PathoPharm 1 Drugs (GI, vitamins, diabetes, obesity, thyroid)

Suffix: -tidine

suffix for H2 receptor antagonist

Suffix: -prazole

suffix for proton pump inhibitors

suffix: -prostol

suffix for protaglandin analogs

suffix: -setron 

suffix for antiemetics

funcion of antiacids

neutralize stomach acid to relief pain/heartburn 

antiacids stimulate secretion of

mucus, bicarbonate and prostaglandins

funcion of mucus

protective barrier against HCl

funcion of bicarbonate

helps buffer acidic properties of HCl

funcion of prostaglandins

prevents activation of proton pump

indication of antiacid use

acute relief of symptoms of GERD and PUD

common combination of antiacid drugs

simethicone - anti-flatulent drug

double funcion of magnesium

acid neutralizing and counteracts constipating effects of aluminum and calcium

indications of aluminum salts

GERD, heartburn, peptic ulcer disease and gastritis 

side effects of aluminum salts use

constipation, hypophosphatemia

manifestations of hypophosphatemia

anorexia, malaise, tremors, muscle weakness

special considerations with aluminum salts use

aluminum toxicity with prolonged use

often recommended for patients with renal disease (more easily excreted)  

indications of magnesium salts

GERD, intermittent heartburn, sometimes as a laxative

side effects of magnesium salt use

diarrhea

why is magnesium salt usually combined with Al

because its main side effects is diarrhea

special considerations for patients using magnesium salts

dangerous in renal failure

caution in patients with neuromuscular disease 

indications for use of calcium salts

GERD, heartburn relief, calcium supplementation

side effects of calcium salt use

constipating effects, hypercalcemia, hypophosphatemia, metabolic alkalosis

special considerations in using calcium salts

may lead to development of kidney stones (hypercalcemia)

indications for use of sodium bicarbonate

heartburn, GERD, upset stomach with headache/body pain

side effects of sodium bicarbonate use 

metabilic alkalosis with overuse gas (belching, distention)

special considerations for using sodium bicarbonate

avoid in heart failure, hypertension or renal disease

Maalox contains

aluminum hydroxide, magnesium hydroxide, simethicone

action of maalox

neutralizes gastric acid, promotes gastric mucosal defense mechanisms, anti-gas

indication for Maalox

peptic ulcer disease, GERD, gas pain, heartburn relief

contraindications for Maalox

renal impairment (hypermagnesemia or aluminum toxicity because kidneys can't excreted) 

common adverse effects for Maalox

constipation, decreased GI motility, hemorrhoids, stomach cramping

serious adverse effects for Maalox

prolonges use can cause hypophosphatemia (aluminum binds and decreases Phosphate absorption) 

special considerations for Maalox use

avoid aluminum antiacids in infants or young pediatric patients with kidney impairment

administration of Maalox

oral (liquid, suspension, tablet)

shake well suspension before taking

assessment during use of Maalox

monitor for relief of symptoms

assess renal disease history before use 

monitor for abdominal pain, distention and tenderness 

patient and family teaching for Maalox

take 1 hour before or after meals

avoid taking more than directed

maalox is an

antacid

nursing implications: antiacids - assess for:

allergies and preexisting conditions

nursing implications: antiacids - restrict use if:

fluid imbalance, renal disease, GI obstrubtion, HF or HTN, pregnancy

caution when using antacids with enteric-coated medications because

antacids can cause premature dissolving of those medications, resulting in stomach upset

problems that can arise with long-term self-medication with antacids

may mask symptoms of serious underlying diseases such as malignancy or bleeding ulcers

funcion of acid-controlling drugs

suppress acid secretion in the stomach

two classes of acid-controlling drugs

histamine (H2) receptor antagonists and proton pump inhibitors

how do H2 receptor antagonists work?

inhibit histamine at H2 receptors within gastric parietal cells, inhibiting gastric acid secretion 

how do proton pump inhibitors work?

inhibit parietal cells which release positive hydrogen ions (protons) during HCl production - H+ is not released = no gastric acid secretion

therapeutic classification of famotidine

antiulcer agent

pharmacologic class of famotidine

H2 receptor antagonist

Smocking _______ the effectiveness of H2 blockers

decreases

actions and uses of famotidine

promotes healing of ulcers and reduces irritation from acid reflux by selectively blockingH2 receptors in the stomach lining 

indications for famotidine

peptic ulcers, GERD, heart burn, indigestion, sour stomach, prevention of stress-induced ulcers in critically ill patients

famotidine is contraindicated in

hypersensitivity to famotidine or other H2 blockers

caution in renal impairment and elderly 

common adverse effects famotidine

headache, dizziness, fatigue, confusion

constipation, diarrhea, nausea

rash, pruritus

serious adverse effects famotidine

rara bone marrow suppression, hallucinations, seizures

arrhythmias, hypotension with rapid infusion (IV)

special considerations famotidine

avoid long-term use without medical supervision

IV administration: give slowly over >2 minutes

famotidine administration routes

PO, IV, IM

can be OTC

famotidine administration for patients with ULCERS

given at bedtime to suppress nocturnal acid secretion

assessment during use of famotidine

monitor for relief of GERD/ulcer symptoms

assess for confusion, dizziness or headache

monitor CBC with prolonged therapy 

evaluate for adverse GI effects 

patient and family teaching famotidine

take as directed, even if feeling better

do not double doses 

avoid smoking, alcohol, caffeine, and NSAIDs

report black/tarry stools, coffee-ground emesis, or persistent abdominal pain 

notify provider if confusion, dizziness or irregular heartbeat

discuss with provider if needed > 2 weeks

omeprazole therapeutic classification

antiulcer agent

omeprazole pharmacologic class

proton pump inhibitor (PPI)

omeprazole action and use

suppresses the final step of gastric acid secretion, leading to a profound and prolonged reduction in stomach acid

indications for omeprazole

short term treatment of GERD

peptic ulcer disease 

erosive esophagitis 

zollinger-ellison syndrome and other hypersecretory conditions 

used with antibiotics for H. pylori eradication 

OTC use: frequent heartburn 

omeprazole is contraindicated in

hypersensitibity to omeprazole or other PPIs

caution with hepatic impairment 

caution in long-term therapy 

common adverse effects omeprazole

nausea, vomiting, diarrhea, constipation, abdominal pain, flatulence

headache, dizziness, fatigue 

upper respiratory infection symptoms 

serious adverse effects omeprazole

increased risk of C. diff associated diarrhea

long term use associated with osteoporosis-related fractures (OLDER PATIENTS)

vit b12 deficiency 

acute interstitial nephritis 

rare severe hypersensitivity reactions 

special considerations for omeprazole: dose

use the lowest effective dose for the shortest duration necessary

special considerations for omeprazole: monitoring

mag and vit B12 levels with long-term therapy

drug interaction for omeprazole

amphetamines

administration of omeprazole: route

PO or IV

swallow capsules/tablets whole, don't crush or chew (enteric-coated for acid protection) 

when to take omeprazole

before meals, preferably in the morning

therapy with omeprazole is often limited to

4 - 8 weeks

assessment during use of omeprazole

improvement in symptoms

assess for abdominal pain, diarrhea or persistent GI symptoms

assessment during long term use of omeprazole

monitor magnesium, vitb12 and bone density if long term therapy 

evaluate liver funcion

patient and family teaching: omeprazole

take medication 30-60 minutes before eating

do not self treat for more than 14 days OTC

report persistent diarrhea, abdominal pain or black/tarry stools 

stress importance of completing antibiotic regimen if prescribed for H. pylori 

long term users should ensure adequate calcium and vit D intake 

therapeutic classification of misoprostol

antiulcer agent

cytoprotective agent

pharmacologic class of misoprostol

prostaglandin E1 analog

actions of misoprostol

binds to prostaglandin receptors on gastric parietal cells = increases bicarbonate and mucus production in stomach lining 

reduces gastric acid secretion 

indications for use of misoprostol

prevention of NSAID-induced gastric ulcers in high-risk patient 

off label: inducation of labor and management of postpartum hemorrhage

misoprostol is contraindicated in

pregnancy: causes uterine contractions, miscarriage, congenital malformations

hypersensitivity to prostaglandins

common adverse effects: misoprostol

diarrhea, abdominal pain, cramping, nausea, flatulence 

spotting, dysmenorrhea in women 

serious adverse effects: misoprostol

uterine rupture

rare hypersensitivity reactions

special considerations for use of misoprostol in women

women of childbearing age must use effective contraception during therapy

should be discontinued if pregnancy is suspected 

combined with mifepristone for medical termination of pregnancy 

administration of misoprostol

PO (tablet)

for ulcer prevention, take with meals and at bedtime 

always given with NSAID therapy in high-risk patients to protect the stomach

assessment during use of misoprostol

monitor for GI effects, assess for pregnancy status

patient and family teaching for misoprostol

take exactly as prescribed and with food

report severe diarrhea, abdominal pain, or vaginal bleeding

use reliable contraception during therapy  

3 classes of anti-emetic medications

antihistamine drugs (H1 receptor blockers)

prokinetic drugs 

serotonin blockers 

function of antihistamine drugs

prevents cholinergic stimulation in vestibular/reticular areas, preventing nausea and vomiting

function of prokinetic drugs

blocks to dopamine receptors in the chemoreceptor tigger zone and causes this zone to be desensitized to impulses from GI tract 

stimulates peristalsis in GI tract

function of serotonin blockers

prevents the reuptake or blocks the action of serotonin

often used in patients receiving chemotherapy or postoperative

therapeutic classification of metoclopramide

antiemetic

pharmacologic class of metoclopramide

prokinetic

indications for use of metoclopramide

GERD when failed traditional therapy

chemotherapy induced nausea/vomiting

postoperative nausea

metoclopramide is contraindicated in

some neurological disorders

not used for > 12 weeks

common adverse effects metoclopramide

abdominal cramps, diarrhea

acute dystonia, pseudo-paskinsonism

serious adverse effects metoclopramide

CNS toxicity (restlessness, fatigue, drowsiness, depression)

tardive dyskinesia with chronic use (chronic repetitive, involuntary movements) - irreversible

special considerations for metoclopramide use - female

hyperprolactinemia/galactorrhea (increased milk production)

special considerations for metoclopramide use - male

gynecomastia, erectile dysfuncion

administration of metoclopramide

Oral (tablets of solution)

IV, IM, intranasal (IV: direct push or continuous infusion) 

assessment during use of metoclopramide

monitor neurological chances and improvement of nausea/vomiting

patient and family teaching metoclopramide

take exactly as prescribed, 30 min before meal

report depression, restlessness, uncontrollable movements