GI Pharmacology Flashcards by Morgan Stone

upper GI distress drugs that decrease aggressive factors

–treat H. pylori
–H2 blockers
–proton pump inhibitors

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upper GI distress drugs that increase protective factors

–antacids
–sucralfate

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how to treat H. pylori

–several antibiotics + gastric acid inhibitor
–combination therapy

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why combination therapy to treat H. pylori?

–minimize resistance
–H. pylori likes acidic environment

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length of Rx for H. pylori

10-14 days

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adherence to treatment for H. pylori

about $200 with up to 12 pills

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what are two ways drugs target gastric acid production?

–block H2 receptors
–inhibit proton pump

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role of histamine

promotes production of gastric acid

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role of parietal cell

makes gastric acid

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examples of H2 receptor antagonists

–cimetidine (Tagamet)
–famotidine (Pepcid)

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MOA of cimetidine/famotidine

–block H2 receptors in the stomach
–reduces gastric acid secretion by 60-70%
–increases stomach pH

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route for cimetidine/famotidine

PO, IV

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administration tidbit for cimetidine/famotidine

give at least 1 hour apart from antacids

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indications for cimetidine/famotidine

–GERD
–PUD
–ulcer prophylaxis
–heartburn/dyspepsia

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how does cimetidine/famotidine work for ulcer prophylaxis?

prevents aspiration pneumonia risk

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adverse effects of cimetidine/famotidine

–well tolerated
–CNS effects in elderly
–slight increased risk for pneumonia in elderly

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interactions of cimetidine/famotidine

–inhibits CYP450 enzymes (older)
–newer generation H2RAs do not have this problem (ex. Pepcid)

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safety alert for cimetidine/famotidine

–can increase levels of warfarin, phenytoin, theophylline
–give IV form slowly to avoid bradycardia

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examples of proton pump inhibitors (PPIs)

–omeprazole (Prilosec)
–pantoprazole (Protonix)
–esomeprazole magnesium (Nexium)

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MOA of omeprazole/pantoprazole/esomeprazole magnesium

–binds to proton pump
–inhibits hydrogen potassium ATPase enzyme system
–irreversibly inhibits secretion of HCl

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indications for omeprazole/pantoprazole/esomeprazole magnesium

short term treatment of PUD and GERD

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tidbit about omeprazole/pantoprazole/esomeprazole magnesium

more effective than H2RA

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adverse effects of omeprazole/pantoprazole/esomeprazole magnesium

short term: relatively safe
long term: increased risk for pneumonia, bone loss/hip fracture, stomach CA

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nursing implications for omeprazole/pantoprazole/esomeprazole magnesium

short term use only

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example of mucosal protectant

sucralfate (Carafate)

unique drug composed of: --sucrose-base --aluminum hydroxide

MOA of sucralfate

--alters when exposed to gastric acid --sticky, thick gel --> protective barrier

indication of sucralfate

duodenal ulcers, gastric ulcers

route for sucralfate

PO (tablet or suspension)

adverse effects of sucralfate

--no major --may cause constipation

interactions with sucralfate

--decreased drug absorption --PO: take 2 hours apart

major bases for antacids

--aluminum --calcium --magnesium --Al+Mg

example of aluminum antacid

amphojel

example of calcium antacid

tums

example of magnesium antacid

milk of magnesia

example of Al+Mg antacid

Maalox, Mylanta

side effect of aluminum antacid

constipation

side effect of calcium antacid

constipation

side effect of magnesium antacid

diarrhea

side effect of Al+Mg antacid

balanced approach

MOA of antacids

neutralizes acid by approximately 50%

indication of antacids

--PUD --GERD --stress ulcers

adverse effects of antacids

--diarrhea or constipation --acid rebound

interactions of antacids

--chelation --altered gastric absorption of many drugs

example of serotonin blocker

ondansetron (Zofran)

MOA of ondansetron

blocks serotonin receptors in the trigger zone in the brain and in the afferent vagal nerves in the stomach and small intestine

route of ondansetron

PO or IV

use of ondansetron

used to treat N/V (esp. chemo/radiation induced)

adverse reactions of ondansetron

common --> usually mild --HA --dizziness --diarrhea

serious adverse reactions of ondansetron

--serotonin syndrome

drug interactions with ondansetron

--SSRIs --SNRIs --TCAs --MAIs --buspirone --tramadol

examples of antihistamines

--dimenhydrinate (Dramamine) --meclizine (Antivert) --hydroxyzine (Vistaril)

MOA of dimenhydrinate/meclizine/hydroxyzine

blocks the release of histamine H1 receptors in the inner ear

indications for dimenhydrinate/meclizine/hydroxyzine

treatment of dizziness and nausea --> antiemetic and antivertigo associated with motion sickness

adverse reactions of dimenhydrinate/meclizine/hydroxyzine

--sedation --drowsiness --dizziness --anticholinergic effect --FALL RISK

example of dopamine antagonists: prokinetic agent

metoclopramide (Reglan)

MOA of metoclopramide

--blocks dopamine receptors --increases tone of LES --increases peristalsis in both the stomach and the intestine

indications of metoclopramide

--N/V associated with chemo/radiation/opioids --GI motility issues --paralytic ileus

side effects of metoclopramide

--sedation --extrapyramidal symptoms --restlessness --neuroleptic malignant syndrome

extrapyramidal symptoms

--akathisia --acute dystonia --Parkinsonism --Tardive dyskinesia --Neuroleptic malignant syndrome

akathisia

--may feel restless --tense --constant desire to move

acute dystonia

involuntary muscle contractions

Parkinsonism

--muscle tremors --cogwheel rigidity --drooling --shuffling gait --slow movements

Tardive dyskinesia

--abnormal muscle movements (lip smacking, tongue darting, chewing movements, slow and aimless arm and leg movements)

neuroleptic malignant syndrome

rigid muscles, fever, confusion

what are extrapyramidal symptoms common with?

more common with antipsych meds

examples for diarrhea drugs

--diphenoxylate with atropine (Lomotil) --loperamide (Immodium)

MOA of diphenoxylate with atropine/loperamide

--decrease intestinal peristalsis --reduce the intestinal effluent

adverse reactions of diphenoxylate with atropine/loperamide

--drowsiness --constipation --falling and driving precautions --anticholinergic effects --SERIOUS: cardiac arrest/arrythmias

example of 5-aminosalicylates

sulfasalazine (Azulfidine)

indications of sulfasalazine

mild to moderate IBD

MOA of sulfasalazine

sulfonamide antibiotic that converts the intestine into 5-aminosalicylic acid and sulphapyridine

side effects of sulfasalazine

--nausea --fever --rash --HA --hematologic disorders

precaution for sulfasalazine

do not give to patients who are allergic to SULFA drugs or who have certain types of anemias

example of DMARDs for IBD

infliximab (Remicade)

DMARD

disease modifying antirheumatic drug

MOA of infliximab

monoclonal antibody which neutralizes TNF-alpha

side effects for infliximab

--immune suppression --infection --cancer --heart failure --infusion reactions --neutropenia

additional note about infliximab

often require therapeutic drug monitoring and biomarker monitoring for inflammation

GI Pharmacology Flashcards

(79 cards)