Pharm

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Parasympathetic nervous system

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Stimulates digestion

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Peptic ulcer disease

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Lesion or erosion in the stomach or small intestine infection with h pylori family history smoker on drugs that impact protective barriers nsaids

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Smoking

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Increases pH level and vasoconstriction

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Gerd

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Occurs when acidic stomach acid enters the esophagus most often occur in adults due to incompetent lower esophageal sphincter

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Gerd signs and symptoms

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Heartburn dysphagia nausea and belching worsen after large meal or when reclining

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Gerd left untreated

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Can result in esophagitis ulcers weight loss or other lifestyle modifications can help medications only control some may need surgery to fix problem

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PUD treatment

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Relieve symptoms heal the ulcer prevent another. Eradicate h.pylori H pyloris is only specific to pud and not found in gerd

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Ppis

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Block the enzyme responsible for secretion of hydrochloric acid reduce acid secretions 95% and have a longer duration of action than H2 antagonists he almost all ulcers within 8 weeks

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When do you take ppis

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20 to 30 minutes before breakfast

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PPI adverse effects

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Headache diarrhea nausea. Safe for renal impairment

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Omeprazole (prilosec)

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Short-term 4 to 8 week therapy for active Ulcer Disease over-the-counter relief of heartburn. Block enzyme responsible for secreting HCL could lower absorption for some minerals B12 and folic acid

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H2 receptor antagonists

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Used for mild to moderate hyperacidity Disorders Treatment of pud and GERD. H2 receptors produce gastric acid

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H2 receptor blockers adverse effects

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Restlessness depression watch elderly for confusion

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H2 receptor prototype drug

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Ranitidine (Zantac) giving and critical care to reduce prevent stress ulcers

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Drugs similar to Zantac

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Cimetidine (tagamet) interacts with a lot of medicines. Coumadin dilantin valium.

Famotidine (Pepcid)

Nizatidine (Axid)

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Sodium in antacids

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Should not be taken by those that need low salt diets renal impairment hypertension

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Magnesium in antacids

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Will also act as a laxative

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Calcium in antacids

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Can cause constipation aggravate kidney stones and renal failure

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Aluminum in antacids

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Can cause constipation

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Bicarbonate in antacids

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Combines with gastric acid causing belching and bloating

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Antacids

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Neutralize stomach acid absorption of different drugs may be affected enteric-coated or extended-release are meant to dissolve in alkaline environment

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Antacid prototype drug

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Aluminum hydroxide (alternaGel)

May X aluminum given with magnesium counteracts the constipation of aluminum take other meds 1 hour before or two hours after an antacid do to alkaline environment causes

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Miscellaneous drugs

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Sucralfate ( carafate) liquid Band-Aid Vines two officers to promote healing and no further erosion take 3 times a day. Pepto Bismol.

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Diagnosis of chronic constipation

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Two or fewer bm's per week lumpy hard stools at least 25% of the time trying to pass stools at least 25% of the time feeling of them complete evacuation at least 25% of the time

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Modifications for constipation

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Increase fiber fluid intake physical activity

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Prototype drug psylluum muclloid (Metamucil)

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Bulk laxatives insoluble fiber pass right through system assist with bulking up need to drink out of water with medication could swell up and cause problems in esophagus

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Similar to Metamucil

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Bisacodyl (dulcolax)

Docusate (colace)

Magnesium hydroxide (mom)

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Diarrhea usually caused by underlining problems

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Infection. Drugs. Inflammatory disease. Food. Malabsorption.

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Diphenoxylate with atropine (lomotil)

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Opiates work in the CNS to slow peristalsis

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Non opioids

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Bismuth subsalucylate (kaopectate)

Loperamide (immoduim)

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Inflammatory bowel disease

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Over 1 million Americans are estimated to have IBD Crohn's affect small intestine ulcerative colitis large intestine

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IBD treatment goals

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Reduce symptoms in place disease in remission keep the disease in remission with maintenance therapy change the course or progression of disease

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Ibd prototype sulfasalazine (azulfidine)

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Adverse effects GI related nausea vomiting headaches rashes if allergic to sulfa antibiotics or ask for and cannot take me to good fluid intake may cause crystals in urine make color urine and skin orange yellow

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drugs similar to Azulfadine

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Balsalazide (colazal)

Mescalamine (asacol)

Olsalazine (dipentum)

Many types of corticosteroid is also used

May take prednisone during flare up

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Once in remission or if IBD is resistance

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Azathioprine (imuran)

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Vomiting

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Triggered by the vomiting Center in the medulla receives input from digestive tract and chemo receptor Zone in cerebral cortex

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Prototype drug

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Odansetron (Zofran, Zuplenz) serotonin receptor antagonist works on serotonin receptors in brain to inhibit the trigger for vomiting

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Zofran adverse effects

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Headache dizziness drowsiness constipation caution and those with cardiac conduction issues can cause dysrhythmias

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Pancreatitis

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Causes lack of digestive enzymes due to release inside the pancreas itself causing inflammation & necrosis. gallbladder disease in women alcoholism in men

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Pancreatitis prototype drug

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Pancrelipase (pancrease) contains lipasen protease, amylase comes from pork dissolves in duodenum and act locally in GI tract not absorbed

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Enteral nutrition

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Gastric or jejunostomy tube

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Parenteral

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Through iv

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Not compatible w tpn

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Ampicillin. Tetracycline. Amphotericin b. Need seperate iv line

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Lipase inhibitor

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Reduces absorption of fat in small intestine

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Anorexiants

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Increases amounts of norepinephrine serotonin and dopamine and the areas that affect appetite

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Prototype drug (alli, xenical)

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Lipase inhibitor, inhibits pancreatic lipase in the GI tract. Fat absorption inhibited by 30%. Also watch for lowered absorption of fat-soluble vitamins

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Anorexiants black part of the nervous system recognizing hunger

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Lorcaserin (belviq) contrave phentermine (adipex)