2/2 Ch. 45-46

Question 1

What is the goal of drug therapy for PUD?

Answer 1

• Alleviate symptoms
• Heal
• Prevent complication
• Prevent reoccurence

Question 2

What are the five classes of drugs used for ulcers?

Answer 2

• Antibiotics
• Antisecretory
• Mucosal protectant
• Antacids
• Antisecretory agents that enhance mucus secretion

Question 3

What non-pharmacological therapies can be implemented for ulcer treatment?

Answer 3

• Eating smaller meals rather than 3 large meals a day may decrease acid production
• Smoking should be avoided
• ASA and NSAIDs should be avoided (SUB for acetaminophen)

Question 4

Why should NSAIDs be avoided?

Answer 4

NSAIDs prevent the synthesis of prostaglandins therefore it increases the risk for PUD.

Question 5

What causes NSAID ulcers?

Answer 5

Prolonged high dose NSAID therapy

Question 6

Which drug is ONLY approved for prevention of gastric ulcers CAUSED by NSAIDs?

Answer 6

Misoprostol

Question 7

What do NSAIDs inhibit?

Answer 7

Prostaglandins

Question 8

What do misoprostol drugs do?

Answer 8

Serve as a replacement for prostaglandin

Question 9

What are the contraindications for misoprostol?

Answer 9

Contraindicated during pregnancy
- Category X

Question 10

What adverse effect is associated with misoprostol and pregnancy?

Answer 10

• Uterine contractions causing abortion

Question 11

What side effects are associated with misoprostol?

Answer 11

• Diarrhea
• Bleeding

Question 12

What should the nurse monitor in a patient taking misoprostol?

Answer 12

Pain relief and examin the ulcer site

Question 13

What do antacids do?

Answer 13

• Neutralize stomach acid
• Reacts with gastric acid to form neutral salts

Question 14

What side effects are associated with alumnin-based antacids?

Answer 14

Constipation

Question 15

What side effects are associated with magnesium-based antacids?

Answer 15

Diarrhea

Question 16

What side effects are associated with sodium-based antacids?

Answer 16

Fluid retention

Question 17

What side effects are associated with calcium-based antacids?

Answer 17

Hypercalcemia

Question 18

When should antacids be taken in regard to medications?

Answer 18

At least two hours before or after medications
- Change pH of stomach and may complicate absorption of other medications

Question 19

When is the best time to take antacids in relation to meals?

Answer 19

Within an hour after eating
- Don’t take with food

Question 20

Which antacid is the 1st choice of ulcer treatment?

Answer 20

H2 receptor anatagonists

Question 21

What is the mechanism of action of H2 receptor antagonists

Answer 21

Heal by suppressing secretion of acid
- Decrease gastric acidity

Question 22

Why should people with respiratory disease use caution when taking H2 receptor antagonists?

Answer 22

promotes bacteria in the respiratory and GI tracts

Question 23

When is the best time to take an H2 receptor antagonist?

Answer 23

30 minutes to 1 hour prior to eating

Question 24

Why isn’t cimetidine prescribed often?

Answer 24

Adverse reactions in men
- Decreases libido
- Gynecomastia
- Impotence
- CNS changes, especially in elderly (confusion)

Question 25

What drug interactions are associated with cimetidine? (H2 receptor antagonist)

Answer 25

Smoking – decreases effectiveness Warfarin – increases absorption of warfarin

Question 26

What are the 3 H2 receptor antagonists mentioned in class?

Answer 26

Zantac Tagamet Pepcid

Question 27

What is the mechanism of action for proton pump inhibitors?

Answer 27

Blocks acid production by inhibiting the enzyme that produces acid

Question 28

How is esomeprazole given?

Answer 28

PO

Question 29

How is Pantoprazole given?

Answer 29

IV

Question 30

Complications associated with proton pump inhibitors?

Answer 30

Long term – hepatotoxic Pneumonia Osteoporosis (decreases acid = decreased calcium reabsorption)

Question 31

Can the nurse crush or break SR capsules?

Answer 31

No, don't open

Question 32

When is the best time to take prazole?

Answer 32

30 mins - 1 hour pior to eating

Question 33

What type of medication is sucralfate?

Answer 33

Mucosal protectant

Question 34

How does sucralfate work?

Answer 34

Creates protective barrier against acid and pepsin

Question 35

What doesn't sucralfate do?

Answer 35

Do not neutralize acid and does not decrease acid secretion

Question 36

What does sucralfate do once it is ingested?

Answer 36

Turns into gels that sticks to ulcer creating a barrier that can last up to 6 hours

Question 37

When is the best time to take sucralfate?

Answer 37

1 hour before meals and qhs

Question 38

What are the systemic effects of sucralfate?

Answer 38

No systemic effects because it is not absorbed