glycol interventions
monitor BMs, monitor serum electrolytes
68
polyethylene glycol client education
-↑ fluids and activity
-monitor electrolytes
-have toilet near
69
docusate sodium type
surfactant laxative, stool softener
"SURF off the DOC"
70
docusate sodium therapeutic use
costipation, easing BMs past hemorrhoids, softens stool to prevent syncope
71
docusate sodium pharm action
-coats intestinal walls to make stool slip out easier
-↓surface tension of stool
-↑absorption of water in stool
-↑secretions of water and electrolytes in intestines
72
docusate sodium admin
PO w full glass of water
73
docusate sodium complications
-diarrhea, abdominal cramping, dependency
74
docusate sodium contraindications
-GI obstruction or perforation, fecal impactions
caution: can lead to physical dependency
75
docusate sodium interactions
other laxatives
76
docusate sodium interventions
monitor BMs, abdominal assessment
77
docusate sodium client education
↑fluids & activity
report severe diarrhea
78
bisacodyl type
stimulant laxative, irritant laxative
79
bisacodyl use
constipation (especially opioid-induced constipation or bc slowed intestinal transit)
80
bisacodyl pharm action
irritates nerve fibers in large intestine walls, stimulates smooth muscle contractions & ↑ peristalsis
81
bisacodyl complications
-N/V/D
-abdominal cramping
-proctitis w chronic use (irritation of butthole)
-dependency
82
bisacodyl contraindication
GI obstruction, perforation, impaction, anal fissures
caution: abuse with older adults and eating disorders
83
bisacodyl interactions
antacids, milk
84
bisacodyl interventions
monitor BMs
85
bisacodyl client education
do not take every day, not for long term use, ↑fluids
-most misused laxative
86
diphenoxylate w atropine type
anti-diarrheal
87
diphenoxylate w atropine use
diarrhea associate w IBD, nonspecific and noninfectious diarrhea
88
diphenoxylate w atropine pharm action
-opioid agonist (diphenoxylate) + anticholinergic (atropine)
-stims. opioid receptors in circular and longitudinal intestinal muscles -> inhibits peristalsis & prolongs transit time
89
diphenoxylate w atropine admin
PO
90
diphenoxylate w atropine complications
-drowsiness
-constipation
-abdominal cramps
-anticholinergic effects (can't see, can't spit, can't pee, can't shit)
91
diphenoxylate w atropine contraindications
glaucoma, GI bleed, suspected infectious diarrhea (C. diff)
caution: renal or liver impairment
92
diphenoxylate w atropine interactions
other CNS depressants (ETOH, opioids), other anticholinergic agents
93
diphenoxylate w atropine interventions
-give at lowest dose for shortest time
-monitor for anticholinergic SE
-naloxone for overdose
94
diphenoxylate w atropine client education
↑fluids, monitor for infectious diarrhea
anticholinergic SE
95
Why do we add atropine to diphenoxylate?
diphenoxylate alone is a scheduled class II drug, adding atropine makes it class IV drug (decreases risk for addiction) and reduces abdominal cramping and discomfort
96
ondansetron type
antiemetic, serotinin 5-HT3 antagonist, zofran
97
ondansetron use
nausea and vomiting relaed to chemotherapy, radiation, and post-op
98
ondansetron pharm action
blocks 5HT3 serotonin receptors peripherally (on vagus nerve terminal in gut) & centrally in chemoreceptor trigger zone to block transmission to vomiting center (blocks vomiting reflex)
99
ondansetron complications
-headache, dizziness
-QT prolongation, cardiac arrythmias (palpitations)
-constipation
-risk for C. diff
100
ondansetron admin
PO, IV, IM, SL
101
ondansetron contraindications
pt < 3 yo
caution: CHF, liver disease
102
ondansetron interactions
antidepressants (serotonin receptors)
103
ondansetron interventions
give emesis bag, monitor BMs, monitor EKG
104
ondansetron client education
promote fluids, report
105
metoclopramide type
antiemetic, prokinetic agent, dopamine antagonist
106
metoclopramide use
nausea, vomiting, GERD, DM gastroparesis (gastric motility slowed)
107
metoclopramide pharm action
antiemetic: dopamine receptor blocker (in chemoreceptor trigger zone of vomiting center to block reflex)
prokinetic: ach stims gastric emptying and peristalsis (↑motility, ↑tone of lower esophageal sphincter)
108
metoclopramide admin
PO, IV, IM
109
metoclopramide complications
sedation (CNS depression)
hypotension
anticholinergic effects
diarrhea
110
metoclopramide contraindications
GI obstruction, perforation, hemorrhage
caution: parkinson's
111
metoclopramide interactions
other CNS depressants
112
metoclopramide interventions
monitor BMs, monitor mental status, fall risk
113
metoclopramide client education
↑fluids
avoid driving
ETOH
Pharm
flashcards
Decks in class (14)
# Cards
-
Cholinergic & Adrenergic Meds40
-
Pharmacodynamics/kinetics36
-
Drug Interactions13
-
GI Meds115
-
Opioids48
-
Blood & Blood Products13
-
Anticoagulant Drugs75
-
Antihypertensive Cardiac Meds66
-
Antidysrhythmic Meds40
-
Antihyperlipidemic Drugs18
-
Endocrine DM Meds58
-
Antibiotics104
-
Diuretics39
-
PHARM BANK1
