NR565 Week 7 & 8 Study Guide questions and answers with accurate solutions 2026(PASSED)

Antacids Pharmacodynamics

Neutral salts or low-acidic salts are produced when gastric acid reacts with antacids. The destruction of the stomach's wall is lowered when these drugs neutralize the acid in this location. With antacid use, pepsin activity may be decreased if the gastric pH is increased above 5. Additionally, prostaglandin production is accelerated with antacid use, which can strengthen mucosal protection. It is important to note that antacids do not place a protective barrier or coating over the ulcer from pepsin or acid. Antacid absorption is poor, with the exception of sodium bicarbonate, thus, systemic pH is not modified.

Antacids Pharmacokinetics

renally eliminated

Antacids Pharmacotherapeutics

severe renal failure, and GI obstruction. The four basic antacid mechanisms that cause interactions are: Absorption of other drugs to antacids, which reduces the ability of the other drug to be absorbed into the body. Chelation, which is the chemical inactivation of other drugs that produces insoluble complexes Increased stomach pH, which increases the absorption of basic drugs and decreases the absorption of acidic drugs. Increased urinary pH, which increases the excretion of acidic drugs and decreases the excretion of basic drugs. Most drugs are either weak acids or weak bases. Therefore, pH conditions in both the GI and urinary tracts will affect the extent to which drug molecules are absorbed. Benzodiazepines, sulfonylureas, sympathomimetic acid, and valproic acid are drugs that may be chemically enhanced by antacid presence (due to the effects of pH). The efficacy of other drugs, such as anticonvulsants (e.g., phenytoin sodium), is reduced when antacids are present because antacids impede the GI absorption of the drugs. When the quinolone antibiotics (ciprofloxacin, levofloxacin, moxifloxacin), which are orally administered to treat serious infections, are given with antacids, severe harm may occur to a patient because antacids can reduce absorption of the antibiotics by more than 50%.

Antacids Clinical indications & dosing

Peptic ulcer disease (PUD) is the primary indication for antacid use. The healing rates are equal to that of H2RAs. In the past, antacids were primarily used for antiulcer therapy; however, newer options have replaced these drugs (H2RAs, PPIs, sucralfate) that are just as beneficial and effective, with easier administration, and cause fewer side effects. Aspiration pneumonitis is prevented by antacid administration before anesthesia. In addition, medication can be used to prevent and treat stress-induced ulcers. GERD patients can have relief from antacid use, but unfortunately, healing is not accelerated. Even though antacid use is generally used by the public, there are no studies that show the effectiveness of antacid use for symptoms such as dyspepsia, heartburn, and indigestion. It is essential for the nurse to administer antacids appropriately, follow accurate dosing parameters, and properly monitor lab values closely to avoid adverse effects. Before administering, shake suspension well and follow with water. Due to the delay in other drug absorption, antacid administration should be avoided with other oral drugs. Antacids should not be given with tetracycline, digoxin, or quinidine, because it binds with and inactivates most of the drug. Therefore, antacids should be given 1 to 2 hours after other medications. Monitor electrolytes, urinary pH, calcium, and phosphate levels after antacid administration. Drug (Pregnancy Category) aluminum hydroxide (Amphojel) (A) aluminum hydroxide and magnesium hydroxide (Maalox, Mylanta) (A) calcium carbonate (Tums) (A) magnesium hydroxide (milk of magnesia) (A) Pharmacologic Class Aluminum-containing antacid Combination antacid Calcium-containing antacid Magnesium-containing antacid Usual Adult Dosage Range Adult PO: 600-1500 mg 3-6 times per day Adult 400-2400 mg 3-6 times per

Antacids ADRs and contraindications

Magnesium containing products, especially Milk of Magnesia, can cause diarrhea. Constipation can result from both the aluminum- and calcium-containing formulations. The combination of aluminum and magnesium hydroxide is favored because the side effects are then decreased. Kidney stones can develop from the calcium products. Systemic alkalosis can result from extreme antacid use, which primarily occurs with sodium bicarbonate use. Excess sodium, which is present in some antacid preparations, can worsen hypertension and heart failure. Patients with these conditions should avoid the formulations that have high sodium content. Rebound hyperacidity, or acid rebound is an adverse effect the patient experiences with the discontinuation of antacids. This adverse effect mainly occurs with calcium-containing products. Serious diseases, such as cancer or bleeding ulcers, may be masked with long-term antacid use. Therefore, ongoing symptoms must be checked and evaluated because other medical interventions may be required.

Antacids Patient Education

Proper patient education regarding administration of antacids is important for the nurse and patient. Below are some key points to include with the patient when teaching: Emphasize the importance of taking antacids correctly. Tablets that are chewable must be completely chewed and followed with water. Drink 2-4 ounces of water after taking the liquid antacid. Gastric emptying time increases when the amount of water with antacids increases. Report pain, coughing, or vomiting of blood. Take the antacid 1 to 3 hours after meals and at bedtime. The patient does not need to take antacids at mealtime; they slow gastric emptying time, causing increased GI activity and gastric secretions. Taking an unlimited amount of the antacid is contraindicated. Do not take the antacids with milk or foods high in vitamin D. Avoid taking antacids within 1 to 2 hours of other oral medications, because they may interfere with absorption. Follow a sodium-restricted diet and monitor antacid labels for sodium content.C onsult with their health care provider before taking antacids for longer than 2 weeks. Guide patient on the use of relaxation techniques.

Antidiarrheals Pharmacodynamics

block stimulation of the GI tract for symptomatic relief from diarrhea. Available agents include bismuth subsalicylate (Pepto-Bismol), crofelemer (Fulyzag), loperamide (Imodium), and opium derivatives (Paregoric). Several antidiarrheal products are available in combination (Box 58.3). There is also a drug approved strictly for use in treating traveler's diarrhea

Antidiarrheals Pharmacokinetics

Kaolin and pectin act locally in the bowel and are not systemically absorbed. Bismuth subsalicylate undergoes chemical dissociation in the GI tract; the salicylate moiety is absorbed, with plasma levels similar to those of aspirin. There is only negligible absorption of the bismuth moiety. Diphenoxylate with atropine and difenoxin with atropine are both well absorbed from the GI tract. The salicylate portion of bismuth subsalicylate is metabolized in the liver and more than 90% is excreted in urine. Diphenoxylate with atropine is rapidly and extensively metabolized to diphenoxylic acid, which is biologically active and its main metabolite. It is excreted in urine and feces.

Antidiarrheals Pharmacotherapeutics

Drugs that reduce intestinal motility or delay intestinal transit time have induced toxic megacolon, especially in patients with inflammatory bowel disease. Diphenoxylate with atropine, difenoxin with atropine, and loperamide should be used cautiously for these patients and promptly discontinued if abdominal distention occurs. Because of their hepatic metabolism and renal excretion, these drugs should also be used with extreme caution in patients with advanced hepatorenal disease and in all patients with abnormal liver function studies because hepatic coma may occur.

Antidiarrheals Clinical indications & dosing

After the cause of the diarrhea has been determined and, if possible, eliminated, absorbent preparations are commonly used for relief of symptoms in adults. Kaolin-pectin or bismuth subsalicylate taken after each loose stool may be effective. The majority of acute diarrheal illnesses are self-limiting, and the main concern is to maintain hydration.

Antidiarrheals ADRs

The main adverse drug reaction for all traditional antidiarrheals is rebound constipation. For bismuth subsalicylate, additional reactions that all patients should be warned about are gray/black stools and black tongue, the results of the bismuth. Patients should be told to expect this reaction and that it does not indicate GI bleeding.

Antidiarrheals Monitoring

There is no specific monitoring beyond that required for the disease process being treated. Patients with chronic diarrhea may benefit from monitoring of hydration status and electrolyte studies.

Antidiarrheals Patient Education

Patients need to be informed that they should take the antidiarrheal exactly as directed; to not make up missed doses or double the doses, and to not exceed the maximum number of doses recommended for 24 hours. The health-care provider should be notified if the diarrhea continues beyond 48 hours or if abdominal pain, fever, or distention occurs.

Antidiarrheal Clinical Pearl

Oral Rehydration Therapy

Evaluation of the effectiveness of oral rehydration is based on at least three wet diapers per 24 hours in infants. For children older than 1 year, avoid all fruit juices and other drinks that contain fructose because they usually make the diarrhea worse. If the infant or child is drinking milk or lactose-based formula, try withholding milk or lactose products. Probiotics may decrease the duration of diarrhea. Resolution of the diarrhea suggests lactose intolerance.

Cytoprotectives Pharmacodynamics

Sucralfate is a basic aluminum salt of a sulfated disaccharide, which is believed to act by polymerization and selective binding to necrotic ulcer tissue, where it covers the ulcer site and acts as a barrier to acid, pepsin, and bile salts. It has no acid-neutralizing activity, and little is absorbed, although some aluminum salts are released. In addition, the drug may directly absorb bile salts and stimulate endogenous prostaglandin synthesis. Prostaglandins are central to the formation and maintenance of the protective mucosa of the GI tract.

Cytoprotectives Pharmacokinetics

Sucralfate is minimally absorbed. Its action is largely topical. Misoprostol is rapidly and extensively absorbed after oral administration. Distribution of this drug is unknown. Sucralfate is essentially not absorbed; more than 90% is excreted in feces. Misoprostol is rapidly converted to its free acid, which is responsible for its clinical activity.

Cytoprotectives Pharmacotherapeutics

Sucralfate's action is topical; there are no specific precautions or contraindications. It is Pregnancy Category B. Its safety and efficacy have not been established in children.

Cytoprotectives Clinical indications & dosing

Prophylaxis and Treatment of Duodenal Ulcers Associated With NSAID. Treatment of Duodenal Ulcers From Other Causes.

Cytoprotectives ADRs

Adverse reactions in clinical trials with sucralfate were minor and rarely led to discontinuance of the drug. Constipation, the most frequent complaint. Other adverse reactions, including dizziness and gastric discomfort.

Cytoprotectives Monitoring

No specific monitoring parameters exist for these drugs. Monitoring should relate to the disease process being treated. Women of childbearing age should have a negative pregnancy test before misoprostol is prescribed to them.

Cytoprotectives Patient Education

Patients should be taught to take the drug exactly as prescribed. Sucralfate is taken on an empty stomach; misoprostol with food. Patients should not take antacids while taking sucralfate. Advise the patient to continue the therapy even if feeling better. Sucralfate is given for 4 to 8 weeks to ensure ulcer healing; misoprostol is given for the duration of NSAID therapy. Missed doses should be taken as soon as remembered unless it is almost time for the next dose. Doses should not be doubled. Women of childbearing age should have a negative pregnancy test and start misoprostol on day 2 or 3 of their menstrual period.

Antiemetics Pharmacodynamics

Antihistamines that possess significant antiemetic activity have strong anticholinergic effects as well as histamine1-blocking effects. Blockade of histamine1 receptors results in decreased exocrine gland secretion (e.g., salivary and lacrimal). First-generation antihistamines with strong anticholinergic properties bind to central cholinergic receptors and produce antiemetic effects, decreasing nausea and vomiting. They are especially helpful in the nausea associated with motion sickness because of their depression of conduction in the vestibulocerebellar pathway. The antiemetic drugs in this class are dimenhydrinate, diphenhydramine, hydroxyzine, and meclizine.

Antiemetics Pharmacokinetics

All of the antiemetic drugs (except for transdermal scopolamine) are well absorbed after oral administration. Oral liquid formulations provide the most reliable absorption. The antihistamines, phenothiazines, 5-HT3 receptor antagonists, and aprepitant come in IV form. Prochlorperazine, promethazine, and trimethobenzamide have formulations for administration by the rectal route. The IM and rectal routes are commonly used when vomiting is present. Scopolamine is available as a transdermal patch and is well absorbed through the skin behind the ear.

Antiemetics Pharmacotherapeutics

The drug class determines the precautions and contraindications. Antihistamines have anticholinergic properties and have precautions and contraindications similar to anticholinergics. Cautious use in narrow-angle glaucoma, seizure disorders, pyloric obstruction, hyperthyroidism, cardiovascular disease, and prostatic hypertrophy is in order. Because they are metabolized so extensively by the liver, they are contraindicated in severe liver disease. Cautious use is also suggested for older adults, and dosage reductions may be required.

Antiemetics Clinical indications & dosing

The only clinical use presented here is to treat nausea and vomiting.

Antiemetics ADRs

The most common adverse reactions for antihistamines are drowsiness and the common anticholinergic effects of dry mouth, blurred vision, and urinary retention. Paradoxical excitation may occur in children. Pain at the injection site occurs in IM injections.

Antiemetics Monitoring

When antiemetic drugs are used for a single dose or very short-term, no specific monitoring is required beyond that associated with the disease process and the potential fluid and electrolyte shifts that may result from vomiting. If treatment is needed for longer than a few days, the following monitoring parameters are suggested. Promethazine has been associated with bone marrow depression. A complete blood count (CBC) prior to initiation of therapy is appropriate. Phenothiazines have also been associated with blood dyscrasias that tend to occur between week 4 and week 10 of therapy. A CBC may be done prior to initiation and after 4 weeks of therapy.

Antiemetics Patient Education

These drugs should be taken as prescribed (Table 20-12). Each of them has special considerations related to administration, which are presented in Table 20-12. All of the drugs used to treat motion sickness should be taken 1 to 2 hours prior to departure, except for extended-release dimenhydrinate, which is taken 12 hours before departure. For all liquid formulations, a calibrated measuring device should be used to attain an accurate dose. All injections should be administered deep into well-developed muscle, avoiding the deltoid and subcutaneous (SC) injections. A Z-track method of injection should also be used for hydroxyzine. All tablets except extended-release ones can be crushed or mixed with food, water, or milk to minimize GI distress and for patients who have difficulty with swallowing. Capsules can be opened and emptied to allow mixing for the same reasons. Transdermal scopolamine is applied to the hairless area behind one ear at least 4 hours before the antiemetic effect is needed and may be left in place for up to 3 days. If therapy is required for longer than 3 days, the patch should be removed and a new patch placed behind the other ear.

Histamine 2 Receptor Antagonists Pharmacodynamics

Gastric parietal cells have three receptors that can be stimulated to cause the parietal cell to produce H+: acetylcholine, gastrin, and histamine2. H2RAs are reversible competitive blockers of histamine at histamine2 receptors. They are highly selective, do not affect histamine1 receptors, and are not anticholinergic agents. They are potent inhibitors of all phases of gastric acid secretion, including that caused by muscarinic agonists and gastrin.

Histamine 2 Receptor Antagonists Pharmacokinetics

All drugs in the class are well absorbed following oral administration. The absorption of cimetidine, famotidine, and ranitidine may be decreased by antacids but is unaffected by food. The absorption of nizatidine is decreased by 10% by aluminum and magnesium hydroxides. With food, AUC and maximum concentration of nizatidine increases by 10%. Cimetidine and ranitidine also have IM routes of absorption. All agents enter breast milk and cerebrospinal fluid.

Histamine 2 Receptor Antagonists Pharmacotherapeutics

Renal impairment requires cautious use of the H2RAs and dosage adjustments. Patients with renal impairment are more subject to the CNS adverse reactions. Older adults may have reduced renal function, and these drugs should be used cautiously with this age group. Cimetidine seems to have the most problems with decreased renal clearance, and ranitidine the fewest.

Histamine 2 Receptor Antagonists Clinical indications & dosing

Gastroesophageal Reflux Disease, Peptic Ulcer Disease, Heartburn, Acid Indigestion, and "Sour Stomach"

Histamine 2 Receptor Antagonists ADRs

All of these drugs have similar adverse reaction profiles. Cimetidine appears to have the greatest degree of antiandrogenic reactions (e.g., gynecomastia and impotence). Reversible CNS adverse reactions (e.g., mental confusion, agitation, psychosis, depression, and disorientation) have also occurred with this drug.

Histamine 2 Receptor Antagonists Monitoring

Because of the potential for hepatocellular damage, patients who require higher doses or more than short-term use of this class of drugs should have laboratory testing of liver function prior to initiation of therapy and at regular intervals throughout therapy.

Histamine 2 Receptor Antagonists Patient Education

Instruct patients to take the drug as prescribed for the full course of therapy, even if they are feeling better. If a dose is missed, it should be taken as soon as remembered but not if it is almost time for the next dose. They should not double doses. H2RA should be taken with meals or immediately afterward and at bedtime to achieve the best effects. Doses taken once daily are best taken at bedtime.

Prokinetics Pharmacodynamics

Metoclopramide stimulates motility in the upper GI tract. Its mode of action is unclear but appears to be related to sensitizing tissues to the action of acetylcholine. The action does not depend on an intact vagal innervation system, but anticholinergic drugs can reverse the action. This drug increases the tone and amplitude of gastric contractions, relaxes the pyloric sphincter and duodenal bulb, and increases peristalsis of the duodenum and jejunum, resulting in accelerated gastric emptying and increased speed of gastric transit. It has almost no effect on the colon or gallbladder, nor does it stimulate gastric, biliary, or pancreatic secretions.

Prokinetics Pharmacokinetics

Metoclopramide is well absorbed after oral administration and has an injectable formulation. It has low protein binding and high bioavailability.

Metoclopramide is widely distributed throughout body tissues, crosses the blood-brain barrier and the placenta, and enters breast milk in concentrations greater than in plasma.

Prokinetics Pharmacotherapeutics

Metoclopramide has a Black-Box Warning because of the risk of developing tardive dyskinesia. The risk for tardive dyskinesia increases with the length of treatment. Metoclopramide should be discontinued if patients develop signs of movement disorder. Treatment should not exceed 12 weeks, except in rare cases.

Prokinetics Clinical indications & dosing

Gastroesophageal Reflux Disease, Nausea and Vomiting, Diabetic Gastroparesis

Prokinetics ADRs

The most serious adverse reaction are EPS, including acute dystonic reactions and the development of tardive dyskinesia and parkinsonian-like symptoms. Children and young adults more frequently develop EPS with metoclopromide use. Metoclopromide should be discontinued in any patient exhibiting movement disorders. There have been rare reports of neuroleptic malignant syndrome in patients taking metoclopramide. Other adverse reactions associated with metoclopramide include depression, dizziness, diarrhea, and hypoglycemia in patients with diabetes.

Prokinetics Monitoring

Because of the need to adjust dosage in the presence of renal impairment, renal function should be assessed before therapy with metoclopramide is begun. Patients should be educated about and monitored for movement disorders or EPS. No other monitoring is required except that for the disease process being treated.

Prokinetics Patient Education

Advise the patient to take the drug exactly as prescribed. Metoclopramide is taken 30 minutes before each meal and at bedtime. If a dose is missed, it should be taken as soon as the patient remembers unless it is almost time for the next dose. Patients should not double doses or exceed the recommended dose.

Proton Pump Inhibitors Pharmacodynamics

PPIs do not exhibit anticholinergic or histamine2-blockade properties but suppress gastric acid secretion These drugs reduce H+ secretion by inhibition of the H+/K+/ATPase enzyme system at the secretory surface of the parietal cell itself to block the final step in H+ secretion. The effect is dose-related and inhibits basal and stimulated acid secretion regardless of the stimulus.

Proton Pump Inhibitors Pharmacokinetics

All of the PPIs are acid labile and so most are formulated as enteric-coated tablets or granules. Absorption is rapid and begins after the granules leave the stomach and reach the less acidic duodenum. Peak plasma concentrations are approximately proportional, but because of a saturable first-pass effect, omeprazole has a greater-than-linear response when given in doses above 40 mg.

Proton Pump Inhibitors Pharmacotherapeutics

The only true contraindication to the PPIs are hypersensitivity to the ingredients. The PPIs are extensively metabolized in the liver; therefore, they should be used cautiously in patients with hepatic dysfunction and in the elderly. No dosage adjustments are recommended for these patients, however.

Proton Pump Inhibitors Clinical indications & dosing

Duodenal and Gastric Ulcers, Gastroesophageal Reflux Disease, Hypersecretory Conditions (Including Zollinger-Ellison Syndrome)

Proton Pump Inhibitors ADRs

These drugs are generally well tolerated when used for short-term treatment, and the adverse reactions that did occur in more than 1% of patients in clinical trials included dizziness, drowsiness, abdominal pain, constipation, diarrhea, and flatulence. It is difficult to determine if the GI-related symptoms were associated with the disease or the drug.

Proton Pump Inhibitors Monitoring

The only monitoring relates to the disease process being treated. However, patients taking proton pump inhibitors to treat ulcers should be tested for H. pylori infection. Patients taking PPIs should stop therapy for 2 weeks before undergoing urea breath testing to diagnose this infection or be tested via stool antigen testing. PPIs alone rarely eradicate H. pylori infection, but they can suppress it so that testing during antisecretory therapy may lead to false-negative results.

Proton Pump Inhibitors Patient education

Patients should take the drug exactly as prescribed, even if they are feeling better. If a dose is missed, it should be taken as soon as the patient remembers it, unless it is almost time for the next dose. Patients should not double up on doses. All of these drugs are taken before a meal. Drugs taken once daily are preferably taken in the morning. These drugs may safely be taken with antacids. Patients who have difficulty swallowing should be instructed not to chew or crush tablets or granules. Patients or caregivers should have clear instructions on how to administer PPIs to those with swallowing problems or tube feedings.

Laxatives Pharmacodynamics

The stimulant laxatives have a direct action on intestinal mucosa by stimulating the myenteric plexus. Stimulants facilitate the release of prostaglandins and increase cyclic adenosine monophosphate (cAMP) concentration. This increase in cAMP increases the secretion of electrolytes and stimulates peristalsis. Drugs in the stimulant class include cascara, senna, bisacodyl, and castor oil.

The class of osmotics exerts its effects mainly by drawing water into the intestinal lumen to increase intraluminal pressure. These drugs are hypertonic salt-based solutions that cause the diffusion of fluid from the plasma into the intestine to dilute the solution to an isotonic state. The magnesium salts also cause an increase in the release of cholecystokinin by the duodenum.

The bulk-producing laxatives are the safest and most physiological because their action is similar to that achieved by increasing fiber in the diet. They do not hinder absorption of nutrients and are less likely to be habit-forming. The bulk-producing laxatives consist of natural and semisynthetic polysaccharides and cellulose. When combined with water in the intestine, they produce mechanical distention resulting in an increase in peristalsis. Drugs in this class include psyllium, methylcellulose, and polycarbophil.

Mineral oil is the main ingredient in lubricant laxatives. Its action is to retard colonic absorption of fecal water and soften the stool. It does not stimulate peristalsis. It is used to soften stool associated with fecal impaction. Mineral oil also lubricates the intestine to facilitate the passage of stool. Major concerns with the use of mineral oil are that it may decrease absorption of fat-soluble vitamins, and there is concern for aspiration in children younger than 4 years of age if given orally.

Surfactants are often referred to as "stool s

Laxatives Pharmacokinetics

Only minimally absorbed and exert their therapeutic effect directly in the GI tract

Laxatives Pharmacotherapeutics

Precautions and contraindications vary by class of laxative, but all share the contraindication of use in the presence of nausea, vomiting, or undiagnosed abdominal pain or if bowel obstruction is suspected or diagnosed. Other precautions and contraindications are specific to a class or a drug.

Laxatives Clinical indications & dosing

All laxatives are used to treat constipation or to prepare the bowel for a procedure. Specific uses for each class are discussed in the Pharmacodynamics section.

Laxatives ADRs

Adverse drug reactions are most commonly extensions of the drug's action and include excessive bowel activity, cramping, flatulence, and bloating. Perianal irritation may also develop. Allergic reactions such as urticaria, dermatitis, rhinitis, and bronchospasm have occurred when patients accidentally inhaled bulk-forming laxatives. Phenolphthalein may cause a skin hypersensitivity characterized by a fixed drug eruption. Discontinue the drug if this occurs.

Laxatives Monitoring

In general, the monitoring for patients taking laxatives for more than 6 months includes laboratory assessment of fluid and electrolyte status, especially potassium and in the case of magnesium hydroxide use, magnesium level. For patients taking lactulose for hepatic encephalopathy, the overall management of this disorder requires careful monitoring because it is a serious disease with a high potential for complications. Monitoring includes serum electrolytes for hypokalemia and hypernatremia. For older adults taking lactulose for more than 6 months to manage their constipation, laboratory assessment of potassium, chloride, and carbon dioxide should be done periodically or with any indication of fluid or electrolyte disturbance.

Laxatives Patient education

Laxatives should not be taken in the presence of nausea, vomiting, or abdominal pain. These symptoms may indicate serious disorders that may be the cause of the constipation and that require a work-up. Patients should not take a laxative but instead contact their health-care provider.

Treatment, dosing and patient education for: GERD

Treatment, dosing and patient education for: PUD

Treatment, dosing and patient education for: IBS

Treatment, dosing and patient education for: Traveler's Diarrhea

Black box warning for metoclopramide

may cause tardive dyskinesia

Step wise progression of PPIs

Effectiveness of different PPIs

Triple therapy for H. pylori

PPI, clarithromycin, amoxicillin

Misoprostol use for duodenal ulcer prophylaxis and treatment

Mechanism of action for lubiprostone

lubiprostone (Amitiza) opens the chloride channels so that chloride followed by water enters the channels in an attempt to maintain isotonic balance, accelerating transit time and softening the stool.

Clinical Peal Laxative

Polyethylene Glycol/Electrolyte Solution The taste of polyethylene glycol/electrolyte solution Is quite salty, and many patients find It difficult to consume the required volume in the required amount of time. Place the container of solution in ice in a basin. Do not pour it over ice, which will melt and increase the volume the patient must consume. Have the patient drink 240 mL of fluid each 10 minutes and give a Tic-Tac or similar small mint-flavored hard candy to suck on between glasses of the drug. This reduces the salty taste in the mouth and makes the drug more palatable.