Pharm 2 Quiz

What is Relistor? And when do you use it?

•use it when Opioid induced constipation

•When laxatives are not working

What are side effects of relistor?

•Abdominal pain, nausea, diarrhea, flatulence, flushing, tremors

When do you not give relistor?

•If patient has a bowel obstruction of GI issue

•Decrease the dose in renal/hepatic dysfunction

•Only for opioids

What drugs are for acid prevention?

•Antacids

•PPIs

•H2 blockers

What should you not do with antacids?

•No mixing

•Anti mix

•Take one hr before or after other meds

•Not for heart failure (no OTC)

How often do you take antacids?

•Short duration

•Take 7 times a day

•1-3 hours after meals and at 🛌

•1-2 hours after other meds

What do antacids do?

•Increase pH

•Neutralize stomach acids

•Inactivate pepsin if pH > 5

Name some antacids?

S: Sodium Bicarbonate (alka-seltzer)

C: Calcium Carbonate (Tums, Rolaids)

A: Aluminum Hydroxide

M: Magnesium Hydroxide (Milk of Mag)

What are some side effects of aluminum hydroxide and calcium carbonate?

•Constrict and cause constipation

What are some side effects of Magnesium Hydroxide?

•Can cause diarrhea

•Mellows out intestine

•Increases effect of sulfonylureas, quinidine, and others

When to be cautious Magnesium hydroxide?

•Use with caution in patients with renal impairments and heart failure

•Avoid use in undiagnosed abdominal pain

When to use Aluminum Hydroxide?

•In patients with renal issues

When to avoid Aluminum Hydroxide?

•Mfs with hypertension and heart failure

What is calcium carbonate associated with ?

•Acid rebound but all antacids can cause it.

What are some adverse effects of calcium carbonate?

•Constipation, fart, and burps

What is NOT an agent of choice for PUD?

•Sodium bicarbonate

•Used for increasing (treating acidosis)

What to avoid with in sodium bicarbonate?

•Avoid in patients with hypertension, heart failure, and renal impairment

What do H2 blockers do and what do they end with?

•Ends in -tidine

•Turns down acid production (decrease volume and H+)

How long should you wait before taking H2 blockers and PPIs?

•You should take them 30 minutes before meals

•30 minutes Tidine (H2)

•Also take w food apparent? tf?

•Takes like 30 mins to work so ig

Why would someone take H2 blockers?

•Taken for GERD and ulcers

•Reduces gastric secretions

•heal Zollinger ellison syndrome (too much acid)

What do you teach patients regarding H2 blockers?

•No overeating

•No stressing

•No smoking

•No NSAIDS

•Inform HCP if bleeding

\*Elevate HOB

What is Cimetidine (Tagamet)?

•Prototype drug of H2RAs

•Will decrease acid production because blocks histamine.

H2 blockers (cimetidine) crosses the ___ which is important because it can _?

•BBB

•Affect histamine 1, brain functions

How is H2 blockers metabolized?

•By the liver so think ab liver conditions and what can affect it

What are some adverse effects of H2 blockers?

•man titties

•CNS effects

•Pneumonia

What should you not take H2 blockers with?

•Antacids

•Acts as hepatic inhibitor: warfarin, phenytoin, theophylline

What is famotidine?

•H2 blocker

•Not as strong, does not inhibit liver

What do proton pump inhibitors end with? and what they do?

\-prazole

\
•Inhibits H+, so it stops gastric acid

What is noteworthy about PPIs formulations?

•Don’t crush them shits

•Reconstitute for IV therapy

•Take before meals

What are some short term side effects of PPIs?

•Nausea and vomiting

•Headache

•Diarrhea

\

What are some long term effects of PPIs?

•Pneumonia

•Fractures

•Rebound acid hypersecretion

•Hypomagnesemia (muscle shits)

•C. Diff

\
\-Use for 16 weeks bitch

What are some drug interactions with PPI’s?

•Inhibit CYP2C19

•Some HIV drugs

•Some antifungals

•Clopidogrel (Plavix)

What are the 4Ps of PPI’s?

•Prazole

•Prevents holes (stress ulcer prophylaxis)

•Porous bones (conduct regular tests)

•Possible GI infections (C. Diff)

Why do people take PPI’s?

•Heartburn

•GERD

•Ulcer prophylaxis (due to stress)

What is sucralfate?

•Mucosal protectant

•Treats and prevents ulcers

•Creates barrier

What does sucralfate NOT do?

•Does not neutralize acid or decrease acid

What are some drug interactions involving Sucralfate?

•Antacids

•Decreases absorption of phenytoin, digoxin, theophylline, warfarin, fluoroquinolones

What is a key point of Sucralfate?

•Avoid food or meds at least 1-2 hours before or after taking meds

•SucralfATE 2 hours before or after you ATE

•Taken LATE

What is misoprostol?

•Another Mucosal protectant

•Prevents NSAID gastric ulcers

What does Misoprostol not do?

•Does not prevent NSAID duodenal ulcers

What GI protectant is a pregnancy X risk?

•Misoprostol

What are some side effects of Misoprostol?

•Diarrhea

•Spotting and dysmenorrhea in gorls

•Abdominal pain

What are some antibiotics for H. Pylori?

•BATMC

•Bismuth (black tongue and shit)

•Amoxicillin (Best in neutral pH)

•Tetracycline (stains teeth)

•Metronidazole (High resistance)

•Clarithromycin (Distort taste, nausea, diarrhea)

What are three shits that stimulate gastric acid secretion?

•Acetylcholine, histamine 2, gastrin

Constipation is not about frequency but ____

•Consistency

What is group I classification for laxatives?

•Makes watery shits in 2-6 hrs

\

What is group II classification for laxatives?

•Makes semifluid shits in 6-12 hours

What is group III classification for laxatives?

•Makes soft shits in 1-3 days

What do bulk forming laxatives do?

•They group 3

•Keep water in stool, increase bulk, distends colon

•Works in 1-3 days

What are some adverse effects of bulk forming laxatives?

•Esophageal obstruction (TAKE WATER)

•Intestinal obstruction or impaction

What group of laxatives are methylcellulse and psylilium?

•Bulk forming (group III) laxatives

What is docusate?

•Surfactant Laxative (Group III)

•Adds fat and water to shit to soften them shits

•1-3 days

•Prophylactic agent

What group does docusate belong to?

•Group III

•Surfactant laxative

what is important teaching point about Docusate?

•Take with water

What do stimulant laxatives do?

•Group II laxative

•Stimulates intestinal motility (peristalsis)

•Increases water ane electrolytes within intestinal lumen (decrease water absorption)

•Results in 6-12 hours

\

What is bisacodyl (dulcolax)

•Group II stimulant laxative

•6-12 hours

•In ass 15-60 mins

What is anthraquinones: senna?

•Group II stimulant laxative

•6-12 hours

•Changes piss color

What is castor oil?

•Stimulant laxative (group I)

•Works in small intestine

•Can work quicker buts usually 2-6hrs

What do osmotic laxatives do?

•poorly absorbed salts draws water into intestinal lumen

•6-12 hrs (2-6 if given more)

What is an adverse effect of osmotic laxatives?

•Substantial loss of water•

When to NOT use osmotic laxatives?

•When the mf has renal issues

What does sodium phosphate (osmotic laxative) cause?

•Fluid retention

When to not use sodium phosphate (osmotic laxative)?

•Use with caution in patients with renal failure, hypertension, and heart failure

When to use polyethylene glycol (miralax)?

•Osmotic laxative

•For chronic constipations

•Mix with 4-8 ounces of liquid

•colonoscopies

What is lactulose?

•Osmotic laxative

•Metabolized by bacteria

•Draws water into shit

•Draws ammonia into stool to treat HEPATIC ENCEPHALOPATHY

•Check labs

What are some miscellaneous laxatives?

Mineral oil and Glycerin butt plugs (suppositories)

What does mineral oil do?

•Emollient or lube

•Excessive oral administration decreases absorption of fat soluble vitamins (Vit K, A, D, E

What does glycerin suppositories do?

•Gentle laxative, safe in infants, children

•Re-establish bowel patterns after laxative abuse

what is a bowel cleansing laxative?

•For colonoscopies

•Polyethylene glycol

•Water is not lost and electrolytes are preserved

\

When to not use laxatives?

•Undiagnosed abdominal pain

what are serotonin receptor antagonists?

•Antiemetics

•Most effect agent for N/V related to chemo/radiation/anesthesia

•Ondansetron (zofran)

when should you administer serotonin receptor antagonists (zofran)

•Medicate 30 to 60 minutes prior to chemotherapy

•Use with dexamethasone

•for nausea and vomiting

What are some side effects of serotonin receptor

•Diarrhea, headache, dizziness

•Prolonged QT in EKG

What do serotonin receptor antagonists end with?

\-setron

What are neurokinin 1 antagonists?

•Blocks neurokinin 1 receptors

•For nausea and vomiting

What do neurokinin antagonists end with?

•Aprepitant (emend)

\-pitant

What are interactions of neurokinin 1 antagonists?

•inhibits Liver metabolizing drugs like warfarin

•Adverse: Fatigue. hiccups, dizziness, diarrhea

What are dopamine antagonists?

•Antiemetics

•Prochlorperazine (compazine) - Prototype

•Dont use in children

What could dopamine antagonists cause?

•Extrapyramidal side effects

What is dronabinol (marinol)?

•Antiemetics: cannabinoid

•For n/v w chemo

•appetite stimulant for aids

What not to do with dronabinol (marinol)

•Dont take with alcohol, cns depressants

•Careful with cardiac disease

•abuse potential

What are prokinetic drugs?

•Increases motility and tone of GI tract

•Nause and vomiting related to gastroparesis, GERD, post op, chemo

•Increases peristalsis

What is the prototype prokinetic agent?

•Metoclopramide (reglan)

What are adverse effects of Metoclopramide (reglan)?

•Prokinetic

•Cns depression

•Extrapyramidal syndrome

•Diarrhea

When to not use metoclopramid (reglan)?

•Do not use in bowel obstruction, perforation

When to give metoclopramid (reglan)?

•Given prior to N/V

•30 minutes before a meal

Anticholinergic side effects are

•Cant pee

•Cant see

•Cant spit

•Cant poop

What is scopolamine?

•most effective drug for motion sickness

\

What is Dramamin and antivert?

•Motion sickness drug

What are adverse effects of anticholinergic motion sickness drugs?

•Blurred vision

•Dry mouth

•Drowsiness

•sedation

What is Lomotil (diphenoxylate HCl w Atropine sulfate)?

•Anti Diarrhea

•added atropine to discourage misuse

•Prototype

When not to use lomotil (diphenoxylate HCl w Atropine sulfate)?

•Dont use if diarrhea is from infection

•Obstructed jaundice

•Children under 2

What are some interactions with lomotil (diphenoxylate HCl w Atropine sulfate)?

•MAO inhibitors

•Opioids, anticholinergics

•Addictive

What is loperamide (imodium)?

•Anti diarrhea

•used to treat acute or chronic diarrhea

•no abuse potential

What are some more antidiarrheas?

•Bismuth (age concern w kids)

•Kaolin and pectin (adsorbent: traps toxins, absorbent: promotes absorption of fluid and electrolytes)

•Difenoxin w atropine (motoden)

What condition should you use antidiarrheals with caution?

Inflammatory bowel disease (IBD)

what are some interactions with antidiarrheals?

•Bulk-forming laxatives

•Antibiotics

What is IBD?

•Inflammatory bowel disease

•Crohn’s is patchy and affects all layers

•Ulcerative colitis is continuous and only first layer

What is alosetron (lotronex) for?

•Used for irritable bowel syndrome in women

What is unique about alosetron (lotronex)

•For use in women ONLY