MIDTERM - UNIT 5 Flashcards
1
Q
- most do not require a prescription
- treat GI disorders that require:
- altering of _______
- protection from intestinal inflammation
- adsorbent for intestinal toxins
- cathartic or laxatives for constipation
A
GASTROINTESTINAL AGENTS
- gastric pH
2
Q
receives food from the esophagus where it secretes acid and enzymes that digest food
muscular organ located on the left side of the upper abdomen
A
stomach
3
Q
FUNCTIONS OF GASTRIC HCl
- kill bacteria in ingested food and drinks, soften fibrous foods, promotes formation of _____ (proteolytic enzyme: proteo-protein; lytic-destroy)
- about ___ liters are produced by parietal cells each day with a pH range of 1.5-3.5
A
- pepsin
- 2 liters
4
Q
A. ACIDIFYING AGENTS
A
- achlorhydria
- esophageal ulcer
- gastric ulcer
5
Q
- absence of HCl in the gastric secretions
- problems lie in lack of pepsin activity which possess its greatest proteolytic act below pH ____, not the lack of enzyme itself
2 CLASSIFICATIONS
A
- ACHLORHYDIA
-3.5
classifications:
a. free of gastric HCl
b. lack of gastric HCl (responds to stimulation by histamine)
6
Q
responds to stimulation by histamine
A
lack of gastric HCl
7
Q
even after stimulation with histamine phosphate (parietal cells)
A
free of gastric HCl
8
Q
general symptoms
- mild diarrhea
- epigastric pain
- sensitivity to spicy foods
intervention
a. dilute HCl, NF: ____ dose added to ____ ml of water
b. ___________ (______) - capsules
A
- ACHLORHYDIA
- 5ml dose; 200ml water
- Glutamic acid hydrochloride (Acidulin)
9
Q
- esophageal _________ is defective
general symptoms: heartburn
A
- ESOPHAGEAL ULCER
- esophageal sphincter
10
Q
- more common
- occurs in the __________ of the stomach
CAUSE: not always hyperacidity
a. decreased tissue resistance to _____
b. people who contain his or her emotion
* most of this is a _____ condition
- complications:
- hemorrhage
- perforation
- pyloric substitution due to scar tissue
- transformation of benign to malignant condition
A
- GASTRIC ULCER
- lesser curvature
- pepsin
- chronic
11
Q
INTERVENTION: depends on severity and location of ulcer
a. diet: inhibit gastric stimulants like ____________
b. ________ and/or ________ activity
c. after surgery –> complete bed rest
d. food intake: smaller amount but more oftern
A
- GASTRIC ULCER
a. coffee, ulcer, spices, and fried food
b. antacid and/or anticholinergic activity
12
Q
B. ANTACIDS, PROTECTIVES, AND ADSORBENTS
A
- SODIUM BICARBONATE (aka: washing soda or soda ash)
- ALUMINUM-CONTAINING ANTACIDS:
a. Aluminum hydroxide - Al(OH)3
i. aluminum hydroxide gel, USP (amphogel)
ii. dried aluminum hydroxide gel, USP
b. Aluminum phosphate gel, USP (Phosphagel): pH 6.0-7.2 - CACIUM-CONTAINING ANTACIDS
a. Calcium carbonate (precipitated chalk) - MAGNESIUM-CONTAINING ANTACIDS
a. Magnesium hydroxide
b. Magnesium trisilicate - COMBINATION ANTACID PREPARATIONS
a. Aluminum hydroxide gel - magnesium hydroxide combinations
- aludrox
- WinGel
- maalox
- creamalin
b. Aluminum-hydroxide gel - magnesium trisilicate combinations
- gelusil
- tricreamalate
- triosgel
c. Magaldrate - SIMETHICONE-CONTAINING ANATACIDS (Dige, Mylanta)
- CALCIUM CARBONATE-CONTAINING ANTACID MIXTURES (tums, titralac, ducon)
- ALGINIC ACID-SODIUM BICARBONATE-CONTAINING ANTACID MIXTURE (gaviscon, foamtab)
13
Q
REASONS FOR TAKING ANTACIDS:
- overeating –> uncomfortable
- heartburn
- unnatural hunger between meals
- chief indication: excess gastric HCl –> causing pain and ulceration
INTERVENTION:
- ________________
- ________________
A
- neutralize excess gastric HCl
- inactive pepsin
14
Q
ANTACID THERAPY
- _________ neutralize the excess gastric HCl associated with ________ and _______ disease
- ______ pepsin (functions optimally at low pH)
- administered on a _______ basis
- used to raise gastric pH to ____ (initally __) (greatly reduces pepsin’s proteolytic action)
- side effects:
- _________
- _________
- _________
A
- alkaline bases; gastritis; peptic ulcer
- inactivates pepsin
- continuous
- 4-5 (initally 1-2)
- side effects:
- rebound acidity
- systemic alkalosis
- constipation
15
Q
- highly water-soluble
- very rapid onset of action but short duration
- causes sharp increase in gastric pH >= 7
- NaHCO3 + HCl —> NaCl + CO2 + H2O | CO2 –> ________
A
SODIUM BICARBONATE
(washing soda or soda ash)
16
Q
- widely used antacids
- non-systemic
- buffer in the pH 3-5 scale
- constipating
A
ALUMINUM-CONTAINING ANTACIDS
a. aluminum hydroxide - Al(OH)3
i. aluminum hydroxide gel, USP (amphogel)
ii. dried aluminum hydroxide gel, USP
b. aluminum phosphate gel, USP (phospagel) - pH 6.0-7.2
17
Q
- white, viscous suspension (pH __-__)
A
i. aluminum hydroxide gel, USP (amphogel)
- pH 5.5-8.0
18
Q
- white, odorless, tasteless amorphous powder
- soluble in _______ and _______
- DF: _________
- slower onset of action
- ______ –> nonabsorbable and exert little systemic effect
- ____________ –> ideal buffers
- ____________ –> adsorb pepsin and can interfere the adsorption of other drugs
- can cause N&V
- forms ___________ salt –> increased fecal phosphate excretion [treats phosphatic urinary calculi by retarding phosphate absorption]
- large doses for long periods –> _________
- usual dose: _________
A
ii. dried aluminum hydroxide gel, USP
- dilute mineral acids; fixed alkali hydroxides
- __________
- gels
- amphoteric character
- adsorbent properties
- insoluble aluminum phosphate salt
19
Q
- white, viscous suspension –> separate into small amounts in water upon standing
- water insoluble
- non-absorbable
- replace aluminum hydroxide gel –> if loss of phosphate is a problem for the patient
- usual dose: __________
A
b. Aluminum phosphate gel, USP (phosphagel) pH 6.0-7.2
20
Q
- BASIC –> raises pH to ____
- rapid acting and ________
A
- CALCIUM-CONTAINING ANTACIDS
a. Calcium carbonate (precipitated chalk)
21
Q
- fine, white, odorless, tasteless, microcrystalline powder, stable in air
A
a. Calcium carbonate (precipitated chalk)
22
Q
- practically ______ in water –> Remedy: increased solubility with ______ or ______
- the presence of ________ reduces its solubility
- insoluble in ________
- dissolved with ______ in _______, _______, and _______
- popular
- most are combination with _________
- CI: Pts w/ renal disease, urinary calculi, GI hemorrhage, HTN, dehydration, & electrolyte imbalance
- usual dose: _________
- DF: ________
A
a. Calcium carbonate (precipitated chalk)
- insoluble; ammonium salt or CO2
- alkali hydroxide
- alcohol
- effervescence; dilute acetic, hydrochloric, and nitric acids
- magnesium antacid
23
Q
- poorly soluble in water
- magnesium salt –> _________
- in combination with ________ and calcium antacids to counter the constipative and laxative effects
- non-systemic and excreted in the feces as insoluble magnesium salts
- contraindicated in patients with impaired renal function
A
- MAGNESIUM-CONTAINING ANTACIDS
24
Q
- bulky, white powder
- practically insoluble in _______ and ______ but dissolved in _________
- high doses –> _______
- antacid –> combo w/ __________
- DF: __________, _________ and _________, _______
A
a. Magnesium hydroxide
- alcohol and water; diluted acids
- laxative
- _________
DF:
- magnesia tablets
- magnesia and alumina oral suspension/tablets
- MOM
25
- fine, white, odorless, tasteless powder free from grittiness
➤ _______ in water and alcohol but readily decomposed by __________
➤ The _______ capability varies considerably
➤ ________ - colloidal silicates protect the ulcer from acid and peptic attack
➤ ________ - adsorb pepsin
➤ Non-systemic antacid
➤ _________ is excreted by the kidneys in direct proportion to the amount absorbed Usual dose:
DF: _________
b. Magnesium trisilicate
- insoluble; mineral acids
- antacid
- __________
- __________
- Silicon dioxide
26
o Combined to meet all the criteria for an ideal antacid
o Most --> balance: constipative effect of ____ & ____ with laxative effect of ____
o Antacid with rapid onset of action + Antacid with longer duration of action
5. Combination Antacid Preparations
- Ca and Al
- Mg
27
USP DF:
➤ Alumina and Magnesia Oral Suspension USP (___________)
➤ Magnesia and Alumina Oral Suspension USP (___________)
Usual dose: _________
a. Aluminum Hydroxide Gel- Magnesium Hydroxide Combinations (
- Aludrox®
- WinGel®
- Maalox®
- Creamalin
➤ 4% Al2O3 and 2% Mg(OH)2
➤ 2.2% Al2O3 and 3.8% Mg(OH)2
28
➤ One of the most _________
➤ Balances ________ and ________ effects
➤ Produces ________ effect
b. Aluminum Hydroxide -Gel Magnesium Trisilicate Combinations
- Gelusil®
- Tricreamalate®
- Triosgel®
29
- White, odorless, crystalline powder
➤ Combination of Al(OH)3 [__-__] and Mg(OH)2 [__-__]
➤ Insoluble in water and alcohol but soluble in dilute solutions of mineral acids.
➤ Usual dose: _________
➤ DF: _________
c. Magaldrate
- 17-25%
- 28-39%
30
- For gassy patients
➤ Simethicone is a _________ agent
6. Simethicone-Containing Antacids
- Digel®
- Mylanta®
31
➤ Combination with aluminum hydroxide gel =
➤ Combination with magnesium containing antacids =
7. Calcium Carbonate- Containing Antacid Mixtures
- TumsR
- Titralac®
- Ducon®
32
➤ Provide symptomatic relief of reflux esophagitis.
➤ Chewable tablet + water in the stomach => Alginic acid + Sodium bicarbonate => Sodium alginate & CO2 = foam
➤ in acidic environment, _________ is precipitated as a light, viscous gel w/c floats on top of the stomach contents
8. Alginic acid-Sodium Bicarbonate-Containing Antacid Mixture
- Gaviscon®
- foamtab®
➤ alginic acid
33
Clinical correlation:
________
➤ When a factor impairs digestion and/or absorption -> increasing the bulk of the GIT -> stimulates ___________
Diarrhea
- peristalsis
34
_____________
o Caused by:
o Effects:
- tissue damage, irritation -> electrolytes flow form body fluids -> ↑ osmotic load of the GIT Chronic diarrhea
Acute diarrhea
35
o Caused by:
- GIT surgery
- carcinomas
- chronic inflammatory conditions
- various absorptive defects.
Chronic diarrhea
36
o Treats symptoms, occasionally treats the cause, doesn't treat the complications
o Most products (adsorbent-protective + anti-diarrheal + antibacterial agent)
o Ideal antidiarrheal agent-> spasm-like effect which __peristalsis & __segmentation.
o __________: adsorb toxins, bacteria & viruses; provide a protective coating to the intestinal mucosa
C. Antidiarrheal agents
- Adsorbent-protectives
37
_____________
➤ Bismuth salts _______ independent of pH
➤ Water-insoluble, only a small amount goes into a solution.
➤ Intestinal _______ + _______ = bismuth sulfide = _________
1. Bismuth-containing Products
- hydrogen sulfide + bismuth salts = black stools
38
- White, slightly hygroscopic powder
➤ Acid reaction with blue litmus paper.
➤ Practically insoluble in water and in alcohol, but is readily dissolved by HCI, or nitric acid.
➤Bismuth subnitrate + tragacanth = hard mass precipitate (Incompatible)
➤ Remedy: protective action of sodium biphosphate or trisodium phosphate.
➤ Main use: component of where it functions as a mild astringent-protective.
d. Bismuth subnitrate
39
➤ Contains bismuth hydroxide and bismuth subcarbonate in suspension in water.
➤Drug Classifications:
➤ Usual dose:
b. Milk of Bismuth
40
Non-official Bismuth Compounds:
o _____________: (Pepto-bismol®)
o _________ - have excellent adsorbent properties, used for mild diarrhea
o ________- - Soft, white, or yellowish white powder or as lumps.
➤ Native hydrated aluminum silicate, powdered and free from gritty particles
➤ Use:
o ________ (Quintess®, Diamagma) - a non-official clay. Adsorbent properties are ↑ by heating
o _________ - has been used as an adsorbent in the treatment of diarrhea.
- Bismuth subsalicylate
- Activated Clays and other adsorbents
- Kaolin
- Attapulgite
- Activated charcoal
41
Clinical correlation:
__________ - infrequent or difficult evacuation of feces.
o Causes:
➤ Due to a person resisting the natural urge to defecate
➤ Intestinal atony
➤ Intestinal spasm, Emotions, drugs and diet.
Constipation
42
- quicken and increase evacuation of bowels
- __________ are mild cathartics; most are purchased without a prescription
Saline Cathartics (Laxatives/Purgatives)
- laxatives
43
Cathartics uses:
1. Ease defecation in patients with rectal disorders, painful hemorrhoids or other rectal disorder
2. Avoid potentially hazardous rises in BP during defecation in patients with HTN, cerebral, coronary or arterial disease
3. Relieve acute ___________
4. Remove solid material from the intestinal tract prior to certain roentgenographic studies/procedures
*Prolonged use -> loss of spontaneous bowel rhythm -> patient becomes dependent on laxatives AKA laxative habit.
44
TYPES OF LAXATIVES
1. Stimulant
2. Bulk-forming
3. Emollient laxatives
4. Saline cathartics
45
o MOA: Local irritation of intestinal tract = __________
Ex:
- Phenolphthalein
- Aloin
- Cascara extract
- Rhubarb extract
- Senna extract
- Podophyllin
- castor oil
- Danthron
- Oxyphenasatin
- Bisacodyl
- calomel
stimulant
46
O Made from cellulose and other non-digestible polysaccharides
O MOA: Swell when combined with water -> increased bulk = ________
Ex:
- Psyllium seeds
- methyl cellulose
- Na Carboxymethylcellulose
- karaya gum
bulk-forming
47
o MOA: Either as lubricants or as stool softeners.
Ex:
- Mineral oil
- d-octyl sodium sulfosuccinate
emollient laxatives
48
o Increasing the osmotic load of the GIT -> increased bulk = _______
o Water soluble, taken with large amounts of water that prevents excessive loss of body fluids and reduces N&V
o They are free of SE if used in brief periods
Ex:
- Biphosphates
- sulfates
- tartrate
saline cathartics
