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115 Cards in this Set

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what are two unique drugs that assist in the protection of GI mucosa from the effects of NSAIDs
sucralfate and misoprostol
otc agents that neutralize hydrochloric acid and increase gastric PH, thus inhibiting pepsinq
what is antacid used to treat
gastric ulcers, peptic esophagitis, HH, esophageal reflux
what are the side effects of antacids
malaise, anorexia, bowel obstruction, constipation, dizzy, frequent burping, thirst, muscle weakness.
what are the most severe reactions of antacids
coma, decreased reflexes, resp depression
antacids prevent the absorption of
when a pt is taking antacids what should be increased
the fluid intake because of constipation
acids are available in many forms . what is the best form to give it in
liquid or solutions - because they neutralize acid more rapidly. tablets should be considered the last alternative
antacids with a laxative should be taken when
at bedtime
what is the pt teaching with antacids
1. take one hour after meals
2.mantain a good fluid intake
3. chew tablets thoroughly and take w/full glass of water
4. liquid meds should be stored in a cool place
5.if dr prescribes aluminum containing antacids make sure the pt gets enough phospherus
6. antacids destroy the enteric coating and they should not be taken within 1 hour of amedication w/enteric coating
these are unique becuase they promote healing of ulcers and act with antacids to produce more alkaline conditions in the GI tract
histamine H2 antagonists
h2 receptor anatagonist inhibit secretion of gastric acid, rapidly absorb and they reach there peak effectiveness in
45 - 90 minutes
what is considered to be the first line of therapy to relieve symptoms and prevent complications of peptic ulcers disease
Histamine H2 blockers - when used over 6 to 8 weeks
what else is Histamine H2 blockers used for
prophylaxis and tx of peptic esophagitis, gastric ulcers, duodenal ulcers, stress ulcers, and zollinger - ellison syndrome
many peptic ulcers are caused by
helicobacter pylori
Helicobacteter pylori may be controlled and the ulcer healed by use of
antibiotic plus ranitidine products
what are the side effects of H2 receptor antagonist
dizzy, HA, somnolence, mild and breif diarrhea, rash, gynecomastia, muscle pain and fever
H2 receptors may be given how
orally or IV
oraly for H2 receptors shoudl be given when
with meals and at bedtime
how should IV be given
diluted and injected over 1 - 2 minutes
h2 receptors should be given for how long
for 2 - 6 weeks until endoscopy tests reveal healing
what do proton pump inhibitors do
they work to heal gastric ulcers, , they irreversibly stop the acid secretory pump embedded within the gastric parietal cell membrane by altering the activity, they decrease acid secretion
proton pump inhibitors ae used in the
short term treatment of active duodenal ulcers usually after H2 receptors have not been successful.
what are other indications to use proton pump inhibitors
when longer therapy is not indicated, severe esrosive esophagitis, and poorly responsive GERD.`
pts taking proton pump inhibitors must do what
swallow the tablet whole - they should not crush or chew the tablet
proton pump tablets should not be taken before
proton pump inhibitors and ______ should not be used at the same time.
H2 blockers
aluminum carbonate gel (G)
T - basalijel
1- 2 capsules or 2 tsp with water or fruit juice up to 12 times a day
aluminum hyroxide gel - G
T - alu- cap, amphojel, dialume
helps delay stomach emptying and binds bile salts. drug of choice for peptic ulcers
calcium carbonate

T - dicarbosil, tums
v. powerful, given for short term therapy
dihydroxyaluminu sodium carbonate - G
T - calcium rich, rolaids, tablets
chew 1-2 tablets
magnesium hydroxide - G
helpful because cathartic effect couteracts constipation of alminum hyroxide
aluminum hydroxide, magnesium hydroxide, and simethicone
T - gelusil, mylanta
reduce gas formation
1- 2 tsp 4 times a day between meals and at bedtime

1-2 tablets 4 x day
do not exceed 24 tsp or tablets in 24 hours
T -tagament
widely used for ulcers 300 mg po with meals and at bedtime. should be taken with antacid
given at bedtime
HA are frequent, extrapyramidal sx may be noted
agents to treat h pylori
bismuth subsalicylate, etronidazole, tetracyline

T- helidac

drink plenty of water with medication
treats h pylori
rantidine ismuth citrate - tritec
for duodenal ulcers take on empty stomach 1 hour before melas and at bedtime. take antacids as needed for pain releif, but not within 30 min. before or after this medication
proton pump inhibitor
proton pump inhibitor

t- losec, prilosec
take before eating, do not open chew or crush capsule

proton pump inhibitor
what do anticholinergics do
they reduce GI tract spasm and intestinal motility, acid production, and gastric otility. gastric emptying is slowed and neutralization is increased
what does anticholinergics - antispasmodic agents do
tx peptic ulcers, pylorospasm, biliary colic, hypermotility, hyperacidity, irritable colon, acute pancreatitis
adverse reactions are common in anticholinergic therapy because high dosage are usually required. they are
rapid, weak pulse, blurring of vision, dysphagia, difficulty talking, dilation of pupils, drowsy, photophobia, confusion, resltessness, staggering, talkativeness, rash over face, neck uppertrunk, thirst, urinary urgency,
anticholinergics containing phenobarbital may decrease the effects of
anticoagulants, requiring higher doses
these reduce the fluid content of hte stool and decrease peristalsis and motility of hte intestinal tract. . they increase smootht muslce tone and diminish digestive secretions
antidiarrheals are used to treat
nonspecific diarrhea and diarrhea caused by antibiotics
all antidiarrheal drugs are given how
bismuth subsalicylate

pepto bismaol, bismatrol
antidiarrheal agent
may cause temporary darkening of he stool and tongue
kaolin and pectin

kaopectate and parapectolin
used for self tx of diarrhea

nocturnal heartburn related to GERD ( GI stimulant)

give 10 mg 30 min before each meal and at bedime for 2 -8 weeks may increase to 15 mg if needed

imodium, kaopectate II
antidiarrheal - more potent and has a longer duration of action with less CNS depression than diphenoxylate

adults give 4 mg po, then 2 mg afer each unformed stoo, max of 16 mg po daily

antidiarrheal gibe 800 mg 3 times daily for 6 weeks in ulcerative colitis

use for mild to moderate ulcerative colitis

give 3 - 4 gm in evenly divided doses
drugs that help draw fluid into the intestine to promote fecal softening, speed the passage of feces throught the colon, aid in the elimination of stool from the rectum
laxatives can be classified in five major categories
bulk forming, fecal softener, hyperosmolar or saline solutions, lubricants and stmulant or irritant laxatives
laxatives have a high rate of
bulk forming laxatives do what
they absorb water and expand, increasing both the bulk and the moisture content of the stool. the incresed bulk stimulates perstalsis and the absorbed water softens the stool these agents do not have systemic effects
fecal softeners soften stool by doing what
lowering the surface tension, which allows the fecal mass to be softened by intestinal fluids. they also inhibit fluid and electrolyte reabsorption by the intestine
hyperosmolar laxatives (such as lactulose and glycerine) produce what
an osmotic effect in the colon by distending the bowel with fluid accumulation and promoting peristalsis and bowel movement.
this type of laxative carries a barrier between the feces and the colon wall that prevents the colon from reabsorbing fecal fluid, thus softenig the stool. also helps with the ease of passage
lubricant laxatives
when are bulk laxatives used
simple constipation, when the coolon looses muscle tone w/ the overuse of hathartics. postpartum, elderly and weakened pts. they are also used to tx diverticulosis and irritable bowel syndrome
fecal softeners help relieve constipation produced by a delay in
rectal emptying
fecal softeners are used when it is important to reuce
straining of the stool, such as in HH, cardiovascular disease, postpartum pts, rectal surgery
saline lax are used for
cleansing the bowel in prep for endoscopic or coloscopic exams, xray or surgery
lactulose and glcerine are most commonly used to treat
siple constipation
lubricant lax are used to soften sool in condtions where straining should be avoided such as
MI,aneurysm, sroke, hernia, rectal surgery
stimulantor irritant lax are used to treat constipation resulting from
prolonged bed rest or poor dietary habits or constipation induced by other drugs.
what are some adverese reactions
cramps, diarrhea, blockages (when not taken with enough liquid),
long term use of stimulant laxatives result in what
antibioitics, anticoagulants, digitalis preps, and salicylates may have reduced effectiveess if used at the same time as
bulk forming agents - 2 hour interval between doses of these meds is required
fecal softeners should never be used along with
mineral oil or other laxatives - systmeic absorption of other agents are enhanced
antacids or milk should not be ten with
bisacodyl tablets - they cause the enteric coating to dissovle too rapidly, resulting in gastric irritation
many bulk forming agents containg high amounts of dextrose, galactose and sucrose and should be avoided in pts with
bulk forming agents should have lots of
water - or they can become hard or cause intestinal obstruction
pt teaching for laxatives
pg 341
bulk forming laxatives are
methycellulose (citrucel, unifiber)

psyllium seed (fiberall, metamucil)
methycellulose (citrucel, unifiber)
produces a lax effect in 12 - 72 hours all doses should be taken with 1 full glass or more of liquid
psyllium seed (fiberall, metamucil)
this product is indigestible and is not absorbed and odes not interfere with absorption of nutrients. less likely to cause lax abuse. 1 - 2 tsp po in full glass of water 1 - 3 times daily follow with second glass of water

colace, modane
fecal softener

give 50 - 200 mg po daily
bulk forming laxatives such as citracel and metacmucil should be
taken with full glass of water, should not be taken within 2 hour of any medication
fecal softner (colace)
softens stool by lowering the surface tension which allows the fecal mass to be softened by intestinal fluids. they also inhibit fluid and electrolyte reabsorption by the intestine
the main action of skeletal muscle relaxants are to
reduce muscle tone and involuntary (uncontrolled) movement w/o loss of voluntary (controlled) motor function
skeletal muscle relaxants do what
limit the transmission or movemetn oof impulses in the motor pathways at the level of the spinal cord and the brainstem, or they interfere wit hthe mechanism that shortens skeletal muscle fibers with the mechanism that shortens skeletal muscle fibers so that they contract
other actions of skeletal muscle relaxants are
mild sedation, reduction of anxiety and tension and changes in pain perception
what is the use of the skeletal muscle relaxant
to relieve pain i the usculoskeletal and neuro disorders involving peripheral injury and inflammation, such as muscle strain or sprain, arthiritis, bursitis, low back syndrome, cervical syndrome, tension HA, cerbral palsy, MS
what are some advererse reactions of skeletal muscle relaxants
flushing, (red color in the face and neck) hypotenison, syncope (light headed and fainting) blurred vision, confusion, drwosy , HA, insomnia, irritability, abdominal pain, anorexia, bleeding, diarrhea, hiccups, blood cell dosroders, dysuria
skeletal muscle relaxants are available
orally or injectible forms
what has been reported with the use of muscle relaxers
hepatoxicity, nephrotoxicity and blood dyscrasias
signs of hepatoxcity are
abdominal pain, fever, nausea, diarrhea
signs of blood dyscrasias include
fever, sore throat, mucosal irritaition, malaise, petechia
lowest dose should be used for skeletal muscle relaxants and should be stopped in how many days if no imporvement
the nurse or dr should be contacted immmediately if the pt is experiencing these symptoms with skeletal muscle relaxants
dizzy, fainting, SOB, nausea, diarrhea, malaise

T - lioresal
muscle relaxant antispastic begin dosage at 5 mg 3xd for 3 days then increase for 3 days 5 mg until thedesired respnse is obtained max daily dosage is 80 mg
relieves acute skeletal muscle spasms of local origin w/o interfereing with muscle function
what drugs tx arthritis
salicylates and NSAIDs first line drug to tx arthritis
This medication slows the activity of the stomach and intestinal tract, thus relieving cramping and reducing acid secretion. It is used in the treatment of peptic ulcers
antispasmotic durgs
how do you use antispsmotic drugs
This medication is usually taken 30 to 60 minutes before meals and at bedtime. Take this medication exactly as prescribed. Do not increase the dose or take it more frequently without consulting your doctor. Drink plenty of fluids while using this medication unless your doctor directs you otherwise.
what are some side effects of antipsmotic drugs
flushing of the face, problems sleeping, headache, blurred vision, drowsiness, increased sensitivity to light, constipation, dry mouth, decreased sweating or thirst
these drugs incrrease the excretion of urate salts in the urine by blocking tubular reabsorption of these salts in the kidney.
urocosuric acid
uricosuric agents are no help in an
acute episode of gout
this is a special drug used to treat acute gouty attacks
this is used in preventitive therapy of gout
allopurinol (zyloprim)
the dx of gout is confirmed by serum uric acid levels greater than
7 mg/100 ml and a 24 hour urine test for uric acid of less than 800 mg/day. the pt has usually had more than one acute attack before starting on these agents
what is used in out for pt who do not respond to all other drugs
allopurinol is usually used when objective finding show any of these conditions
overproduction of uric acid on a general diet (greater thn 700 mg / day
-uric acid nephropathy with impaired renal function
-kidney stones
-gout not controlled by uricosuric drugs alonge
what are the adverse reactions to uricosuric agents
fever, dizzy, pruritus, rashes, anorexia, constipation, diarrhea, n/v, aplastic anemai, kidney and liver problems
colchicine ma cause what
abdominal pain, severe diarrhea, n/v,
allopurinol may produce
drowsiness, alopecia, purpura, diarrhea, abdominal pain, n/v, blood dyscrasias
A condition where any of the blood components are abnormal in any way. an abnormal condition of the blood
Blood dyscrasia:
Sedimentation rate (sed rate) measures the speed at which red blood cells settle to the bottom of a test tube. The presence of certain abnormal proteins in the blood can cause red blood cells to stick together and sink to the bottom more quickly.
sed rate
Sed rate is a screening test for many different diseases. A high sed rate is not specific to any one disease. Possible causes include:
Inflammatory diseases, such as rheumatoid arthritis and lupus
Blood cancers, such as leukemia and lymphoma
Cancers that have spread (metastasized)
people with RA usually have an elevated
sed rate