Test 2 GI Meds

Question 1

famotidine: class

Answer 1

• H2 receptor antagonist

Question 2

famotidine: MOA

Answer 2

• binds to H2 R and blocks it, so suppresses secretion of gastric acid

Question 3

famotidine: indications

Answer 3

• tx and prevention of duodenal ulcers
• tx of gastric ulcers
• GERD
• ZE Syndrome (hypersecretory states)
• OTC: heartburn, acid indigestion, sour stomach

Question 4

famotidine: SEs

Answer 4

• elevation of gastric pH may inc risk of pneumonia
• **no antiandrogenic effects b/c does not bind to androgen Rs

Question 5

famotidine: ADRs

Answer 5

• arrhythmias
• agranulocytosis
• aplastic anemia

Question 6

ranitidine: class

Answer 6

• H2 receptor antagonist

Question 7

ranitidine: MOA

Answer 7

• H2 receptor blocker that suppresses secretion of gastric acid from parietal cells

Question 8

ranitidine: indications

Answer 8

• short term tx of gastric/duodenal ulcers
• prophylaxis of recurrent duodenal ulcers
• tx of ZE Syndrome: better than cimetidine
• tx of GERD

Question 9

ranitidine: SEs

Answer 9

• rare CNS effects: b/c penetrates BBB poorly
• **no antiandrogenic effects b/c does not bind to androgen Rs

Question 10

ranitidine: ADRs

Answer 10

• arrhythmias
• agranulocytosis
• aplastic anemia

Question 11

H2 receptor antagonist: nursing implications

Answer 11

• may be taken w/o regard to meals
• make sure pt knows the dosing schedule
• avoid cigarettes and aspirin/NSAIDs
• advise pt to stop drinking b/c drinking exacerbates ulcer symptoms
• tell pts 5-6 small meals may be preferable to 3 larger meals
• educate pt about signs of GI bleed: black/tarry stools, coffee ground vomitus
• inform pt about S/S of respiratory infection, notify provider if these occur
• for PUD, need dx with visualization of ulcer and test for H. pylori

Question 12

omeprazole: class

Answer 12

• proton pump inhibitor (PPI)

Question 13

omeprazole: MOA

Answer 13

• undergoes conversion to its active form w/in parietal cells of the stomach
  
  • the active form causes irreversible inhibition of H/K ATPase (proton pump) which is the enzyme that generates gastric acid
• b/c it blocks the final pathway of gastric acid production, it can inhibit basal and stimulated acid release
• see effects w/in 2 hours
  
  • b/c inhibition of the ATPase is not reversible, effects persist until new enzyme synthesized

Question 14

omeprazole: indications

Answer 14

• short term therapy of duodenal ulcers, gastric ulcers, erosive esophagitis, and GERD
• long term therapy of hypersecretory conditions (ZE Syndrome)
• prevent stress ulcers (when used in the hospitals), but should only use on pts in ICU and with other risk factors

Question 15

how do PPIs compare to H2RAs?

Answer 15

• omeprazole and other PPIs reduce 24 hour acid secretion by 90% compared with 65% for H2RAs
• PPIs also act faster than H2RAs to reduce gastric acidity and relieve ulcer symptoms
• pts who fail to respond to H2RAs can often benefit from PPIs

Question 16

omeprazole: SEs

Answer 16

• headache
• diarrhea
• nausea
• vomiting
  
  • all are rare though

Question 17

omeprazole: ADRs

Answer 17

• pneumonia b/c of alteration of upper GI flora (due to reduced acid) and impairment of WBC function
• fractures/osteoporosis, b/c reducing acid secretion can dec absorption of calcium
• rebound acid hypersecretion when they stop taking PPIs
• hypomagnesemia b/c reduced Mg absorption
• C. diff
• nephrotoxic

Question 18

omeprazole: nursing implications

Answer 18

• contraindicated if hypersensitive to the drug or to component of the formulation
• tx should be limited to 4-8 weeks unless taking for hypersecretory states
• pts should be encouraged to take Ca and vitamin D to prevent osteoporosis
• use for shortest time and in lowest effective dose to prevent rebound dyspepsia
• watch Mg levels and supplement if necessary
• take just before eating

Question 19

misoprostol: class

Answer 19

• PG E1 analog
• anti-ulcer drug

Question 20

misoprostol: MOA

Answer 20

• prevents NSAID induced ulcers by acting as a replacement for endogenous PG
  
  • PGs protect stomach by suppressing secretion of gastric acids and promotes secretion of bicarbonate and protective mucous

Question 21

misoprostol: indication

Answer 21

• prevention of gastric ulcers caused by long term therapy with NSAIDs
  
  • w/ mifepristone, can induce medical termination of pregnancy

Question 22

misoprostol: SEs

Answer 22

• dose related diarrhea
• abdominal pain
• spotting
• dysmenorrhea

Question 23

misoprostol: ADRs

Answer 23

• miscarriage

Question 24

misoprostol: nursing implications

Answer 24

• women of child bearing age must:
  
  • be able to comply with birth control
  • be given oral/written warnings about the dangers
  • have a negative serum pregnancy test result w/in 2 weeks before beginning therapy
  • begin therapy only on 2nd or 3rd day of next normal menstrual cycle
  • category X

Question 25

bismuth subsalicylate: class

Answer 25

* anti diarrheals * anti ulcer

Question 26

bismuth subsalicylate: MOA

Answer 26

* Promotes intestinal adsorption of fluids and electrolytes. * Decreases synthesis of intestinal prostaglandins. * act to disrupt the cell wall of H. pylori and cause lysis and death * also inhibit urease activity and prevent H. pylori from binding to gastric surface

Question 27

bismuth subsalicylate: indications

Answer 27

* Mild to moderate diarrhea. * Nausea, abdominal cramping, heartburn, and indigestion that may accompany diarrheal illnesses. * **Treatment of ulcer disease associated with Helicobacter pylori (with anti-infectives).** * Treatment/prevention of traveler's (enterotoxigenic Escherichia coli) diarrhea.

Question 28

bismuth subsalicylate: SEs

Answer 28

* black tongue * black stool

Question 29

bismuth subsalicylate: nursing implications

Answer 29

* medication contains aspirin, so do not take any other medications with aspirin * report any ringing in the ears (tinnitus) * do not give children b/c of possible Reye's Syndrome

Question 30

metronidazole: class

Answer 30

* anti infective * anti protozoal * anti ulcer

Question 31

metronidazole: MOA

Answer 31

* prodrug that is harmless until converted to more chemically active form that only occurs in anaerobic cells * so does not occur in human cells, since most are aerobic * interacts with DNA and causes strand breakage and loss of helical structure

Question 32

metronidazole: indications

Answer 32

* symptomatic intestinal amebiasis * systemic amebiasis * giardiasis * trichomoniasis * E. histolytica

Question 33

metronidazole: SEs

Answer 33

* nausea * headache * dry mouth * metallic taste in mouth * stomatitis * vomiting * diarrhea * insomnia * vertigo * weakness * darkening of urine

Question 34

metronidazole: ADRs

Answer 34

* hypersensitivity rxns * Stevens Johnson syndrome * seizures * neurologic injury

Question 35

metronidazole: nursing implications

Answer 35

* avoid during 1st trimester of pregnancy and be cautious after * DO NOT use alcohol for at least 3 days after med is stopped * be careful is using warfarin * do not drink grapefruit juice