Pharm- Gi Med

Front 1

when a pt cant absorb Vit B12

must take vit B12 IM (Z-track), then subcutaneous

Back 1

pernicious anemia

Front 2

Secretes Pepsinogen to break down protein

Back 2

chief cell

Front 3

secretes HCL

Affected by Histamine, muscarinic and nicotinic receptors

Back 3

parietal

Front 4

Function of the ___- emulsify fats
___function produces lipase (fat) and amylase (carbs)

Back 4

liver/gallbladde
Exocrine

Front 5

Acid contents from the stomach move upwards into the esophagus

*caused from the weakening of the lower esophageal sphincter which may no longer seal tightly

Back 5

GERD

Front 6

Causes an intense burning & may have belching

Complications from severe cases include:
Barret's esophagus*

Back 6

GERD

Front 7

GERD for a long time that goes to dysplasia and neosplasia

-occurs at LES

Back 7

Barrett's esophagus

Front 8

treatment with GERD

Back 8

H2 blockers
Proton pump inhibitors
Antacids (temp relief, but a rebound hyperacidity accurs)
lifestyle changes
Smoking, drinking, bending down, small frequent meals, avoid spicy greasy meals
Surgery may be used for persistent patients

Front 9

what happens if someone is in a constant stressful state

Back 9

Increase in cortisol-> Less prostaglandin -> erosion of stomach

Front 10

An erosion of the mucosal layer in the GI tract
A lesion in the stomach
A lesion in the intestine (most common)
NSAIDs most common after h pylori, and systemic steroids (exogenous or endogenous)

Back 10

ulcer
peptic ulcer
duodenal ulcer
other causes (secondary)

Front 11

main cause of PUD

Back 11

H. pylori

Front 12

treatment of H. pylori

Back 12

7-14 days (short term)
PPI &/or H-2 receptor antantagonist
+/- Bismuth Subsalicylate (Pepto- Bismol)
systemic antibiotic therapy

Front 13

dec growth of H. pylori and prevents it from sticking into mucosa of stomach

Back 13

pepto-bismol

Front 14

If you develop PUD from NSAIDs, what do you do? Steroids?

Back 14

nsaid- stop
steroids- taper down

you can also have miscellaneous drugs and lifestyle changes

Front 15

Gram negative (-) bacteria
Associated with development of PUD and gastric cancer
Infection remains for life if not treated
Requires combination of meds to treat and eradicate

Back 15

H. Pylori

Front 16

stool may be dark
contraindicated in asthmatics

Back 16

Bismuth Subsalicylate (Pepto- Bismol)

Front 17

Choose 2 of the following:
Amoxicillin
Clarithromycin
Flagyl
Tetracycline

In what therapy?

Back 17

systemic antibiotic therapy

Front 18

peptic acid meds

Back 18

1. PPIs - Prilosec (omeprazole)- 2nd line meds
2. H-2 Receptor Antagonists (first line meds)
3. Antacids
4. Antibiotics for H. pylori
5. Miscellaneous meds

Front 19

Second line meds
a. To reduce acid secretion in the stomach
GERD or hyper-secretion
b. To heal ulcerations
duodenal in 4 weeks
gastric 6-8 weeks

Back 19

PPI

Front 20

Works
By binding irreversibly to the enzyme H+, K+, ATPase

Blocks the gastric-acid pump to reduce secretions

Back 20

PPI

Front 21

we use ___ When H-2 receptor antagonists don’t last long enough or work as well

Back 21

PPI

Front 22

should not be taken with plavix

may decrease effectiveness, and it aggravates the stomach lining

should take on empty stomach before breakfast

Back 22

PPI

Front 23

takes 2 hours to work & lasts up to 72 hours
*some don’t have relief for 2 weeks
binds to enzymes irreversibly
drug of choice for Zollinger-Ellison Syndrome
usually short term (up to 8 weeks) for ulcers

Back 23

Prilosec (omeprazole)

Front 24

how would you know if PPI is not working

Back 24

a. Pt is guarding (holding stomach), N&V
b. dark stools

Front 25

OTC
used for Tx PUD & GERD by:
decreasing acid production in the stomach by blocking H-2

Back 25

H-2 receptor antagonist

Front 26

use __ When antacids don’t last long enough or work as well

Back 26

H-2 receptor antagonist

Front 27

Can be taken with Plavix
Taken with food or after the pt eats
first line med

Back 27

H-2 receptor antagonist

Front 28

Decreases gastric acid secretion
* B-12 is released based on gastric acid levels
Heals ulcers (4-8 weeks)
OTC

Back 28

Zantac

Front 29

zantac

Back 29

H-2 receptor antagonist

Front 30

Alert/Interactions:
high doses may lead to impotence in men
Monitor Vit B-12, especially in elderly
Don’t take at the same time with antacids and take after meals.

Back 30

H-2 receptor antagonist

Front 31

Prilosec

Back 31

PPI

Front 32

Action:
Neutralizes gastric secretions
DO NOT reduce acid production
No longer recommended as primary Tx PUD
Doesn’t promote healing of ulcer
Doesn’t eradicate H. pylori

Goal- Relief of gastric pain

Back 32

Antacid's

Front 33

Examples of antacids

Back 33

Magnesium hydroxide & aluminum hydroxide
Maalox
Magnesium hydroxide
MOM
Aluminum hydroxide gel
amphogel
Calcium carbonate
Tums
Calcium carbonate w/magnesium hydroxide
Mylanta
Sodium bicarbonate
Alka-seltzer

Front 34

Avoid acid ‘rebound’
Avoid constipation/diarrhea
Effectively neutralize the volume of acid
May affect or be affected by other meds
May affect labs if renal insufficiency or is on a sodium-restriction

Back 34

considerations when choosing an antacid

Front 35

Doesn’t affect gastric secretion
Coats with a gel-like substance which helps to heal the ulcer
Must be taken 4 times daily
Taken on empty stomach
Pt who already have ulcers

Back 35

Carafate (sucralfate

Front 36

Serotonin (5HT3) Antagonists

Back 36

Anti-emetics

Front 37

Ondasetron (Zofran)
Metoclopramide (reglan)-
Compazine and Promethazine (Phenergan)

Back 37

Anti-emetics

Front 38

2. Prevents N/V associate with chemo
3. Off-label: OD tylenol vomiting
4. Adverse effect:
arrythmias
EPS- Parkinson like side affects
HTN

Back 38

Ondasetron (Zofran)

Front 39

education:
Change position slowly
Fall precautions

Back 39

Ondasetron (Zofran)

Front 40

diff b/n PRN and around the clock

Back 40

6. PRN-
Ask; do you have any N and/or V
Do not give in oral form if vomiting
7. Around the clock
Ex: every 8 hours the pt will get the drug, no matter what- does not need to ask pt about N&V

Front 41

a. Used initially for Post chemo nausea.
b. Works by blocking serotonin 3 receptors decreasing the urge to vomit.
d. Can be given PRN or around the clock after chemotherapy

Back 41

Ondasetron (Zofran )

Front 42

New black box warning of QT prolongation in patients with hypokalemia and hypomagnesaemia

First line medication for nausea in the acute care settings.

Back 42

Ondasetron (Zofran )

Front 43

From the Phenothiazine family

Short-term, 3rd line med for GERD, N/V, minor headaches, prokinetic

Increases peristalsis, increases the strength of the lower esophageal sphincter.

Back 43

Metoclopramide (reglan)-

Front 44

Side effect / Adverse reactions
i. Mental- Depression, Hallucinations, Confusion
ii. GI
iii. **Drowsiness/dizziness
iv. **EPS- Tardive dyskinesia, Parkinson-like effects
slow IV- to prevent EPS

Back 44

Metoclopramide (reglan)-

Front 45

Works at chemo-recepter trigger zone- blocks dopamine
Used for nausea and vomiting, very common after surgery
Can be given IM, IV, PR
IV form you half the dose of IM. From 25 mg IM to 12.5 mg IV

Back 45

Compazine and Promethazine (Phenergan)

Front 46

Can cause sedation and Parkinsonism.
Watch out for paradoxical effects like agitation and AMS.
Antihistamines/Anticholinergics
OTC- Dramamine (dimenhydrinate) & Ativert (meclizine)

Back 46

Compazine and Promethazine (Phenergan)

Front 47

is a decrease in frequency of bowel movements. It is not a disease, but the symptom of an underlying process.

Back 47

constipation

Front 48

Lifestyle modifications that include physical activity, increase fluids and fiber should be considered before any pharmacological agent

Back 48

constipation

Front 49

is an increase in the frequency and fluidity of bowel movements.
Also not a disease, but a symptom of an underlying disorder
if Prolonged may lead to fluid, acid base and electrolyte disorders

Back 49

Diarrhea

Front 50

treatment of constipation

Back 50

Increase fluid (6-8 glasses), fibers, exercise

Front 51

before treating constipation with laxatives what should you ask?

Back 51

Ask about bowel movements (frequency and consistency of stool)

Front 52

types of laxatives

Back 52

bulkforming, saline, stimulant, stool softners and surfactants, herbals

Front 53

absorb water, thus adding size to fecal mass. Preferred for treatment and prevention of chronic constipation. Example: Psyllim mucilloid (Metamucil)

Back 53

bulkforming

Front 54

also known as osmotic laxatives, they pull water to the fecal mass making it more watery. Produce bowel movements very quickly and should not be used regularly. Can lead to fluid and electrolyte imbalances and loss of natural urge. Example: sodium biphosphate (Fleet phospho Soda), magnesium Hydroxide (Milk of magensia)

Back 54

saline

Front 55

promote peristalsisi by irritating the bowel mucosa. They should only be used occasionally because of dependence. May also cause fluid and electrolyte imbalances. Examples: bisacodyl (Dulcolax)

Back 55

stimulants

Front 56

cause more water and fat to be absorbed into the stool. They are used often to prevent costipation in surgical patients. Example: ducosate (Colace)
1. treatment of chronic constipation
2. prevents constipation

Back 56

stool softners and surfactants

Front 57

commonly used by patients as self treatment of constipation. Example: Senna, creates irritations increasing peristalsis. Others are cascara sagrada, aloe and flaxseed.

Back 57

herbals

Front 58

2 or more water stools

Back 58

diarhea

Front 59

For __ diarrhea OTC products are effective.
For ___ severe cases opiates containing products are the most effective.

Back 59

mild
chronic

Front 60

Main complication of __ is dehydration, electrolyte imbalances, renal failure and ph disturbances

Back 60

diahrea

Front 61

Hydration is a must and the only indicated treatment with mild diarrhea, normal saline if the patient is in the hospital setting, oral hydration with electrolytes can be used at home.
**Avoid apple juice which acts as a osmotic laxative.

Back 61

diarrhea

Front 62

diphenoxylate with Atropine (Lomotil), combination of opiate and anticholinergic medication.
1. Controlled

Back 62

opiates- treatment for diarrhea

Front 63

meperidine (imodium), chemically related to meperidine (demerol) an opiate. Low doses can be obtained OTC.

Back 63

opiate related- treat diarhea

Front 64

Bismuth Subsalicylate (Pepto-Bismol).

Back 64

non-opiate related to diarrhea

Front 65

ix. ABG diahrea -> ___
x. ABG- vomit -> __

Back 65

ix. ABG diahrea -> Acidosis
x. ABG- vomit -> alkalosis

Front 66

Induces vomiting
For OD (early)
NOT for corrosives
No longer recommended in homes (OTC

Back 66

IPECAC syrup