GI, Immune & Pain-Relief Pharmacology

Vocabulary flashcards covering key drugs, classes, mechanisms, therapeutic uses, side effects and nursing considerations from the GI, immune and analgesic pharmacology lecture.

Peptic Ulcer Disease (PUD)

Upper-GI disorder involving erosion of gut wall; most often caused by H. pylori infection or chronic NSAID use.

Helicobacter pylori

Spiral bacterium that colonizes stomach mucosa and is the primary infectious trigger of PUD.

Gastroesophageal Reflux Disease (GERD)

Back-flow of stomach acid into esophagus; hallmark symptom is heartburn; H. pylori not involved.

Aggravating Factors for PUD

Smoking, NSAIDs, stress, alcohol; all delay ulcer healing or increase acid injury.

Proton Pump Inhibitors (PPIs)

-prazole drugs that irreversibly suppress gastric H⁺/K⁺-ATPase and markedly lower stomach acid.

Omeprazole

Prototype PPI; taken once daily 30–60 min before meals; long-term use linked to osteoporosis, hypomagnesemia and C. difficile.

Esomeprazole

Isomer of omeprazole (brand Nexium); same PPI class and cautions.

Pantoprazole

IV-capable PPI (brand Protonix) often used when oral route not possible.

Lansoprazole

PPI (brand Prevacid); available in orally disintegrating tabs.

Administration Rule for PPIs

Swallow whole; capsules may be opened and granules sprinkled on soft food but must not be chewed or crushed.

Histamine-2 Receptor Blockers (H2 blockers)

-tidine drugs that competitively block gastric H2 receptors, decreasing acid and pepsin output.

Famotidine

H2 blocker (Pepcid); preferred due to minimal CYP interactions; risk of confusion in elders.

Ranitidine

H2 blocker (Zantac); withdrawn/restricted in some markets for NDMA impurity concerns.

Cimetidine

First H2 blocker (Tagamet); crosses BBB, causes confusion & many drug interactions via CYP inhibition.

Talicia

Fixed-dose combo of amoxicillin + rifabutin + omeprazole; 4 caps TID x14 days for H. pylori eradication.

Antacids

Basic compounds that neutralize stomach HCl; provide rapid symptomatic relief of dyspepsia & GERD.

Calcium Carbonate

Tums; potent, fast antacid; excessive use (>10/day) risks hypercalcemia & arrhythmias.

Magnesium Hydroxide

Milk of Magnesia; antacid and osmotic laxative; common SE is diarrhea.

Aluminum Hydroxide

Antacid that tends to cause constipation; often combined with magnesium to balance bowel effects.

Mylanta

Commercial mix of magnesium + aluminum salts that neutralizes acid while minimizing diarrhea/constipation.

Sucralfate

Mucosal protectant forming viscous barrier over ulcers; give on empty stomach 1 h before or 2 h after meals.

Bismuth Subsalicylate

Pepto-Bismol; coats ulcers, has mild antimicrobial & anti-secretory actions; also antiemetic.

Bulk-Forming Laxatives

Non-digestible fiber (e.g., psyllium) that swells with water to soften stool in 1–3 days (Group 3).

Psyllium

Metamucil; bulk-forming fiber laxative; take with full glass of water.

Surfactant Laxatives

Stool softeners (e.g., docusate sodium) that lower surface tension allowing water into stool (Group 3).

Docusate Sodium

Colace; surfactant laxative used to prevent straining in cardiac or post-op patients.

Stimulant Laxatives

Bisacodyl & senna; increase intestinal motility producing semi-fluid stool in 6–12 h (Group 2); risk dependence.

Bisacodyl

Dulcolax; stimulant laxative available PO or suppository (rectal faster).

Senna

Senokot; stimulant laxative that may discolor urine brown-pink.

Osmotic Laxatives

Polyethylene glycol, magnesium salts; draw water into bowel creating watery stool in 2–6 h (Group 1).

Polyethylene Glycol (PEG)

Golytely / Miralax; bowel prep or short-term constipation; watch for dehydration and electrolyte shifts.

Mineral Oil Enema

Lubricates fecal mass; SE includes anal leakage and lipid pneumonitis if aspirated.

Loperamide

Imodium; peripheral µ-opioid agonist that slows gut transit; may cause QT prolongation at high doses.

Ondansetron

Zofran; 5-HT₃ antagonist antiemetic; SE headache & dose-related QT prolongation.

Metoclopramide

Reglan; dopamine blocker & prokinetic; risk of sedation, diarrhea, tardive dyskinesia with long-term use.

Promethazine

Phenergan; H1 blocker with antiemetic & sedative properties; IV can cause severe tissue necrosis (extravasation).

Hyoscyamine

Antispasmodic anticholinergic for IBS; BEERS list drug causing dry mouth, blurred vision, urinary retention.

Dicyclomine

Bentyl; similar antispasmodic with anticholinergic side effects.

Cyclosporine

Calcineurin inhibitor immunosuppressant for transplant rejection prophylaxis; notable nephrotoxicity & drug interactions (CYP3A4).

Tacrolimus

More potent calcineurin inhibitor; narrow therapeutic index; avoid grapefruit; DO NOT crush ER capsules.

Methotrexate

Antimetabolite DMARD that inhibits folate pathways; give weekly with folic acid supplementation.

Glucocorticoids

-sone / ‑solone steroids that suppress inflammation and immunity; chronic use causes Cushingoid effects.

Monoclonal Antibodies (-mab)

Biologic immunosuppressants targeting specific cytokines; must be refrigerated and monitored for infusion reactions.

First-Generation H1 Antagonists

Diphenhydramine, promethazine, hydroxyzine; cross BBB, highly sedating, significant anticholinergic effects.

Second-Generation H1 Antagonists

Loratadine, cetirizine, fexofenadine; non-sedating because they poorly cross BBB; avoid fruit juices with fexofenadine.

Cyclo-oxygenase-1 (COX-1)

Constitutive enzyme producing prostaglandins that protect gastric mucosa, support renal blood flow, and aid platelet aggregation.

Cyclo-oxygenase-2 (COX-2)

Inducible enzyme up-regulated by tissue injury; generates prostaglandins responsible for pain, fever, and inflammation.

Non-steroidal Anti-inflammatory Drugs (NSAIDs)

Agents (ibuprofen, naproxen, aspirin, celecoxib) that inhibit COX-1 and/or COX-2 to reduce pain, fever, inflammation.

Aspirin (Acetylsalicylic Acid)

Irreversible COX inhibitor providing antiplatelet, analgesic, antipyretic, anti-inflammatory effects; risk GI bleed, tinnitus, Reye’s syndrome.

Ibuprofen

Motrin/Advil; non-selective NSAID; less antiplatelet effect than aspirin but linked to thrombotic events.

Naproxen

Aleve; longer half-life NSAID; similar cautions as ibuprofen.

Celecoxib

Celebrex; selective COX-2 inhibitor; highest NSAID risk for cardiovascular events.

Acetaminophen

Tylenol; analgesic & antipyretic without anti-inflammatory or antiplatelet effect; hepatotoxic in doses >4 g/24 h.

N-Acetylcysteine (NAC)

Antidote for acetaminophen overdose; restores hepatic glutathione; most effective within 8 h of ingestion.

Reye’s Syndrome

Potentially fatal hepatic-encephalopathy in children taking aspirin during viral illness.

Beers Criteria

List identifying potentially inappropriate medications in older adults (e.g., first-gen antihistamines, non-selective NSAIDs, antispasmodics).