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Pharm Exam 2 > GI and Hormones > Flashcards

GI and Hormones Flashcards

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1
Q

Antiulcer antibiotics Drugs

A 
Amoxicillin
Bismuth 
Clarithromycin 
Metronidazole 
Tetracycline 
Tinidazole
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2
Q

Antiulcer Antibiotics MOA

A

Eradicate H. pylori

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3
Q

Antiulcer-secretory agents

A

H2 receptor antagonists

PPI

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4
Q

Antiulcer Mucosal protectant Drugs

A

Sucralfate

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5
Q

Antiulcer Antisecretory agent that enhances mucosal defenses

A

Misoprostol

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6
Q

Antiulcer Antacids

A

Aluminum hydroxide/ Calcium Carbonate/ Magnesium hydroxide

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7
Q

H2 receptor antagonist Drug

A

Cimetidine*
Ranitidine
Famotidine
Nizatidine

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8
Q

Cimetidine MOA

A

Blocks H2 receptors, reducing both volume of gastric juice and its hydrogen ion concentration
Suppresses basal acid secretion

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9
Q

Cimetidine Use

A 
Gastric, Duodenal ulcers from H. pylori
GERD
Zollinger-Ellison syndrome
Heartburn
Acid indigestion 
Sour stomach
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10
Q

Cimetidine A/E

A 
Rare: (most likely to occur in elderly or renal/ hepatic impairment)
-confusion
-hallucinations
-CNS depression and excitation 
Pneumonia
Imbalance of microbiome 
Gynecomastia
Impotence 
Hematological effects
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11
Q

Cimetidine A/E IV bolus

A

Hypotension

Dysrhythmias

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12
Q

Cimetidine Therapy duration

A

normally 8-12 wk for PUD, can be longer

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13
Q

Cimetidine Reduced dosing

A

Renal impairment– reduce by 50%

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14
Q

Cimetidine Drug interactions

A 
Increase levels of: 
-Warfarin
-Theophylline
-Phenytoin
-Lidocaine 
Antacids decrease level of Cimetidine
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15
Q

Cimetidine Food interactions

A

Food may extend the effects of the drug

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16
Q

Proton Pump Inhibitor Drugs

A

Omeprazole

Pantoprazole

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17
Q

Omeprazole MOA

A

More efficiently and longer than H2 receptor antagonists

Blocks gastric acid production by irreversibly inhibiting H, K, ATPase (enzyme that generates gastric acid)

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18
Q

Omeprazole Use

A 
Gastric, Duodenal ulcers from H. pylori 
Esophagitis
GERD
Hypersecretion conditions
Stress ulcers
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19
Q

Omeprazole A/E

A

Rare:

  • HA
  • N/V/D
  • Pneumonia
  • FRACTURES – from decreased Ca reserves
  • Rebound acid hypersecretion– taper off
  • HYPOMAGNESEMIA
  • B12 deficiency ( Cobalamin)

C. dif– report diarrhea immediately

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20
Q

Omeprazole Drug interactions

A

reduce effects of some HIV drugs
reduce absorption for some antifungals
↓ effects of Clopidogrel
CYP3A4

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21
Q

Omeprazole Patient educations

A

increased diet in Ca, Mag, B12

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22
Q

Omeprazole Nursing thoughts

A

should not be used longer than absolutely necessary → 6-12 wk
some patients may need longer (hiatal hernia)

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23
Q

Pantoprazole Use

A

IV for stress ulcers in the ICU

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24
Q

Pantoprazole Dosing

A

IV → 40mg vial to be reconstituted for IV use

Convert to PO ASPA

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25
Pantoprazole A/E
``` Diarrhea❊ Dyspepsia ❊ Hypomagnesemia❊ Osteoporosis/fractures❊ Nausea Dizziness Thrombophlebitis ```
26
Sucralfate MOA
Undergoes polymerization and cross-linking reactions - creates a barrier over the ulcer - last >6 hours
27
Sucralfate Use
Promote healing of ulcer duodenal ulcers -NOT CURATIVE (only promotes healing)
28
Sucralfate A/E
Constipation → increase fluid intake
29
Sucralfate Drug interactions
``` DO NOT give oral meds within 30 minutes of this drug → impedes absorption ↳Phenytoin ↳Theophylline ↳Warfarin ↳Fluoroquinolones ABX (give 2 hr apart) Antacids with Al ```
30
Sucralfate Nursing considerations
can be crush, dissolved in water, or given as a suspension
31
Sucralfate Dose
QID
32
Misoprostol MOA
Prostaglandin E1 analog Suppresses secretion of gastric acid, promotes secretion of bicarbonate and cytoprotective mucous -Protective mucous that protects the lining of the GI tract ( makes the lining of the intestine healthier)
33
Misoprostol Use
Prevents gastric ulcers caused by long term used of NSAIDs
34
Misoprostol A/E
Diarrhea Abdominal pain Women may have spotting and dysmenorrhea
35
Misoprostol Contraindications
Pregnancy | ↳must have negative pregnancy test
36
Antacids drugs
Magnesium hydroxide Aluminum hydroxide Calcium carbonate Sodium bicarbonate
37
Antacid MOA
Neutralize stomach acid decreasing destruction of the stomach wall Can reduce pepsin activity Stimulate prostaglandin to improve mucosal protection
38
Antacid Use
PUD GERD Ulcers: need to be taken on a regular schedule
39
Antacids A/E
``` Can be unpleasant to take Constipation: Al Diarrhea: Mg Sodium loading (HTN, HF): Na Flatulence: Ca, Na ```
40
Antacids Drug interactions
interferes with dissolution and absorption of many drugs (Cimetidine) -give 30 min -1 hr apart
41
Antacids Caution
renal impairment
42
Laxatives Types
Bulk forming Surfactant Osmotic Stimulant
43
Bulk forming drugs
Methylcellulose Psyllium Polycarbophil
44
Surfactant Drugs
Docusate sodium | Docusate Calcium
45
Osmotic Drug
Lactulose
46
Stimulant Drug
Bisacodyl
47
Bulk forming MOA
Same as fiber
48
Docusate Na, Ca MOA
lower the surface tension, inhibit fluid absorption and stimulate secretion of water and electrolytes into the intestinal lumen
49
Bisacodyl MOA
Stimulate intestinal motility | Increase the amount of water and electrolytes within the intestines
50
Lactulose MOA
Osmotic action draws water into the intestine, causing feces to soften, swell, thereby stretching the intestines and stimulate peristalsis
51
Laxative Use
``` Stool Softener Adjunct to antihelminthic treatment Surgical/Dx prep Modifying effluent from ileostomy/colostomy Prevent fecal impaction Removal of ingested poisons Correcting constipation ```
52
Lactulose Uses
High dose: bowel prep for Dx procedures | intestinal excretion of ammonia
53
Bulk forming DOC
constipation
54
Bulk forming Other uses
Diverticulosis | IBS
55
Docusate Use
Stool softener
56
Bisacodyl Use
Opioid induced constipation | Constipation from slow intestinal transit
57
Bisacodyl Drug interactions
Milk increases the speed of dissolution, should be avoided
58
Bisacodyl A/E
burning | proctitis
59
Lactulose A/E
Dehydration | Hypermagnesemia
60
Docusate Sodium A/E
Fluid retention HF exacerbation HTN Edema
61
Laxative Contraindications
``` Abdominal pain Nausea Cramps Acute abdomen Fecal impactions Bowel obstruction ```
62
Laxative Cautions
pregnancy and lactating
63
Lactulose Cautions
renal impairment | ↳can cause hypermagnesemia
64
Bulk forming/Surfactants Nursing considerations
take with lost of fluids
65
Bisacodyl Nursing considerations
Can be abused
66
Lactulose Nursing considerations
Fluid loss | Good for those with hepatic encephalopathy, chronic liver diseases
67
Laxative Nursing considerations
Hypermagnesemia w/Mg salts | Fluid retention w/Na salts
68
Serotonin antagonist Antiemetic
Ondansetron
69
Ondansetron MOA
Blocks type 3 serotonin receptors (5-HT)
70
Ondansetron Use
Relief and prevention of nausea and vomiting related to chemo, cancer, anesthesia, viral gastritis, pregnancy
71
Ondansetron A/E
``` HA Dizziness Diarrhea ❊Prolonged QT interval ↳increases risk for torsades de pointe Exacerbate fluid/electrolyte imbalance ```
72
Ondansetron Combo
sometimes combined with Dexamethasone to increase effects
73
Benzo Antiemetic Drug
Lorazepam
74
Lorazepam MOA
Sedation, suppression of anticipatory emesis, anteretrograde amnesia
75
Lorazepam Use
Combo with other drugs to reduce CINV | May help control EPS
76
Dopamine Antagonist Antiemetic Drugs
Phenothiazine | Metoclopramide
77
Phenothiazine MOA
Suppresses emesis by blocking dopamine 2 receptors in the chemoreceptor trigger zone
78
Phenothiazine Use
reduce emesis associated with surgery, cancer, chemo, other toxins
79
Phenothiazine A/E
Extrapyramidal reactions Anticholinergic effects Hypotension Sedation
80
Promethazine A/E
respiratory depression and local tissue injury are serious concerns
81
Motion sickness drug
Scopolamine
82
Scopolamine MOA
``` Muscarinic antagonist (anticholinergic) Suppresses the nerve traffic in the neuronal pathway that connects vestibular apparatus of inner ear to the vomiting center ```
83
Scopolamine Route
Transdermal behind the ear
84
Scopolamine A/E
``` Dry mouth Blurred vision Drowsiness Less common: -Urinary retention -Constipation -Disorientation ```
85
Antidiarrheal Opioids Drug
Loperamide (Imodium) | Diphenoxylate
86
Loperamide MOA
Structural analog of meperidine Low potential for abuse Does not cross the BBB
87
Diphenoxylate MOA
Activate opioid receptors in the GI tract, decreasing intestinal motility and slowing intestinal transit time Allows more time for absorption of fluid and electrolytes Fluid, volume, and frequency of defecation is reduced
88
Diphenoxylate A/E
High dose: morphine like effects | Those with IBD may develop toxic megacolon
89
Diphenoxylate Drug interactions
Add Atropine to prevent abuse
90
Diphenoxylate Antidote
Naloxone
91
Prokinetic Agent Drug
Metoclopramide
92
Metoclopramide Use
Suppress emesis Increase upper GI motility N/V in pregnancy
93
Metoclopramide Oral Use
GERD | Diabetic gastroparesis
94
Metoclopramide IV Use
Post op N/V, chemo, facilitation of small bowel intubation/ GI tract
95
Metoclopramide A/E
High doses: -Sedation -Diarrhea Tardive dyskinesia: elderly
96
Metoclopramide Contraindications
Hemorrhage Perforation Obstruction
97
Metoclopramide Nursing considerations
give 30 min before a meal or before chemo | give smallest amount for shortest time
98
IBS-D Drug
Alosetron
99
Alosetron MOA
Blocks 5HT3 receptors in the viscera, causing an increase in colonic transit time, reduced intestinal secretions, more normal bowel pattern with less pain
100
Alosetron Use
Women with IBS-D for more than 6 mo
101
Alosetron A/E
``` CONSTIPATION ❊ impaction bowel obstruction perforation fatal GI toxicity Ischemic Colitis ```
102
Alosetron Drug interactions
``` CYP3A4 Carbamazepine Phenobarbital Cimetidine Quinolone Ketoconazole ```
103
Alosetron Contraindications
History of other bowel problems
104
Alosetron Nursing considerations
Very dangerous | Must have a patient/physician agreement signed
105
IBS-C Drugs
Lubiprostone | Linaclotide
106
Sulfasalazine MOA
Metabolized in the gut to form 5-ASA and sulfapyridine | 5-ASA reduces inflammation in the gut
107
Sulfasalazine Use
``` Acute, mild-moderate ulcerative colitis Crohn's disease RA Pregnancy Inflammatory bowel disease ```
108
Sulfasalazine A/E
``` Nausea Fever Rash Arthralgias Hematologic disorders (anemias) Increased risk for infection ```
109
Sulfasalazine Monitoring
CBC regularly
110
Immunomodulator for IBD
Infliximab
111
Infliximab MOA
Monoclonal antibody products which modulate immune responses Tumor necrosis factor alpha-inhibitor
112
Infliximab Use
May be 1st line for inducing remission for IBD 1st line for severe disease or perianal Crohn's disease RA
113
Infliximab dosing
0,2,6 wk, followed by infusions every 8 wk
114
Infliximab A/E
``` Infusion reaction Fever Chills Pruritus Cardiopulmonary complications ↑R/f lymphoma Immunosuppressant: ↑r/f -bacterial sepsis -TB -HIV -invasive fungal infection ```
115
Palifermin MOA
Synthetic form of human keratinocyte growth factor (KGF), a naturally occurring compound but produced by recombinant DNA technology Increases epithelium cell level
116
Palifermin Use
1st drug for Mucositis | ✔︎ pt with hematological malignancies (but only in those receiving high dose chemo and whole body irradiation
117
Palifermin A/E
Rash, Erythema (most common, skin and mouth) ↑Amylase/ lipase Distorted taste Thickening and or discolored tongue Oral/periodontal diseases Growth in lens of eye can cause vision problems
118
Palifermin Drug interaction
Binds with Heparin | Give 2hr before or after chemo since it can make mucositis worse
119
Estrogen
Premarin, Estradiol
120
Estrogen produced
Produced by the follicular cells for the 1st 14 days
121
Premarin, Estradiol Use
``` Menopausal hormone therapy Female hypogonadism Acne Cancer palliative care Transgender transition ```
122
Premarin, Estradiol A/E
``` W/O progestin: endometrial hyperplasia*, cancer* Breast cancer Thromboembolic event (MI over 60) Gallbladder disease Accentuate preexisting liver disease HA Nausea Fluid retention Breast tenderness ```
123
Premarin, Estradiol Route
Any | Transdermal and intravaginal decrease risk for liver injury and 1st pass effect
124
Premarin, Estradiol Drug interactions
P450 Drugs Antidiabetic thyroid Anticoagulants
125
Premarin, Estradiol Absolute Contraindications
History of DVT, PE, MI, liver disease, estrogen dependent tumor, breast cancer Pregnancy Undiagnosed vaginal bleeding: can be vaginal hyperplasia= cancer
126
Premarin, Estradiol Nursing considerations
Screening is most important | Use smallest dose for the shortest time possible
127
Nursing considerations for Estrogen and Progestin
``` Educate regarding personal risk profile Non-pharm strategies for symptom relief With uterus need estrogen and progestin Without uterus only estrogen Combo given PO continuously Some combos can be given cyclically Educate on taking correctly D/C estrogen then progestin ```
128
Transdermal Application
Daily or twice weekly
129
Vaginal ring
left in for 3 mo
130
Progestin Use
Menopausal hormone therapy - counter weight for estrogen Dysfunctional uterine bleeding Amenorrhea (women who don't bleed give progestin for a few days then stop= bleeding) Infertility Prematurity prevention Endometrial carcinoma and hyperplasia Balance estrogen
131
Pregestin A/E
``` Breast tenderness HA Abdominal pain Spotting, irregular bleeding Feeling heavy Depression Decreased cervical mucus/ reduced endometrial layer ↑r/f breast cancer ```
132
Combo Oral Contraceptives
YAZ (Ethinyl estradiol + Drospirenone) Loestrin (Ethinyl estradiol + Norethindrone) Ortho-tri-cyclen (Ethinyl estradiol + Norgestimate)
133
COC MOA
Causes uterine lining to be hostile Inhibits follicular maturation and thereby ovulation Thickening cervical mucus
134
COC Decrease risk of
``` Iron deficiency anemia acne ovarian cysts PID ovarian cancer endometrial cancer benign breast disease ```
135
COC A/E
``` Thromboembolic disorders Breast cancer HTN Abnormal bleeding Stroke Benign Hepatic adenoma ```
136
COC Drug interactions
P450 ↓ effects of COC: rifampin, ritonavir, antiseizure, St. John wort ↓effects of: Warfarin, hypoglycemic agents ↑effects of theophylline, TCA, Diazepam, Chlordiazepoxide
137
COC Absolute Contraindications
``` Thromboembolic disorders Thrombophlebitis CV diseases Liver abnormalities Breast cancer Undiagnosed vaginal bleeding Pregnancy Smokers >35y/o ```
138
COC Relative Contraindications
``` HTN Heart disease DM History of Cholestatic jaundice or pregnancy Gallbladder disease Uterine leiomyoma Epilepsy Migraines ```
139
COC Patient education
``` S/S of thromboembolic problem, HTN risk Take as prescribed -1st day of meses or Sunday -may need back up for the 1st week -take same time everyday ```
140
Nexplanon
3 yr implant
141
Depo
3mo IM/SubQ
142
Mirena, Skyla, Liletia
IUD 3-5 yr
143
28 day
levels of hormone vary with pill color | inert pill is only iron
144
Extended cycle
84 days active pill/ 7 days no pill 84 days active pill/ 7 days low estrogen fewer a/e
145
Testosterone Use
``` Male hypogonadism Male reproductive therapy Delay puberty Replacement therapy in menopausal women Transgender transition Cachexia Anemia ```
146
Testosterone A/E
``` Thrombosis Virilization in women, girls and boys Premature epiphyseal closure Worsening cholesterol profile promotes prostate cancer Edema Substance abuse ```
147
Testosterone Toxicity
Hepatotoxic
148
Testosterone Contraindications
Pregnancy | those over 65y/o
149
Testosterone Patient education for topical use
Cover area to prevent transference
150
Testosterone Monitoring
LFTs periodically
151
Sulfasalazine Use
Inflammatory bowel disease | RA
152
Sulfasalazine MOA
Intestinal bacterial metabolize the drug unto 2 compounds (5-ASA and Sulfapyridine) Results in reduced inflammation (Most effective for acute episodes of ulcerative colitis and Crohn's
153
Sulfasalazine A/E
``` Nausea Arthralgia Rash Fever Agranulocytosis** - report immediately ```
154
Estrogen suppresses release of
FSH and inhibits follicular maturation
155
Progestin suppresses
Luteinizing hormone and prevents ovulation
156
Non contraceptive benefits of COC Tx of menstrual symptoms
Cramps are reduced Menstrual flow is reduced Menses are more predictable

Pharm Exam 2 (4 decks)

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