phm final

prevalence of peptic ulcers

25 million americans, 10-12%

robaxin use, adr

acute muscle pain
seizure, sedation, leukopenia

baclofen use, adr

muscle spasm, alcoholism
cns and anticholinergic

which muscle relaxant has withdrawal

baclofen

flexaril use, adr

muscle spasms
same as tricyclic seizure, arrythmia, anticholinergic, cns, sedation

zanaflex use, adr

back spasm, multiple scleoris, anticonvulsant
liver, hypotension, spasm, cns, GI

causes of peptic ulcers

H pylori

NSAIDS

stress related mucosal damage

how does H pylori cause ulcers

lives between mucus layer and surface epithelia, blocks protection

h pylori eradication

optimized bismuth quadruple therapy

rifapubtin triple

vonoprazan dual

optimized bismuth quadruple therapy drugs

helidac PPI- bismuth subsalicylate, metronidazole, tetracycline, PPI

pylera+PPI- bismuth subcitrate, metronidazole, tetracycline, PPI

why do NSAIDS increase ulcers

decrease prostaglandin production

GERD s/s

heartburn

acid regurgitation

belching

ab bloat

early satiety

nausea

antacid MOA, onset, duration

neutralize gastric acid

rapid onset

20-40 min fasting duration, 3 hr after meals

antacid types

aluminum

magnesium

calcium carbonate

sodium bicarb

combos

aluminum hydroxide drug names and ADR

ALternaGEL

amphojel

antacid

constipation

phosphate depletion

osteoporosis

hyperaluminemia in renal insuff

magnesium adrs and names

diarrhea

hypokalemia

hypermagnesemia

milk of magnesia

mag ox

calcium carbonate ADRs and names

calcium stone formation

acid rebound

milk-alkali syndrome

tums, chooz

sodium bicarbonate names and ADRs

alka seltzer

baking soda

systemic alkalosis

acid rebound

sodium overload

combo antacids names and ingredients

rolaid- calcium and magnesium

mylanta,maalox- magnesium, aluminum

antacid drug interactions

direct complexation (tetracyclin, bisphosphonates)

increased gastric pH, dec absorption (ketoconazole, iron)

patient education for antacids

take 1, 3 hr after meals and at bedtime

take 1 hr before or 2 hr after meds

shake, refrigerate, no milk w calcium

chew fully

gaviscon moa and use

mix of antacid and alginic acid

forms foam that floats on stomach liquid

works in upright

H2RA MOA ADR

decrease histamine release of acid from parietal cells

mild side effects

hormonal with cimetidine

H2RA drug names

cimetidine

famotidine

nizatidine

PPI drug names

end in -prazole

PPI MOA, ADR

decrease gastric acid by inhibiting secreting enzyme

80-95% decrease in acid

mild side effects- dizzy, drowsy, constipation

PPi long term use ADRS

pneumonia (in COPD especially)

osteoporosis

PPI duration and instructions

long duration

take 20-30 mins before first major meal

vonoprazan

novel PPI, acid stable

take day or night

very expensive

sucralfate MOA ADR use

protective barrier for peptic ulcers

constipation

use in chemo induced, burn wounds, radiation

simethicone drug names and use

mylicon

gas-x

mylanta gas

defoaming agent to prevent large gas bubble formation

anticholinergic use and adrs

simple nausea, motion sickness

drowsy, dry mouth, constipation

anticholinergic agents

transderm-scop

antivert

dramamine

serotonin receptor antagonists names, use, adrs

-setron ending

acute nausea and vomit

headache, constipation, diarrhea

dopamine antagonists agents, use, adr

phenergan, reglan

acute nausea and vomiting, general purpose

dizzy, confused

cannabinoids agents, use, adrs

dronabinol, nabilone

mild-mod nausea w minimal vomiting

sedation, dizziness, ataxia

corticosteroid agent, use, adrs

dexamethasone, methylprednisolone

used for chemo and post surgery vomiting

used short term to avoid systemic side effects

neurokinin antagonist agent, use, adrs

emend

chemo nausea and vomiting, post surgical

well tolerated, no adrs

drugs that cause constipation

opioids, Ca channel blockers, iron, Aluminum antacids, anticholinergics

constipation epidemiology

20% of population, 1/3 seek medical attention

red flags of constipation

blood

weight loss

fever

anorexia

nausea, vomiting

complications of constipation

excessive strain- anal fissure, hemorrhoids, rectal prolapse

fecal impaction or complete bowel obstruction

vibrant

drug free alternative for constipation that vibrates through colon

bulk forming laxative names

metamucil, citrucel, fibercon, benefiber

MOA, onset of bulk forming laxatives

absorb water to increase fecal mass, distends bowel

preventative

onset 12-72 hours

ADRs of bulk forming laxatives

flatulence, cramp, bloat

stool softeners (surfactants) names

docusate surfak (calcium)

docusate colace (sodium)

stool softener MOA onset ADR

wetting agent

onset 1-2 days

diarrhea

stimulants names

senna, biscodyl, castor oil

stimulants MOA, onset, ADR

irritate colon nerves

6-12 hr orally, 15-30 min suppository

ADR are ab cramps and diarrhea

which drug is associates with laxative dependency

stimulants

osmotic laxative names

hypertonic electrolytes (mg citrate, MOM, sodium phosphate, goLYTELY)

non absorbable sugar (lactulose, sorbitol)

polyethylene glycol (miralax)

glycerin 

osmotic laxatives MOA, onset, ADR

increase water content in bowel

dose dependent onset (quick though)

ADR are diarrhea, cramp, dehydration, electrolyte imbalance

which laxative is caution in renal failure

osmotic laxatives

lubricants type

mineral oil

lubricants MOA, onset

ease passage of stool

24-48 hr orally, minutes enema

ADR of lubricants

could be absorbed, inflammatory

lipid pneumonia

drug interaction with lubricants

absorb fat soluble vitamins

contraindications for laxatives

fecal impaction

bowel obstruction

acute surgical abdomen

nausea, cramp, abdominal pain

ulcerative colitis

diverticulitis (bulk forming ok)

adsorbent name

AD—→ATTA

attapulgite

adsorbents MOA, onset, ADR, DI

absorb extra fluid (clay)

12 hr-2 day

constipation

DI from complexation when not absorbed

antiperistaltic name

immodium A-D

antiperistaltic MOA, onset, ADR

prolongs intestinal transit time, GI opioid receptors

45-60 min

constipation, cramp, nausea

dosing of antiperistaltic

4 mg + 2 mg after a loose stool

max 16 mg/day

black box in diarrhea

antiperistaltic, cardiac arrythmia in higher than recommended dose

antisecretory names

pepto bismol

kaopectate

antisecretory MOA, onset

prevent secretion into bowel and antibiotic

4-24 hr onset

ADR for antisecretory

temporary dark tongue

IBS-C drugs

constipation

linzess, ibsrela, amitiza

IBS-D drugs

rifaximin

viberzi

tolerance, dependence, addiction

tolerance is needing bigger dose

dependence is withdrawal when stopped

addiction is both, disease

nociceptive vs neuropathic pain

nociceptive is from pain receptors

neuropathic is nerve injury

somatic vs visceral pain

somatic is from skin, bone, joint, muscle, tissue

visceral is from internal organs

somatic therapy options

heat.cold, exercise, massage

TENS, acupuncture, ultrasound

surgery, nerve block

is there a safe pain med for chronic pain

NO

simple analgesic examples, pros, cons

aspirin, acetominophen, NSAIDS

no tolerance or dependence, OTC

ceiling affect to pain relief

aspirin type, MOA, dose

salicylated NSAID

blocks COX 1, 2, CNS, PNS

antiplatelet

75-81 mg/day for antiplatelet

aspirin names and ADRs

ecotrin, ascriptin, bufferin

GI ulcer, anticoagulant, impaired kidney, tinnitis, headache, dizziness

why don’t you use aspirin for kids

Reyes syndrome, especially w viral infection

NSAID names

I’ve Now Kicked Knees In Every Direction

ibuprofen

naproxen

ketoprofen

ketorolac (STRONG)

indomethacin

etodolac

diclofenac

NSAID MOA and use

blocks COX 1, 2, CNS, PNS

analgesic, antipyretic, anti-inflammatory

ADRs of NSAID

renal dysfunction

GI ulcer

Black Box for NSAID

cardiovascular and GI ulcer or perforation

2nd gen NSAID AKA and names

selective COX 2 inhibitors

celocoxib, meloxicam

how do selective CoX 2 inhibitors work

and ADRS

block mostly just COX 2

increased risk of adverse cardiac events

also hold NSAID Black box

NSAID drug interactions

anticoagulants

glucocorticoids/steroids

alcohol

ibuprofen, low dose aspirin

acetaminophen name, MOA, use

tylenol

inhibit central COX only, not PNS

pain and fever only

acetopminophen dosing

4g/day max daily

3g/day max chronic

2g/day max heavy drinker or hepatic issue

acetominophen ADR

hepatotoxicity

topical NSAID name, use, ADRS

voltaren

for acute strains, sprains or hand/knee arthritis

only 50% decrease for 20% ppl

skin irritation

rubefacients type of drug, name, use

bengay

“THINK- RUBY FACE, RED SKIN, WARM SKIN”

topical pain relief

irritates skin to warm skin 

not very effective

capsaicin use, names, ADRS

zostrix, capzasin, solonpas

warms skin to stop pain

no good evidence for using

rash, rough skin, runny nose

topical lidocaine use, names, effectiveness

aspercreme, colarcaine

topical anesthetic

skin pain, post herpetic neuralgia

pretty ineffective

morphine like drugs

morphine

hydroporphone

oxymorphone

levorphanol

oxycodone

codeine

hydrocodone

meperidine like drugs

meperidine***

fentanyl***

remifentanyl

sufentanil

afentanil

morphine routes

PO, IV, IM, subQ, PR, IT

dilaudid (hydromorphone) differences from other morphines

more potent, IV IM subQ only

oxycodone difference from other morphines

PO only

less potent

many combo with ASA, APAP, ibuprofen

meperidine potency, ADR, duration

shorter duration

1/10 potency of morphine

liver turns it into normeperedine and can cause seizures in renal insufficiency

meperidine use

for Rigors post anesthesia