Pharm Quiz 3

Acid-Controlling Drugs: Antacids MOA

Neutralize acid only by stimulating secretion of mucus, bicarbonate & prostaglandins + promoting gastric mucosal defensive mechanisms.

Acid-Controlling Drugs: Antacids Indications

Acute relief of symptoms associated with acid-related disorders:

Peptic ulcers

Gastritis

Gastric hyperacidity

Heart Burn

Acid-Controlling Drugs: Antacids contraindications

Allergy, severe RF, electrolyte disturbance, GI obstruction

Acid-Controlling Drugs: Antacids caution

Pregnancy (usually safe, consult HCP first)

Types of antacids (4)

Aluminum Salts

Magnesium Salts (magnesium hydroxide)

Calcium Salts (tums)

Sodium Bicarb (baking soda)

The ONLY antacid that’s easily excreted with patients with renal disease

Aluminum salts (Aluminum hydroxide)

Aluminum salts adverse effect

Constipation

Magnesium salts adverse effects

Diarrhea

Calcium Salts Adverse Effects

Constipation

Gas/Belching

Kidney stones due to hypercalcemia

Sodium Bicarbonate adverse effects

May cause metabolic alkalosis. (confusion, dizziness, muscle cramps, tingling, and possible dysrhythmias)

Which antacid is dangerous when used in clients with renal disease?

Magnesium salts due to lack of excretion which causes accumulation.

Which antacid is not recommended for clients with renal disease?

Calcium salts

Antacid nursing implications

Do not give 1-2 hours before or between any medication

Antacid interaction: Chelation

Binds & inactivates other drug

Acid-Controlling Drugs: H2 Receptor Antagonists MOA

Suppress but do not completely inhibit acid production

Acid-Controlling Drugs: H2 receptor antagonists medication names:

Anything ending with -tidine.

Ex: Cimetidine

Famotidine

Nizatidine

Acid-Controlling Drugs: H2RA -tidine Indications

Treatment of Gerd, PUD, erosive esophagitis, adjunct therapy to upper GI bleeding, Zollinger-Ellison syndryome

Prophlaxis (prevention) of stress ulcers

Acid-Controlling Drugs: H2RA -tidine Precautions

liver/kidney dysfunction

Acid-Controlling Drugs: H2RA -tidine Adverse Effects

CNS: Elderly patients - confusion & disorientation, HA

Thrombocytopenia (low blood platelet count)

Agranulocytosis (low WBC)

Acid-Controlling Drugs: H2RA Interactions

All H2 antagonists may inhibit the absorption of drugs that require an acidic GI environment for absorption

Acid-Controlling Drugs: H2RA Antagonists optimal results:

Take 1-2 hours before antacids, with food

Acid-Controlling Drugs: H2RA therapeutic effect

Reduces heartburn

Acid-Controlling Drugs: H2RA Contraindication

Abdominal pain

Acid-Controlling Drugs: Proton Pump Inhibitors medication names

Any med ending with -prazole

Acid-Controlling Drugs: PPI -prazole MOA

Suppresses gastric acid secretion of parietal cells by blocking & turning off the proton pump → acholrhydia

Acid-Controlling Drugs: PPI -prazole Indications

FIRST LINE THERAPY for GERD, erosive esophagitis, active ulcer

Prophylaxis (prevent) → stress ulcer, NSAID induced ulcer

Treatment of H plyori

Acid-Controlling Drugs: PPI -prazole adverse effects

Possible disposition to GI tract infections ( C diff)

Long term use → Osteoporosis.

Others: Pneumonia, Mg+ depletion, Steven’s Johnson syndrome, toxic epidermal necrolysis

Acid-Controlling Drugs: PPI -prazole interactions

Risk of bleeding with Warfarin.

Acid-Controlling Drugs: PPI -prazole Nursing teachings

Admin: tablet, delayed release capsules, IV

Take 30-60 minutes before eating on empty stomach

Report rashes skin changes

Antidiarrheals: Adsorbents- examples

Bismuth subsalicylate, activated charcoal, aluminum hydroxide

Antidiarrheals: Adsorbents MOA

Coat the walls of GI tract → bind to the causative bacteria or toxin → eliminate through stool

Chemical sponge

Antidiarrheals: Adsorbents Adverse effects

Common: Constipation, dark stools

Serious: Same adverse effects associated with aspirin. ex: tinnitus, caution in children & teens

Antidiarrheals: Adsorbents interactions

Lowers effectiveness of many drugs since it decreases absorption

Increased bleeding risk with warfarin, aspirin, NSAIDS

Antidiarrheals: Adsorbents- contraindications

Childrne/adolscents w/possible viral infection

Antidiarrheals: Anticholinergics - Examples

atropine, hyosycamine

Antidiarrheals: Anticholinergics MOA

Decrease intestinal muscle tone and peristalsis of GI tract → slow movement of fecal matter through GI tract.

Drying effects lower GI secretions

Antidiarrheals: Anticholinergics Contraindications

Glaucoma, GI obstruction, MG, paralytic ileus, toxic megacolon

Pregnancy category C to X

Antidiarrheals: Anticholinergics Adverse Effects

Anticholinergic effects ( dry mouth, blurred vision, constipation, urinary retention, increased heart rate)

Antidiarrheals: Opiates examples

Codeine, diphenoxylate with atropine, loperamide. Only loper available OTC!

Antidiarrheals: Opiates MOA

Reduce bowel motility.

Decrease transit time of food through GI tract → more time for water and electroytes to be absorbed

Lowers stool frequency/volume

Decreases pain by relief of rectal spasms

Antidiarrheals: Opiates adverse effects

Serious: Resp depression, hypotension, dependency.

Others: Urinary retention, flushing, drowiness, dizziness, lethargy, N/V constipation

Antidiarrheals: Type of Opiate: Loperamide contraindications:

Severe ulcerative colitis, diarrhea associated with Cdiff/ecoli

Antidiarrheals: Type of Opiate: Loperamide MOA

Inhibits intestinal peristalsis & intestinal secretions → decreasing number and water content of stools

Exhibits characteristics of opiate class, but does not cause physical dependence

Available OTC

Antidiarrheals: Probiotics examples

Lactobacillus acidophilus, Lactobacillus GG (treatment of uncomplicated diarrhea & antibiotic induced diarrhea)

Saccahromyces bouldarii (treatment of c diff)

Antidiarrheals: Probiotics MOA

Probiotics function by restoring the natural balance of gut microbiota, enhancing intestinal barrier function, and modulating immune responses.

Acid controlling drugs maximum allowed time to take without MD guidance

6-8 weeks

Adverse effect for ALL anti diarrhea medication:

Constipation

Contraindications for all anti-diarrheal medication:

Severe adbominal pain, intestinal obstruction, colitis, infectious diarrhea

Contraindications for all laxatives

Undiagnosed abdominal pain/distention, intestinal obstruction, diarrhea.

OVERUSE CAN DAMAG EBOWELS

Laxatives precautions

acute surgical abdomen, appendicits symptoms N/V, fecal impaction

Laxatives: Bulk forming examples

Psyllium, methlycellulose

Laxatives: Bulk forming MOA:

high fiber→ absorb water to increase bulk and water content of stool →

distends bowel & stimulates intestines by increasing peristalis to initiate reflex bowel activity

Laxatives: Bulk forming indications

THE ONLY LONG TERM USE LAXATIVE

Acute and chronic constipation, IBS, diverticulosis

Laxatives: Bulk forming administration

Take with at least 240 ml 8 oz of water

Laxatives: Bulk Forming adverse effects

Impaction, F & E disturbance, esophageal blockage, gas formation

Laxatives safe in pregancy yes or no

Yes

Laxatives: Emollients (docusate) Example

Docusate

Laxatives: Emollients (docusate) MOA

Lubricants: directly lubricate fecal material & intestinal walls and prevent water from moving out of intestines (softens & expand stool.

Ex: mineral oil

MAKES IT SLIPPY

Stool softenersrs: faciliatates passage of water & fats into stool: docusate salts

Laxatives: Emollients (docusate) indications

Acute and chronic constipation, fecal impaction, facilitation of bowel movements in anorectal conditions

Prevention of straining during constipation. NOT long term use

Laxatives: Emollients (docusate) adverse effects

Skin rashes, decreased absorption of vitamins

Electroylte imbalances, lipid pneumonia

Laxatives: Hyperosmotics examples

Polyethylene glycol, magnesium citrate - Very potent total cleansing of bowel

Glycerin - mild often used in children

Lactulose - reduction of elevated serum ammonia levels, constipation

Laxatives: Hyperosmotics MOA

Hypertonic solutions, rapid action

pulls water into the bowel from surrounding tissues, softening stool and stimulating peristalsis.

Laxatives: Hyperosmotics indications

Diagnostic & surgical prep

Severe constipation

Laxatives: Hyperosomtics adverse effects

Abdominal bloating, electrolyte imbalances, rectal irritation, bloating

Laxatives: Hyperosomotic nursing teachings

bathroom privilege beside accomodaiton

Laxatives: Stimulants examples

Senna, biascodyl

Laxatives: Stimulants MOA

induce peristalsis via intestinal nerve stimulation, site of action is entire GI tract

Laxatives: Stimulants indications

Acute constipation

Diagnostic & surgical preps

Laxatives: Stimulants adverse effects

Most likely of all laxative classes to cause dependence.

Nutrient malabsorption, rashes, GI irritaiton, electrolyte imbalances, rectal irritation

Laxatives: Stimulants admin

Give biascodyl with water due to interactions with milk, antacids, & juices

Anticholinergic example

Scopolamine

Anticholinergic (Scopolamine): MOA

Naturally occuring cholinergic blocker.

Admin: Transdermal patch

Anticholinergic (Scopolamine): indications

motion sickness

post op nausea/vomiting

How to place

Anticholinergic (Scopolamine) patch

4-5 hours before TRAVEL or 1 hour before surgery. Remove 24-36 hours later

Anticholinergic (Scopolamine): adverse effects

dry mouth, drowsiness, blurred vision

Anticholinergic (Scopolamine): Contraindications

do not with other CNS depressants, anticholinergics

Prokinetic drugs example

Metoclopramide (IV & PO form)

Prokinetic Drugs (Metoclopramide): MOA

Blocks dopamine receptors in CtZ

Stimulates peristalsis in GI tract→ enhance empty of stomach contents

Prokinetic Drugs (Metoclopramide): Indications

Prevention of aspiration with tube feedings!

GERD, delayed gastric emptying

Prokinetic Drugs (Metoclopramide): conraindications

seizure disorder, gi obstruction

Prokinetic Drugs (Metoclopramide): Nursing teachings

interacts with alcohol

take 30 mins before meals

long term use may cause irreversible tardive dyskinesia

Serotonin blockers medication examples

any med ending with setron

OndanSETRON administraiton

PO, oral disintegrating tablets, IV

Serotnin blockers (-setron): MOA

Blocks seretonin receptors in GI tract, CTZ, and VC

Serotnin blockers (-setron): indications

N/V in clients receiving chemo

Post OP n/V

Hyperemesis Gravidarum

Serotnin blockers (-setron): adverse effects

QT prolongation, cardiac dysrhytmias, HA

When to give

Serotnin blockers (-setron):

Give 30-60 minutes before nausea starts

Diuretics therapeutic effects

Increase urine output

Decrease BP

Derease swelling/edema

Diuretics Common Adverse effects

Urinary: Polyuria

CNS: Dizziness, headache, weakness

GI: Nausea/vomiting, diarrhea

Diuretics common contras

hypotension

severe renal failure

Diuretics common patient edu:

Take when: Morning

Monitor: Urine I/O, electorlytes, daily WEIGHT

Change positions slowly

What to report ICP- weight gain, severe illness

Diuretics: Osmotic examples

Mannitol (IV)

Diuretics: Osmotics (mannitol): MOA

Work in proximal tubule, no absorbale producing an osmotic effect.

Pulls water into renal tubules from surrounding tissues

Diuretics: Osmotics (mannitol): indicaitons

Reduce ICP - treat cerebral edema (not peripheral)

Acute renal failure - early oliguric phase

Diuretics: Osmotics (mannitol): adverse effects

Serious: convulsions, thrombophlebitis, pulmonary congestion

Others: headache, nausea, vomiting

Diuretics: Osmotics (mannitol): Nursing teachings

be aware of crystals do not give it, use IV filter

monitor improvement in LOC

Thiazide Diuretics examples

hydrochlorothiazide

Thiazide Diuretics (hydrochlorothiazide): MOA

Will lose K+, Cl, NA, but gain glucose

Dilate arterioles by relaxation

Thiazide Diuretics (hydrochlorothiazide): indications

hypertension (First line for HTN)

Others: edema, idiopathic hypercalciuria

Thiazide Diuretics (hydrochlorothiazide): adverse effects

Steven’s Johnson Syndrome, skin cancer, electrolyte imbalance

Hypokalemia

Hyponatremia

Hypoglycemia