Pharmacology IBD + PUD

Question 1

Infliximab classification

Answer 1

T: antirheumatics, DMARDS gastro-intestinal anti-inflm
P: monoclonal antibodies

Question 2

Infliximab
Indication
Mechanism of action

Answer 2

Active rheumatoid arthritis, Crohn’s disease, ulcerative colitis

Neutralizes and prevents activity of TNF-alpha
(one of the cytokines that make up the acute phase reaction)

Question 3

Infliximab

Side effects/contraindications?

Answer 3

• Contraindicated in HF

Common: fatigue, headache, upper resp infection, abdominal pain, nausea, vomiting
Severe = INFECTIONS, MALIGNANCY

Question 4

Nursing implications for infliximab?

Answer 4

• Monitor for signs of systemic infection and infusion-related rxns
• Fatal TB assoc with this drug: recommended to be tested for latent TB before going on it

Question 5

What are monoclonal antibodies?

Answer 5

mAb or moAb

an antibody produced by a single clone of cells or cell line and consisting of identical antibody molecules.

Question 6

Prednisone
Class
Mechanism of Action/Indications

Answer 6

T: corticosteroids, immune modifiers

Used systemically and locally in wise variety of chronic diseaes including inflammatory, allergic, hematolic, neoplastic…etc

Suppresses inflm and normal IR. Replaces endogenous cortisol in deficient states

Question 7

What drugs should be avoided in pt with PUD?

Answer 7

NSAIDs, prednisone….

Others?

Question 8

Side effects of prednisone?

Answer 8

Common: depression, euphoria, anorexia, nausea, dec wound healing, adrenal suppression, osteoporosis, muscle wasting, cushingoid appearance (+ many more)

Severe: peptic ulceration, thromboembolism

Question 9

Nursing considerations/assessments for pt on prednisone?

Answer 9

• Adrenal insufficiency: hypotension, weight loss, weakness, nauseam vomiting, anorexia, lethargy
• I/O, edema, rales/crackles

Question 10

Salfasalazine
Class.
Mechanism of action/indications?

Answer 10

T: antirheumatics, gatro-intestinal anti-inflm

For ulcerative colitis, rheumatoid arthritis

Locally acting anti-inflm action in colon, action probably inhibition of prostaglandin synthesis

Question 11

Side effects of salfasalazine?

Answer 11

Common: anorexia, diarrhea, nausea, vomiting, rash
Severe: aplastic anemia, angioedema, anaphylaxis + others

• Can cause male infertility

Question 12

Nursing assessments/considerations r/t salfasalzine?

Answer 12

• Assess for allergy to sulfonamides/salicylates (dif breathing, rash, etc)
• I/O
• Abdominal pain, stools

Question 13

What drugs r/t PUD?

Answer 13

1) Ranitidine
(Zantac)
2) Omeprazole
3) Aluminum Hydroxide

Question 14

What drugs r/t IBD?

Answer 14

1) Prednisone
2) Sulfasazine
3) Infliximab

Question 15

Ranitidine
(Zantac)
Classification?
Mechanism of action?
Indications?

Answer 15

T: Antiulcer agent
P: Histamine H2 receptor antagonist

Heartburn, ulcers, GERD, erosive esophagitis

Inhibits action of histamine at H2 receptor sites located primarily in gastric parietal cells, resulting in inhibition of gastric acid secretion

Question 16

Side effects of ranitidine?

Answer 16

Common: Confusion

Severe: aarhythmias, aplastic anemia

H2RA can cause Vitamin B12 deficiency (stomach acid helpful in absorption)

-MS changes in elderly (?from class slides)

Question 17

Important nursing considerations/assessments for ranitidine?

Answer 17

• Syrup contains alcohol
• Epigastric + abdominal pain, frank + occult blood, emesis
• CBC periodically
• Geriatric: look for confusion

Question 18

Omeprazole
Class?
MoA and indications?

Answer 18

T: anti-ulcer agent
P: PPI

GERD/maintenance of healing in erosive esophagitis; duodenal ulcers

Binds enzyme on gastric parietal cells presence of acidic gastric pH, preventing final transport of H+ across lumen

Question 19

Side effects of Omeprazole?

Answer 19

Generally well tolerated
Common: abdominal pain (can exp nausea, diarrhea, fatigue, dizziness)

Severe: pseudomembranous colitis

Question 20

Nursing considerations for omeprazole?

Answer 20

= Containdicated in lactation

• May dec absorption of drugs requiring acidic pH
• GI + monitor bowel fx: diarrhea, cramping, fever, bloody stools,
• CBC
• Do not crush or chew (PPIs enteric coated d/t rapid degredation of drugs in acid conditions of stomach)

Question 21

Aluminum hydroxide
Class?
MoA, indications?

Answer 21

T: anti-ulcer agents
P: Antacids-phosphate binders

Lowering of phosphate levels in pt’s with chronic renal failutre.
Adjunct tx for ulcers.

Binds phosphate in GI tract – neutralizes gastric acid and activates pepsin

Question 22

Nursing implications for aluminum hydroxide?

Answer 22

• Pain
• Monitor serum phosphate + calcium levels when chronic use
• Chew first, take with glass of water
• May interfere with other meds

Question 23

Ending of H2RAs?

Answer 23

-tidine

Question 24

H2RAs

• Why are they used so widely?
• Adverse effects?

Answer 24

• Top pick for PUD b/c safe + effective

- Very rare to have side effects (Cimetidine has highest risk, esp in older adults)

Question 25

WHat is the sole PPI available in injectible form?

Answer 25

Prantoprozole

Question 26

When is it best to take PPIs and H2RAs?

Answer 26

30-60mins before meals

Question 27

Nursing assessments for acid-controlling drugs (according to Lilley)

Answer 27

- GI fx/changes - Liver + kidney fx - Cardiac fx esp as relates to hx of Htn, HF, edema, electrolyte imbalances - Very important to check drug interactions! (as are many) - H2RA: kidney and liver fx, LOC (b/c of AEs) - PPI: liver + kidney fx, drug interactions, bowel fx,

Question 28

Why is it important to look at heart + kidney fx related aspects of pt on acid-controlling drugs?

Answer 28

Antacids have high sodium content...can lead to exacerbation of these issues

Question 29

What changes in bowel fx are aluminum and magnesium based antacids?

Answer 29

Aluminum = constipation Magnesium = diarrhea * These often used in combo to balance these issues

Question 30

Special considerations for calcium and sodium based antacids?

Answer 30

Calcium - risk for rebound hyperacidity, changes in systemic pH Sodium bicarbonate - risk of alkalosis and electrolyte imbalance (watch heart + kidney fx)

Question 31

WHat is an important consideration for timing of H2RAs if simultaneously taking antacids?

Answer 31

Space 1 hour apart

Question 32

Antacids should be given with? Why are they not recommended to be given with other meds?

Answer 32

At least 240ml of water to enhance absorption in stomach Affect stomach acidity, thus influencing absorption of many other oral drugs