Unit 4: Gastrointestinal system Flashcards by Hailie Grieco

What are the 3 categories of drugs that support the treatment of nausea?

Serotonin antagonists, antihistamines, and prokinetic

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What is the mode of action of nausea medications?

Blocks serotonin receptors in the chemoreceptor trigger zone (CTZ)

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What are the 3 categories of drugs that support the treatment of constipation?

Fiber supplements, stool softeners, and stimulant laxatives

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What is the main category that supports the treatment of diarrhea?

Opiods

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What are the 6 kinds of peptic ulcer medications?

Histamine2-receptor antagonists
Proton pump inhibitors
Mucosal protectants
Antacids
Prostaglandin E analog
Antibiotics

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What is the prototype for Histamine2-receptor antagonists?

ranitidine hydrochloride (zantac)

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What is the mode of action for Histamine2-receptor antagonists like ranitidine hydrochloride?

Reduce acid secretion by blocking H2 receptors which decreases gastric acid and pH.

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What does ranitidine hydrochloride treat?

Peptic ulcers, GERD, Heartburn, dyspepsia, and pathologic gastric hypersecretory disorders

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What endings do H2 receptor antagonists have?

-dine

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What is the prototype for proton pump inhibitors?

omeprazole (prilosec)

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What is the mode of action for proton pump inhibitors like omeprazole?

Proton pump inhibitors block ALL gastric acid secretion

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What endings do Proton pump inhibitors have?

-prazoles

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What does omeprazole treat?

Peptic ulcers, GERD, erosive esophagitis, hypersecretion of gastric acid PLUS prolonged dyspepsia

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What are the adverse effects of omeprazole?

Long-term medication ingestions = bone loss
Few other effects, except N/V, diarrhea

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What is the prototype for mucosal protectants?

sucralfate (Carafate)

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What does sucralfate treat?

Acute duodenal ulcers

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What is the pharmacological action:

Chemical reaction in stomach creates a gel or thick paste in the stomach. Coats ulcers, and creates a barrier between the stomach and gastric secretions.

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How often is sucralfate administered?

4x/day on empty stomach: one hour before breakfast, lunch, dinner, and bedtime.

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What is the prototype for antacids?

aluminum hydroxide (Amphojel)

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What is the main adverse effects of antacids?

Constipation and diarrhea

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What is the mode of action for antacids?

Alkaline compound - neutralizes gastric acid

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What is the reasoning behind calling antacids high maintenance?

PO 4x/day
2 hours before/after drugs
-4 ox. milk/water: chew well
Interacts with other drugs

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What is the prototype for Prostaglandin E analogs?

misoprostol (Cytotec)

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What do prostaglandin E analogs do?

Prevent gastric ulcers in patients taking long-term NSAIDs long term and also used in L&D to soften cervix of pregnant women ready to deliver.

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What is the mode of action for prostaglandin E analogs?

Decreased stomach acid, increased production of protective mucous and bicarbonate, and increased vasodilation of blood flow in the gastric wall.

What are the side effects for prostaglandin E analogs?

Dysmenorrhea and miscarriage: do not administer to pregnant women until time to deliver. GI upset, severe diarrhea, and abdominal pain.

What do antibiotics prevent and treat in terms of the GI tract?

Peptic ulcers

What is the leading cause of peptic ulcer disease?

Helicobacter pyloris

What is necessary to heal gastric ulcers?

Antibiotics

What is the mode of action for nausea medications?

block serotonin, dopamine, or histamine1 receptors in CTZ

What is the prototype for serotonin antagonists?

ondansetron (Zofran)

What is ondansetron used for?

nausea/vomiting from chemotherapy, radiation therapy, and postop recovery.

What are key points for serotonin antagonists?

Administer before, not after n/v is occurring; scheduled dosing is most effective. Can be given orally or through IV.

What are the precautions for ondansetron?

young children (under 4), liver dysfunction; rifampin lowers action of ondansetron, and known prolonged QT syndrome

What is the prototype for antihistamines in terms of GI?

dimenhydrinate (Dramamine)

What does dimenhydrinate treat?

Motion sickness and vertigo

What are the adverse effects of dimenhyrinate?

sedation, dizziness, anticholinergic effects

What is the action of antihistamines?

block histamine1 receptors in the inner ear and CTZ

What is a safety alert for antihistamines?

Older men taking antihistamines can cause urinary retention

What are the precautions for antihistamines?

children under 2, elderly: glaucoma, prostate hypertrophy liver dysfunction, GI/urinary obstruction.

What is the prototype for prokinetics?

metoclopramide (Reglan)

What is the mode of action for prokinetics?

dopamine and serotonin receptor blocker, increases peristalsis, lower esophageal sphincter tone, and CTZ threshold

What are the adverse effects of prokinetics?

drowsiness, GI upset, EPS (tardive dyskinesia) with long-term use

What is the prototype for fiber supplements?

psyllium (Metamucil)

What do fiber supplements prevent/treat?

constipation, diverticulosis, irritable bowel syndrome, regulates stools with diarrhea and fecal ostomies

What is the pharmacologic action of fiber supplements?

glutinous mass that forms bulk laxative; absorbs water from the intestine; non-digestible

When should you not give psyllium?

If the patient has a blockage

What is the prototype for stool softeners?

docusate sodium (colace)

Why is psyllium more effective than docusate sodium?

Because it takes two to three days for docusate sodium to begin to work but psyllium works faster.

What do stool softeners treat?

constipation fecal impactions, and hard/painful stools

What is the pharmacologic action of docusate sodium?

lower surface tension to absorb water into stool

When should you not give docusate sodium?

patient has an impaction, n/v, stomach pain, or using mineral oil. diabetes mellitus, heart failure, or edema.

What is the prototype for stimulant laxatives?

bisacodyl (Dulcolax)

What do stimulant laxatives treat?

constipation, slow transit, stool evacuation prior to surgery

What is the pharmacologic action of stimulant laxatives?

increases intestinal motility and transit; increases water/electrolytes secretion from intestine

When should you not give stimulant laxatives?

Children under 1; eating disorders, impaction, hemorrhoids, N/V, stomach pain, and antacids

What is the prototype for opioids in terms of antidiarrheal medications?

diphenoxylate atropine (lomotil) and loperamide (Imodium)

What is the pharmacologic action for opioids in terms of GI?

decreases intestinal peristalsis

What are the side effects of opioids in terms of GI?

CNS effects; anticholinergic effects

What is the prototype for irritable bowel syndrome with diarrhea?

alosetron (Lotronex)

What does alosetron treat?

IBS-D in women only

What is the pharmacologic action of alosetron?

serotonin 5-HT3 receptor antagonist. Decreases visceral pain; slows peristalsis

What must happen for a patient to be administered alosetron?

sign tx agreement

What are the side effects of alosetron?

constipation which can lead to impaction, perforation, and even obstruction

What is the prototype for irritable bowel syndrome with constipation?

lubiprostone (Amitiza)

What does lubiprostone prevent/treat?

IBS in women > 18; chronic idiopathic constipation in men and women

What is the pharmacologic action of lubiprostone?

Serotonin 5-HT3 receptor agonist. Decreases visceral pain and slows peristalsis.

What are the 4 categories of drugs that support the treatment of inflammatory bowel disease?

1. 5-Aminosalicylates 2. Immunosuppressants 3. Immunomodulators 4. Glucocorticoids

What is it believed Crohn's disease and ulcerative colitis are due to?

Autoimmune response

What is the prototype for 5-aminosalicylates?

sulfasalazine (Azulfidine)

What do 5-aminosalicylates treat?

Mild to moderate inflammatory bowel disease

What is the pharmacologic action of sulfasalazine?

sulfonamide antibiotic that converts to aminosalicylic acid

What are the side effects of sulfasalazine?

nausea, fever, rash, arthralgia, blood disorders

What is the administration of sulfasalazine?

PO after meals to decrease transit time

What are the precautions for sulfasalazine?

Sulfa allergy, salicylates (aspirin)

What is the prototype for immunosuppressants in terms of IBD?

azathrioprine (Imuran)

What is the pharmacologic action of azathioprine?

Inhibits production of B and T lymphocytes with decreases immune response.

What are the side effects of azathioprine?

N/V, anorexia, Hepatitis, bone marrow suppression

What are the precautions for azathioprine?

patients with myasthenia gravis, renal/hepatic dysfunction should take only if the benefits outweigh the risks

How do you administer azathioprine?

IV, PO (onset of therapeutic effect may take six months

What is the difference between Crohn's disease and ulcerative colitis?

Crohn's: affects entire intestinal tract Ulcerative colitis: affects only the colon