Pharm chapter 35-37 GI TRACT

what is a vitamin

-required for normal body metabolism, growth, and development

- required for formation of RBCs, nerve cells, hormones, genetic material, bone and other tissues

water soluble vitamins:

- not stored in the body and are rapidly eliminated

- water stored not stored in the body when taken in excess

- B complex, C

fat double vitamins

- stored in the body when taken in excess

- A, D, E, K

- absorbed from the intestine with dietary fat

- important to not overdose

minerals and electrolytes are essential:

-constituents of bone, teeth, cell membranes, connective tissues

- maintain fluid, electrolyte, and acid balance

- maintain osmotic pressure, nerve amd muscle function; assist in diffusion

what are the main electrolytes

-calcium, phosphorus, sodium, postassium, chloride, and magnesium

which electrolyte is usually excess

- usually potassium

how to treat high potassium

Sodium polystyrene sulfonate. This medication is going to help you exchange sodium ions for potassium ions, which will make the potassium draw into your stool so it will get rid of it in your bowel movements. àthis helps a lot with kidney failure pt’s.

how to replace electrolytes

-recommended daily allowance (RDA)

- changes in diet (good nutrition) best way to meet those needs.

- renal failure (can't excrete)

- hepatic failure (can't metabolize)

-vitamin K (careful if pt is on warfarin; high vit. K can reverse effects)

GI strucutures

-mouth; breaks up food

- esophagus; takes food to the stomach

- stomach; digestion, digestive enzymes, stomach acid

- small intestine; duodenum, jejunum, ileum —> where most of the absorption and digestion will happen.

- large intestine; colon, cecum

- rectum

- salivary glands: lubricates food

- liver; produces Bile/ also going to sort nutrients if we are going to store or use them and clear them.

- gallbladder: Bile is stored; bile is important for fat digestion.

- Pancreas: excretes digestive enzymes and some sodium bicarb –going to help regulate that pH.

GI Function

- digestion: breaks down food

- motility; movement "water hose"

- secretion: acid, bicarbonate

- absorption: for water and nutrients

GI reflexes

-swallowing: Involves 25 muscles.

- vomiting; protect body from unwanted irritants

- emetic zone; projectile vomiting. more in children and pts w/ brain damage

- chemoreceptor trigger zone (CTZ); stimulated by irritants to back of throat. A lot of causes you to vomit.

what is obesity

-obese: BMI > 30

- substantially increases risks for development of numerous health problems

- intake > expenditure

- genetic, environmental and psychosocial factors

which drug treats obesity

phentermine

what does phentermine do

-appetite suppressant

action of phentermine

- Stimulation of the satiety(feel like your full) center in the hypothalamic and limbic region

- slows reuptake of serotonin and norepinephrine

adverse effects of phentermine

-Nervousness

-Hyperactivity

-Dry mouth

-Constipation

-Hypertension

- avoid other stimulants. ex. caffeine

What does orlistat do?

- treats obesity

- decreased fat absorption, decreased caloric intake

action of orlistat

-Binds to gastric & pancreatic lipases

-Prevent the absorption of 30% of ingested fat

adverse effects of orlistat

-Abdominal pain

- oily spotting

- fecal urgency and incontinence

- flatuence with discharge

- fatty stools

- increased pooping

acid in stomach is pH of what

1.5-3.5

protection of stomach surface

-goblet cell producing a mucous layer to act like a physical barrier.

-Bicarbonate layer; the neutralizer is going to neutralize the acid the closer it gets to the capillary beds.

what Is peptic ulcer disease (PUD)

erosion of mucosal layer

where can peptic ulcer occur

esophagus, stomach, or duodenum

risk factors for PUD

-Smoking, Caffeine

-Kidney or Pulmonary disease; increases acidity of blood

-Stress

-Drugs; NSAIDs

-H. Pylori; bacteria that can lead to ulcer. fecal to oral spared.

symptoms of PUD

- may cause painless bleeding

- stomach pain esp. at night or on empty stomach

what are the causes of GERD

-Incompetent lower esophageal sphincter - let the gastric contents creep up the esophagus.

-Pyloric stenosis

-Hiatal hernia

-Motility disorder; things back up

-obesity

- Age-related changes - sphincter starts to weaken.

GERD long term complications

-Esophagitis

-Barrett's Esophagus; d/t esophagitis

-Strictures; like rubber bands closing the esophagus

-Esophageal cancers

PUD / GERD Non-Pharmacological Treatment

Lifestyle changes

ETOH

Tobacco

Weight management

Reducing stress

Eliminate causative foods

Eliminate/change drugs (if feasible)

NSAIDS

Corticosteroids

Platelet inhibitors

Caffeine

what drugs are antacids

- Mylanta

- Tums

use of antacids

- prevent or treat PUD, GERD, heartburn from acid reflux

-netrualize or reduce gastric acid

- increases gastric pH

- over the counter

adverse effects of antacids

- Constipation
- Hypophosphatemia (low phosphate level)

- Osteomalacia

-Hypermagnesemia

-Diarrhea

Contraindications of antacids

-renal failure; do not use magnesium based antacids (Mylanta)

- these pts already have high magnesium d/t renal failure

which drugs are histamine 2- antagonists

- Cimetidine

- ending in tidine = to dine (food)

use of cimetidine

- prevent and treat PUD, GERD, heartburn, stress ulcer

- block H-2 receptors, blocks production of hydrochloric acid

- over-the-counter

adverse effects of Cimetidine

- diarrhea

-dizziness

- High IV doses cause heart arrhythmias

pharmacokinetics of Cimetidine

-po

-IV

which drug is proton pump inhibitor (PPI)

-omeprazole

-ends in prazole

action of Omeprazole

- treatment of PUD, GERD, H pylori, stress ulcer prevention

- prevent the release of gastric acid

- most POTENT acid inhibitor

adverse effects of Omeprazole

- osteoporosis

-nausea

-diarrhea

Nursing Implications for Omeprazole

-take before bed

- swallow whole

- do not CRUSH or CHEW

nursing considerations for drugs that treat PUD/ GERD

- give 1-2 hours before or after other meds

- usually given before meals and bedtime

- avoid PPIs with Clopidogrel (anti platelet)

pt education for drugs that treat PUD / GERD

- elevate the head of bed

- small frequent meals

- don't lie down for 1-2 hours after meals

- avoid; fats. chocolates, citrus juice, coffee, alcohol, smoking

- seek treatment if used for more than 2 weeks

Misoprostol use

- if someone has to take NSAIDs, they have to take this med

- inhibits mucosal damage from NSAIDs

-prevention on GI bleeding in NSAID use

black box warning for Misoprostol

-Med is an abortifacient (will cause an abortion)

Sucralfate use

- liquid med that leaves a protective coating as it goes down GI tract

- prevents and treats peptic ulcers

- binds to normal and ulcerated mucosa

- NO EFFECT ON ACID

how to administer sucralfate

-prevents absorption of other drugs

-Give 2 hours after other meds are taken

H pylori treatment

-Combination Therapy

-Usually 14-day treatment

-Triple therapy: 2 antibiotics & acid reducer. Amoxicillin & Clarithromycin

-Quadruple therapy: 2 antibiotics, acid reducer, & bismuth subsalicylate (Pepto-Bismol)