Pharm Exam 4 Part 3

GI and Eyes/Ears/Skin

What is overweight considered as?

BMI of 25 to 29.9

What is obese considered as?

BMI 30 or above

Obesity occurs in anyone but more likely in:

women, minority groups, poor people

What are the physiologic factors of obesity?

\-energy imbalance (intake greater than expenditure)

\-excessive intake (fat cells increase in size and number

What are the clinical manifestations of obesity?

\-Increased body weight, excess body fat, and a BMI score of 25 kg/m2 or greater.​

\-Other physical findings include abnormal levels of lipids and lipoproteins, elevated serum levels of insulin, elevated blood pressure, and respiratory difficulties.​

\-These metabolic abnormalities place overweight and obese people at a significantly higher risk for hypertension, heart disease, diabetes, joint problems, and sleep apnea.

What do you want to assess for obesity?

\-Assess usual patterns of physical activity and exercise, including work and recreational activities.​

\-Assess motivation to develop and adhere to a weight management plan.

\-Assess any obviously overweight patient for health problems caused or aggravated by excessive weight

\-Calculate the BMI and measure waist circumference

\-Check available reports of lab tests

\-List all prescription and nonprescription medications the patient is taking and ask about vitamins, herbals, and other dietary supplements. 

What does anorexiants do?

stimulates the release of norepinephrine and dopamine

What is the prototype of anorexiants?

phentermine

What does phentermine do?

inhibits the reuptake of both serotonin and norepinephrine.

What does phentermine cause?

appetite suppression, resulting from direct stimulation of the satiety center in the hypothalamic and limbic region​

What are the adverse effects of phentermine?

nervousness, hyperactivity, dry mouth, constipation, and hypertension. Impotence, insomnia, and unpleasant taste may also occur

What is the prototype for lipase inhibitors?

orlistat

What does orlistat do?

\-binds to gastric and pancreatic lipases in the GI tract

\-can prevent absorption of 30% of ingested fat

\-decreased fat absorption leads to decreased caloric intake, resulting in weight loss and improved serum cholesterol values

\-improvement in cholesterol levels presumably independent of weight loss effects

What are the adverse effects of orlistat?

abdominal pain, oily spotting, fecal urgency and incontinence, flatulence with discharge, fatty stools, and increased defecation

What are the key classes of GI system?

\-Antibiotics​

\-H2 Receptor blockers​

\-Proton-pump inhibitors​

\-Antacids​

\-Antiemetics​

\-Laxatives​

\-Antidiarrheals

What is digestion?

process by which food substances enter digestive tract and undergo mechanical/chemical changes which allow nutrients to be absorbed and indigestible materials to be excreted

What is peristalsis?

movement of smooth muscle fibers surrounding the canal that (1) mixes the contents and (2) moves the mass through the tract

What are the actions of drugs affecting the GI tract?

\-Act on muscular and glandular tissues (either directly on these cells or indirectly on autonomic nervous system)​

\-Increase or decrease function, tone, emptying time, or peristaltic action of stomach/bowel​

\-Relieve enzyme deficiency​

\-Counteract excess acidity or gas formation​

\-Produce or prevent vomiting​

\-Aid with diagnosis​

What do NSAIDs do?

\-Inhibit the biosynthesis of prostaglandins​

\-Decrease blood flow, mucus, and bicarbonate

What does gastric acid do?

\-Causes ulcers by directly injuring cells of the GI mucosa and indirectly by activating pepsin​

\-Increased acid alone does not increase ulcers but is a definite factor in PUD

What is pepsin?

proteolytic enzyme in gastric juice

What are the defensive factors of peptic ulcers?

\-mucus

\-bicarbonate

\-blood flow

\-prostaglandins

What are the H. pylori tests?

\-noninvasive: breath test, serum test, stool test

\-invasive: endoscopic specimen obtained and evaluated

What are the classes of antiulcer drugs?

\-Antibiotics​

\-Antisecretory agents​

\-Mucosal protectants​

\-Antisecretory agents that enhance mucosal defenses​

\-Antacids

What are the 3 ways antiulcer drugs work?

\-eradicate H. pylori (antibiotics)

\-reduce gastric acidity (antisecretory agnts, misoprostol)

\-enhance mucosal defenses (sucralfate, misoprostol)

What is H. pylori treatment?

minimum of two antibiotics prescribed to decrease risk for developing resistance

What are the drugs for H. pylori treatment?

\-amoxicillin

\-tetracycline

\-metronidazole

What are the histamine2 receptor antagonists?

\-Cimetidine (Tagamet)​

\-Ranitidine (Zantac)​

\-Famotidine (Pepcid)​

\-Nizatidine (Axid)

WHat do the histamine2 receptor antagonists end in?

\-dine

What are histamine2 receptor antagonists?

\-First-choice drugs for treating gastric and duodenal ulcers​

\-Promote healing by suppressing secretion of gastric acid​

\-Completely block the acid from being produced​

\-All four equally effective​

\-Serious side effects uncommon​

What are the therapeutic uses of cimetidine?

\-Gastric and duodenal ulcers​

\-GERD​

\-Heartburn, acid indigestion, and sour stomach

What are the adverse effects of cimetidine?

\-Antiandrogenic effects​

\-CNS effects​

\-Pneumonia​

\-IV bolus – can experience hypotension and dysrhythmias

What is ranitidine?

\-Shares many properties of cimetidine​

\-More potent, fewer adverse effects, causes fewer drug interactions than cimetidine (and has less ability to cross CNS)

What are the therapeutic uses of ranitidine?

\-Short-term treatment of gastric/duodenal ulcers​

\-Prophylaxis of recurrent duodenal ulcers​

\-Treatment of Zollinger-Ellison syndrome and hypersecretory states​

\-Treatment of GERD

What are the adverse effects of ranitidine?

significant ones uncommon

_____ have actions similar to those of ranitidine.

famotidine

What are the therapeutic uses of famotidine?

\-Short-term treatment of gastric/duodenal ulcers​

\-Prophylaxis of recurrent duodenal ulcers​

\-Treatment of Zollinger-Ellison syndrome and hypersecretory states​

\-Treatment of GERD​

\-OTC – to treat heartburn, acid indigestion, sour stomach​

_____ have actions much like those of ranitidine and famotidine.

nizatidine

What are the therapeutic uses of nizatidine?

\-Duodenal/gastric ulcers​

\-GERD, heartburn, acid indigestion, and sour stomach

What is a proton pump inhibitor?

\-Most effective drugs for suppressing secretion of gastric acid​

\-Stop the secretion of acid

\-Therapeutic uses​: Gastric/duodenal ulcers​ and GERD​

\-Well tolerated​

\-Selection of PPI based on cost and prescriber preference​

Proton pump inhibitors end in _____.

\-prazole

What is the actions and characteristics of omeprazole?

\-Inhibits gastric secretion​

\-Short half-life​

\-Used for short-term therapy

What is the adverse effects of omeprazole?

\-headache

\-GI effects

Antacids react with gastric acid to produce:

neutral salts or salts of low acidity​

What is the action of antacids?

\-To neutralize acids and to prevent the conversion of pepsinogen to pepsin in the stomach​

\-May also enhance mucosal protection by stimulating the production of prostaglandins​

_____ are given to suppress nausea and vomiting.

antiemetics

What do antiemetics do?

\-Suppress Emetic response​

\-Complex reflex after activating vomiting center in medulla oblongata​

Antiemetics are _____ antagonists.

dopamine

Antiemetics end in _____.

\-setron

What are the drugs for motion sickness?

scopolamine and antihistamines

What is scopolamine?

Muscarinic antagonist (block muscarinic receptors)​

What are the side effects of scopolamine?

\-Dry mouth​

\-Blurred vision​

\-Drowsiness

What is the function of the colon?

\-absorbs water and electrolytes

\-delayed transport through colon causes excessive fluid absorption and hard stool.​

\-frequency of bowel elimination varies widely (2-3 times/day to 2 times/week)

Proper function of bowel is highly dependent on _____. 

dietary fiber

What is the function of dietary fiber?

\-Absorbs water – softens feces and increases size​

\-Can be digested by colonic bacteria whose growth increases fecal mass​

\-Poor diet – frequent cause of constipation

What is constipation defined as?

hard stools, infrequent stools, excessive straining, prolonged effort, sense of incomplete evacuation, unsuccessful defecation​

What are laxatives used for?

\-Used to ease or stimulate defecation​

\-Soften the stool​

\-Increase stool volume​

\-Hasten fecal passage through the intestine​

\-Facilitate evacuation from the rectum​

\-Misuse comes from misconceptions of what constitutes normal bowel function​

WHat are the indications for laxative use?

\-Obtaining fresh stool sample​

\-Prior to treatment/procedure preparation​

\-Expelling dead parasites after treatment​

\-Constipation (multiple causes, including pregnancy and opioid use)​

\-Preventing fecal impaction in bedridden patients​

\-Removing poisons

What are the contraindications of laxative use?

\-Individuals experiencing abdominal pain, nausea, cramps, or other symptoms of appendicitis, regional enteritis, diverticulitis, and ulcerative colitis​

\-Acute surgical abdomen​

\-Fecal impaction or bowel obstruction​

\-Habitual use​

\-Use with caution in pregnancy and lactation​

What is laxative effect?

\-Production of soft, formed stool over a period of 1 or more days​

\-Relatively mild

What is catharsis?

\-Prompt, fluid evacuation of the bowel​

\-Fast and intense

When do bulk forming laxatives act within?

12-24 hours

What is the prototype of bulk forming laxatives?

Psyllium 

When do surfactant laxatives act within?

1-3 days

What is the prototype of surfactant laxatives?

Docusate sodium

When do stimulant laxatives act within?

30 minutes

What is the prototype of stimulant laxatives?

Bisacodyl

What is the prototype of osmotic laxatives?

milk of magnesia

What is psyllium?

\-Function like dietary fiber – swell with water to form a gel to soften the fecal mass and increase mass​

\-Preferred treatment for temporary treatment of constipation​

\-Used for diverticulosis and irritable bowel syndrome​

\-Adverse effects are minimal​

What are surfactant laxatives?

\-Two effects on bowel​: soften stool​ and increase amount of water and electrolytes in the intestinal lumen​

\-Docusate calcium or docusate sodium​

What are stimulant laxatives?

\-Two effects on bowel​: soften stool​ and stimulate intestinal motility​

\-Strongest and most abused​

​-Legitimately used for opioid-induced constipation and constipation from slow intestinal transit​

\-Bisacodyl (stimulant cathartics)​

What are the adverse effects of osmotic laxatives?

\-Dehydration – substantial water loss​

\-Renal decline – toxicity​

\-Sodium retention – exacerbate heart failure, hypertension, edema

What are the causes of laxative abuse?

\-Misconception that bowel movements must occur daily​

\-Can perpetuate their own use​

\-Bowel replenishment after evacuation can be 2-5 days – often mistaken for constipation

What are the consequences of laxative abuse?

Diminished defecatory reflexes, leading to further reliance on laxatives

What is diarrhea characterized by?

stools of excessive volume and fluidity and increased frequency of defecation

What are the causes of diarrhea?

Infection, maldigestion, inflammation, functional disorders of the bowel

What are the complications of diarrhea?

dehydration and electrolyte depletion

What is the management of diarrhea?

\-Diagnosis and treatment of underlying disease​

\-Replacement of lost water and salts​

\-Relief of cramping​

\-Reducing passage of unformed stools

What are the two major groups of antidiarrheals?

\-Specific antidiarrheal drugs​

\-Nonspecific antidiarrheal drugs

What are the general considerations of management of infectious diarrhea?

\-Variety of bacteria and protozoa can be responsible.​

\-Infections are usually self-limited.​

\-Many cases require no treatment.​

\-Antibiotics should only be used when clearly indicated

Drugs for IBD are _____.

not curative

What is anorectal preparations?

\-Symptomatic relief of hemorrhoids and other anorectal disorders​: Local anesthetics​, Hydrocortisone​, Emollients​, Astringents​

\-Multiple formulations available​

Cationic exchange resin is for treatment of _____.

hyperkalemia

Kayexelate can be given as _____.

enema or orally

What do you want to assess for kayexelate?

assess stools, abdomen, I & O, weight,  and K levels (3.5 – 5 mEq/L) 

What is conjuctivitis?

inflammation of the conjunctive

What is blepharitis?

chronic infection of glands and lash follicles on the margins of the eyelids

What is keratitis?

inflammation of the cornea

What is mydriasis?

dilation

What is miosis?

constriction

What is glaucoma?

visual field loss secondary to ​optic nerve damage​

What are the types of glaucoma?

\-Primary open-angle glaucoma (POAG)​

\-Acute angle-closure glaucoma​

What is aqueous humor?

\-Produced in ciliary body​

\-Secreted into the posterior chamber of the eye​

\-Circulates around the iris into the anterior chamber​

\-Exits the anterior chamber via the trabecular meshwork and the canal of Schlemm

What are the characteristics of primary open angle glaucoma?

\-Most common form of glaucoma in United States​

\-Progressive optic nerve damage with eventual impairment of vision​

\-Devoid of symptoms until significant and irreversible optic nerve injury has occurred

What are the risk factors of primary open angle glaucoma?

\-Elevation of intraocular pressure (IOP)​

\-African American (3 times greater than whites)​

\-Family history of POAG​

\-Advancing age 

What are the goals of treatment for primary open angle glaucoma?

\-Directed at reducing elevated IOP (the only modifiable risk factor)​

\-Principal method: chronic therapy with drugs

Drugs lower IOP by:

\-Facilitating aqueous humor outflow​

\-Reducing aqueous humor production

What are the first line drugs for glaucoma?

\-Beta-adrenergic blocking agents (decrease aqueous humor formation)​

\-Alpha2-adrenergic agonists (decrease aqueous humor formation)​

\-Prostaglandin analogs (increase outflow of aqueous humor)​

What are the second line drugs for glaucoma?

\-Cholinergic agonists (increase outflow of aqueous humore)​

\-Carbonic anhydrase inhibitors (decrease aqueous humor formation)​

\-Osmotic diuretics (reduce IOP)

What are the beta adrenergic blocking agents?

\-Betaxolol, levobetaxolol, carteolol, levobunolol, metipranolol, and timolol: approved for use in glaucoma​

\-Lower IOP by decreasing production of aqueous humor​

\-Used primarily for open-angle glaucoma​

\-Initial therapy and maintenance therapy