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PharmCH 33-35
Nurse 123
| Question | Answer |
|---|---|
| What is Peptic Ulcer Disease (PUD)? | An ulcer is an erosion of the mucosal layer of the GI tract,Peptic ulcers are either in the stomach (gastric) or in the small intestine (duodenal) |
| What is the most common site for PUD? | Duodeneal is the most common siteThese are the result of an imbalance between the acidic stomach contents and the body’s normal defense barriers. |
| What are the risk factors of PUD? | Close family history of peptic ulcer disease,Blood type O,Smoking,Alcohol intake,Caffeine intake,Drugs including ASA, NSAIDs and steroids,Excessive stress,Infection with Helicobacter pylori (H. pylori). |
| What are the causes of PUD? | H. pylori is the main cause.NSAID use in non-infected pts. |
| What are H2-Receptor Blockers? | H2 is responsible for increasing acid secretion in the stomach,These meds are prescription or OTC,Also used to treat GERD and Zollinger-Ellison syndrome. |
| What are the characteristics of H2-Receptor Blockers? | H stands for histamine.These meds block histamine receptors which decreases the amount of HCl that is secreted in the stomach. This allows the pH of the stomach to rise. |
| What are the side effects of H2-receptors? | Dizziness headache, diarrhea, constipation. With high doses may cause confusion, restlessness and hallucinations. Should not be taken with antacids. |
| What are some H2- receptors medications? | Cimetidine (Tagamet),Famotidine (Pepcid),Ranitidine (Zantac). |
| What are CAKA substituted benzimidazoles? | Widely used for GERD and peptic ulcer disease,These drugs reduce acid secretion better and longer than H2-receptor blockers,May take several days for relief to begin- lasts several days after med is D/C |
| What are other chracteristics of PPI? | Block the enzyme responsible for secreting hydrochloric acid in the stomach- they inhibit the gastric acid pump- there are no anticholinergic or H2 receptor antagonists actions.Used for GERD, gastric and duodenal ulcers, hypersecretory disorders. |
| What are the side effects of PPI? | HA,Abdominal pain,Diarrhea,Nausea,Vomiting |
| What are the common PPI meds? | Esomeprazole (Nexium),Omeprazole (Prilosec),Pantoprazole (Protonix),Rabeprazole Sodium (AcipHex). |
| What are Antacids? | These buffer the hydrochloric acid to a lower hydrogen ion concentration- when the acidity is buffered the gastric juice loses its corrosive effect. |
| What are the characteristics of antacids? | Alkaline substances that are used to neutralize stomach acid.Inexpensive and OTC.Inorganic compounds of aluminum, magnesium or calcium.Not recommended as the only medication for peptic ulcer disease. |
| What are the common antacid medications? | Calcium carbonate (Tums).Calcium carbonate with magnesium hydroxide (Rolaids).Magnesium hydroxide (Milk of Mag, MOM).Sodium Bicarbonate (Alka-Seltzer). |
| What are the side effects of antacids? | Increased levels of calcium, sodium or magnesium.Magnesium compounds may cause diarrhea.Need to be careful with recommended doses. |
| What is simethecone? | An antiflatulent drug |
| What is Pepcid Complete made of? | calcium carbonate, magnesium hydroxide and famotidine |
| What does Mylanta contain? | simethicone, aluminum hydroxide and magnesium hydroxide |
| What are some types of antibiotics for Peptic ulcers? | Amoxicillin (Amoxil),Clarithromycin (Biaxin),Metronidazole (Flagyl),Tetracycline . |
| What are Coating agents? | Sucralfate (Carafate),It is a combo of sugar and aluminum hydroxide (antacid),Creates a thick gel-like substance to coat the ulcer to promote healing,Must be taken 4 times per day. |
| What are the side effects of coating agents? | Minimal side effects- constipation is the most common, dry mouth and dizziness - very little of the drug is absorbed from the GI tractUsed to treat duodenal ulcers- it adheres to the ulcer- it doesn’t decrease gastric secretions |
| What are Gastrointestinal prostaglandins? | Porstaglandins are normally present in the GI tract to inhibit gastric acid secretion. Side effects include diarrhea and abd cramps.Pregnancy category X is contraindicated in pregnancy- sometimes used to terminate a pregnancy |
| What are the characteristics of Gastrointestinal prostaglandins? | Misoprostol (Cytotec),Inhibits gastric acid secretion and increases mucous production,Used to prevent peptic ulcers in pts taking high doses of NSAIDs or glucocorticoids,Classified as a pregnancy category X. |
| What are Prokinetic agents? | Mechanism of action isn’t fully known- this med increases peristalsis which results in an increased rate of gastric emptying and intestinal transit. It is also an antiemetic that blocks dopamine in the chemoreceptor trigger zone |
| What are the characteristics of Prokinetic agents? | Gastric stimulant,Used to relieve symptoms of gastric reflux esophagitis and diabetic gastroparesis, to stimulate gastric emptying,Also used as an antiemetic with cancer chemotherapy. |
| What are the Prokinetic agents drugs? | Metoclopramide (Reglan) |
| What are the Prokinetic agents drugs side effects? | Side effects include drowsiness, fatigue, lethargy, dizziness and nausea |
| What are Antispasmodic agents? | There are lots of cholinergic fibers in the GI tract. They stimulate the GI tract causing secretion of saliva, HCl, bile and other fluids necessary for digestion, relaxation of sphincters and peristalsis |
| What are some contraindications of Antispasmodic agents? | There are cholinergic fibers throughout the entire body and the meds aren’t selective to the GI tract. May causes: reduced perspiration, oral and bronhcial secretions, blury vision, constipation, tachycardia, confusion delusions just to name a few |
| What are the characteristics of Antispasmodic agents? | These are cholinergics.Used to treat IBS, mild ulcerative colitis, pancreatitis and peptic ulcer disease- just to name a few. |
| What are some Antipasmodic Agent drugs? | Belladonna,Dicyclomine (Bentyl) |
| What are laxatives? | Meds that promote defecation.They are sub-classified by their mechanism of action.Generally safe meds with few side effects- can become dependent on them for BM. |
| What are Bulk forming laxatives? | Bulk-forming causes water to be absorbed which adds to the size of fecal mass- need to be taken with a full glass of water- can take 12-72 hours to work. It is the safest laxative- good for people who need a laxative on a regular basis. |
| What are the characteristics of Bulk forming laxative? | AKA- fiber!!!Often taken prophylatically to prevent constipation.Examples:Calcium polycarbophil (Fibercon).Methylcellulose (Citrucel).Psyllium muciloid (Metamucil). |
| What are Stimulant laxatives? | These work within 6-10 hours if given orally- if given rectally they work within 60-90 minutes. Should be used intermittently- chronic use may cause loss of normal bowel function and dependency on the agent |
| What are the characteristics of Stimulant laxatives? | Irritates the bowel to increase peristalsis.May cause cramping.Examples:Bisacodyl (Dulcolax),Phenolphthalein (Ex-Lax, Correctol). |
| What are Saline/osmotic laxatives? | These are hypertonic compounds that draw water into the intestine from surrounding tissues- these usually work within 1-3 hours. Continued use of these can alter electrolyte balance and may cause dehydration |
| What are the characteristics of Saline/osmotic laxatives? | Cause water to be retained in the fecal mass- causes watery stools.Examples:Magnesium Citrate,Magnesium Hydroxide (Milk of Magnesia, MOM),Sodium biphosphate (Fleet Phospho-Soda)- enema. |
| What are Stool Softeners/surfactant? | These don’t cause peristalsis and may take up to 72 hours to work. Action from these meds depends on the pts hydration too |
| What are the characteristics of stool softeners? | Causes more water and fat to be absorbed into the stools.May be prescribed postoperatively to relieve straining.Example:Docusate (Colace) |
| What are Lubricant laxatives? | Onset is often 6-8 hours but may be up to 48 hours- if used frequently they and inhibit the absorption of fat-soluable vitamins. These don’t produce significant bowel spasm |
| What are the characteristics of lubricant laxatives? | Lubricate the intestinal wall.Mineral oil (Haley’s M-O). |
| What are some treatments of diarrhea? | If the cause is an infection and ATB or anti-parasitic drug would be used.If the cause is inflammatory- we use anti-inflammatory drugs.If it is drug induced then the med is stopped and a new med is started. |
| What are Anti-diarrheals? | There are 2 broad categories- locally acting and systemic- locally acting absorb excess water to cause a formed stool and absorb irritants or bacteria.Systemic agents act through the autonomic NS to reduce peristalsis and motility of the GI tract |
| What are some characteristics of Anti-diarrheals? | Slower movement through the large intestine allows for better formed stools.Opioids are the most effective drug for controlling severe diarrhea. |
| What are Opioids for diarrhea? | At low doses opioids don’t produce dependence or serious side effects.Diphenoxylate (Lomitil)- RxLoperamide (Immodium)- OTC |
| What are Non-opioids for diarrhea? | Bismuth subsalicylate (Pepto Bismol).Acts by binding and absorbing toxins.Psyllium and pectin preparations slow diarrhea by absorbing large amounts of fluid to form bulkier stools. |
| What are some side effects for Non-opioids for diarrhea? | Side effects for all antidiarrheals can include abdominal distention, nausea and constipationNeed to monitor your pt for how long they have experienced diarrhea and monitor for dehydration |
| What is Dopamine antagonists? | Can cause extrapyramadal symptoms (parkinsonism, tardive dyskinesia)Frequently used for treatment of mild to moderate nausea and vomiting associated with anesthesia and surgery, radiation therapy and chemotherapy. |
| What are the characteristics of Dopamine antagonists? | Prochlorperazine (Compazine).Metoclopramide (Reglan). |
| What are Serotonin Antagoinists used for? | Used a lot with chemo, there aren’t as many side effects (EPS) with this class- most common are HA, diarrhea, constipation |
| What are some of the common Serotonin Antagoinists drugs? | Ondansetron (Zofran) |
| What are Anticholinergic drugs used for in relation to treating N/V? | Used a lot for motion sickness and antihistamines are used in nausea and vomiting associated with pregnancyMost common side effect is drowsiness- need to maintain adequate fluid intake |
| What are some Anticholinergic Agents drugs? | Diphenhydramine (Benadryl).Promethazine (Phenergan).Promethazine (Phenergan). |
| What is motion sickness | A disorder affecting the inner earResults in significant nausea |
| What are some common drugs used to treat motion sickness? | Most common drug used is:Scopolamine (Hyoscine) (Patch)Taken 20-60 minutes before traveling.Also used:Dimenhydrinate (Dramamine),Meclizine (Antivert |
| What are some Corticoidsteroids and their side effects? | Dexamethasone (Decadron),Methylprednisolone. Few side effects- used a lot for pts on chemo- also these meds will improve appetite |
| What are some common drugs for Benzodiazepines ? | Lorazepam (Ativan),Midazolam (Versed),Diazepam (Valium). |
| What are Benzodiazepines and what are they used for? | Uses: sedation, reduce anxiety, and amnesic effect- possible depression of the vomiting center- the amnesic effect can help with pts with chemo- ativan and versed have this effect more than valium |
| What are some Cannaboids drugs and their uses? | Dronabinol (THC)- MarinolSmoking marijuana reduces the frequency of nausea so THC and synthetic analogs are used to decrease nausea and vomiting- used for pts with chemo |
| What are the side effects of Cannaboids? | Side effects include depressed mood, hallucinations, dreaming or distortion of perception. |
| What are Neurokinin-1 Receptor antagonists? | |
| What are the side effects of PPI? | HA,Abdominal pain,Diarrhea,Nausea,Vomiting |
| What are the common PPI meds? | Esomeprazole (Nexium),Omeprazole (Prilosec),Pantoprazole (Protonix),Rabeprazole Sodium (AcipHex). |
| What are Antacids? | These buffer the hydrochloric acid to a lower hydrogen ion concentration- when the acidity is buffered the gastric juice loses its corrosive effect. |
| What are the characteristics of antacids? | Alkaline substances that are used to neutralize stomach acid.Inexpensive and OTC.Inorganic compounds of aluminum, magnesium or calcium.Not recommended as the only medication for peptic ulcer disease. |
| What are the common antacid medications? | Calcium carbonate (Tums).Calcium carbonate with magnesium hydroxide (Rolaids).Magnesium hydroxide (Milk of Mag, MOM).Sodium Bicarbonate (Alka-Seltzer). |
| What are the side effects of antacids? | Increased levels of calcium, sodium or magnesium.Magnesium compounds may cause diarrhea.Need to be careful with recommended doses. |
| What is simethecone? | An antiflatulent drug |
| What is Pepcid Complete made of? | calcium carbonate, magnesium hydroxide and famotidine |
| What does Mylanta contain? | simethicone, aluminum hydroxide and magnesium hydroxide |
| What are some types of antibiotics for Peptic ulcers? | Amoxicillin (Amoxil),Clarithromycin (Biaxin),Metronidazole (Flagyl),Tetracycline . |
| What are Coating agents? | Sucralfate (Carafate),It is a combo of sugar and aluminum hydroxide (antacid),Creates a thick gel-like substance to coat the ulcer to promote healing,Must be taken 4 times per day. |
| What are the side effects of coating agents? | Minimal side effects- constipation is the most common, dry mouth and dizziness - very little of the drug is absorbed from the GI tractUsed to treat duodenal ulcers- it adheres to the ulcer- it doesn’t decrease gastric secretions |
| What are Gastrointestinal prostaglandins? | Porstaglandins are normally present in the GI tract to inhibit gastric acid secretion. Side effects include diarrhea and abd cramps.Pregnancy category X is contraindicated in pregnancy- sometimes used to terminate a pregnancy |
| What are the characteristics of Gastrointestinal prostaglandins? | Misoprostol (Cytotec),Inhibits gastric acid secretion and increases mucous production,Used to prevent peptic ulcers in pts taking high doses of NSAIDs or glucocorticoids,Classified as a pregnancy category X. |
| What are Prokinetic agents? | Mechanism of action isn’t fully known- this med increases peristalsis which results in an increased rate of gastric emptying and intestinal transit. It is also an antiemetic that blocks dopamine in the chemoreceptor trigger zone |
| What are the characteristics of Prokinetic agents? | Gastric stimulant,Used to relieve symptoms of gastric reflux esophagitis and diabetic gastroparesis, to stimulate gastric emptying,Also used as an antiemetic with cancer chemotherapy. |
| What are the Prokinetic agents drugs? | Metoclopramide (Reglan) |
| What are the Prokinetic agents drugs side effects? | Side effects include drowsiness, fatigue, lethargy, dizziness and nausea |
| What are Antispasmodic agents? | There are lots of cholinergic fibers in the GI tract. They stimulate the GI tract causing secretion of saliva, HCl, bile and other fluids necessary for digestion, relaxation of sphincters and peristalsis |
| What are some contraindications of Antispasmodic agents? | There are cholinergic fibers throughout the entire body and the meds aren’t selective to the GI tract. May causes: reduced perspiration, oral and bronhcial secretions, blury vision, constipation, tachycardia, confusion delusions just to name a few |
| What are the characteristics of Antispasmodic agents? | These are cholinergics.Used to treat IBS, mild ulcerative colitis, pancreatitis and peptic ulcer disease- just to name a few. |
| What are some Antipasmodic Agent drugs? | Belladonna,Dicyclomine (Bentyl) |
| What are laxatives? | Meds that promote defecation.They are sub-classified by their mechanism of action.Generally safe meds with few side effects- can become dependent on them for BM. |
| What are Bulk forming laxatives? | Bulk-forming causes water to be absorbed which adds to the size of fecal mass- need to be taken with a full glass of water- can take 12-72 hours to work. It is the safest laxative- good for people who need a laxative on a regular basis. |
| What are the characteristics of Bulk forming laxative? | AKA- fiber!!!Often taken prophylatically to prevent constipation.Examples:Calcium polycarbophil (Fibercon).Methylcellulose (Citrucel).Psyllium muciloid (Metamucil). |
| What are Stimulant laxatives? | These work within 6-10 hours if given orally- if given rectally they work within 60-90 minutes. Should be used intermittently- chronic use may cause loss of normal bowel function and dependency on the agent |
| What are the characteristics of Stimulant laxatives? | Irritates the bowel to increase peristalsis.May cause cramping.Examples:Bisacodyl (Dulcolax),Phenolphthalein (Ex-Lax, Correctol). |
| What are Saline/osmotic laxatives? | These are hypertonic compounds that draw water into the intestine from surrounding tissues- these usually work within 1-3 hours. Continued use of these can alter electrolyte balance and may cause dehydration |
| What are the characteristics of Saline/osmotic laxatives? | Cause water to be retained in the fecal mass- causes watery stools.Examples:Magnesium Citrate,Magnesium Hydroxide (Milk of Magnesia, MOM),Sodium biphosphate (Fleet Phospho-Soda)- enema. |
| What are Stool Softeners/surfactant? | These don’t cause peristalsis and may take up to 72 hours to work. Action from these meds depends on the pts hydration too |
| What are the characteristics of stool softeners? | Causes more water and fat to be absorbed into the stools.May be prescribed postoperatively to relieve straining.Example:Docusate (Colace) |
| What are Lubricant laxatives? | Onset is often 6-8 hours but may be up to 48 hours- if used frequently they and inhibit the absorption of fat-soluable vitamins. These don’t produce significant bowel spasm |
| What are the characteristics of lubricant laxatives? | Lubricate the intestinal wall.Mineral oil (Haley’s M-O). |
| What are some treatments of diarrhea? | If the cause is an infection and ATB or anti-parasitic drug would be used.If the cause is inflammatory- we use anti-inflammatory drugs.If it is drug induced then the med is stopped and a new med is started. |
| What are Anti-diarrheals? | There are 2 broad categories- locally acting and systemic- locally acting absorb excess water to cause a formed stool and absorb irritants or bacteria.Systemic agents act through the autonomic NS to reduce peristalsis and motility of the GI tract |
| What are some characteristics of Anti-diarrheals? | Slower movement through the large intestine allows for better formed stools.Opioids are the most effective drug for controlling severe diarrhea. |
| What are Opioids for diarrhea? | At low doses opioids don’t produce dependence or serious side effects.Diphenoxylate (Lomitil)- RxLoperamide (Immodium)- OTC |
| What are Non-opioids for diarrhea? | Bismuth subsalicylate (Pepto Bismol).Acts by binding and absorbing toxins.Psyllium and pectin preparations slow diarrhea by absorbing large amounts of fluid to form bulkier stools. |
| What are some side effects for Non-opioids for diarrhea? | Side effects for all antidiarrheals can include abdominal distention, nausea and constipationNeed to monitor your pt for how long they have experienced diarrhea and monitor for dehydration |
| What is Dopamine antagonists? | Can cause extrapyramadal symptoms (parkinsonism, tardive dyskinesia)Frequently used for treatment of mild to moderate nausea and vomiting associated with anesthesia and surgery, radiation therapy and chemotherapy. |
| What are the characteristics of Dopamine antagonists? | Prochlorperazine (Compazine).Metoclopramide (Reglan). |
| What are Serotonin Antagoinists used for? | Used a lot with chemo, there aren’t as many side effects (EPS) with this class- most common are HA, diarrhea, constipation |
| What are some of the common Serotonin Antagoinists drugs? | Ondansetron (Zofran) |
| What are Anticholinergic drugs used for in relation to treating N/V? | Used a lot for motion sickness and antihistamines are used in nausea and vomiting associated with pregnancyMost common side effect is drowsiness- need to maintain adequate fluid intake |
| What are some Anticholinergic Agents drugs? | Diphenhydramine (Benadryl).Promethazine (Phenergan).Promethazine (Phenergan). |
| What is motion sickness | A disorder affecting the inner earResults in significant nausea |
| What are some common drugs used to treat motion sickness? | Most common drug used is:Scopolamine (Hyoscine) (Patch)Taken 20-60 minutes before traveling.Also used:Dimenhydrinate (Dramamine),Meclizine (Antivert |
| What are some Corticoidsteroids and their side effects? | Dexamethasone (Decadron),Methylprednisolone. Few side effects- used a lot for pts on chemo- also these meds will improve appetite |
| What are some common drugs for Benzodiazepines ? | Lorazepam (Ativan),Midazolam (Versed),Diazepam (Valium). |
| What are Benzodiazepines and what are they used for? | Uses: sedation, reduce anxiety, and amnesic effect- possible depression of the vomiting center- the amnesic effect can help with pts with chemo- ativan and versed have this effect more than valium |
| What are some Cannaboids drugs and their uses? | Dronabinol (THC)- MarinolSmoking marijuana reduces the frequency of nausea so THC and synthetic analogs are used to decrease nausea and vomiting- used for pts with chemo |
| What are the side effects of Cannaboids? | Side effects include depressed mood, hallucinations, dreaming or distortion of perception. |
| What are Neurokinin-1 Receptor antagonists? | Blocks the effect of substance P in the CNS This is the first oral NK1 receptor antagonist available in the US- used to prevent acute and delayed chemo induced nausea and vomiting |
| What are some common Neurokinin-1 Receptor antagonists drugs? | Aprepitant (Emend) |
| What are some Neurokinin-1 Receptor antagonists side effects? | Most common side effects are nausea, constipation, HA, diarrhea |
| What are some characteristics of emetics? | Used to stimulate vomiting.Ipecac syrup is given orally.Apomorphine is given SQ. Works in about 15 minutes. Needs to be given under MD supervision. |
| What are emetics used for? | Used for poisoning and overdoses- |
| What are some weight loss medications? | Sibutramine (Meridia).Orlistat (Xenical)- Rx or Alli- OTC.Meridia suppresses appetite.Orlistat blocks the absorption of fat in the GI tract. |
| What is a common characteristic of orlistat? | Orlistat can also block the absorption of fat-soluble minerals and coumadin |
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