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34 Cards in this Set
- Front
- Back
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omeprazole [Prilosec] |
20 mg one capsule ONCE daily on empty stomach (proton pump inhibitor) |
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famotidine [Pepcid] |
20 mg one tablet TWICE daily [H2 blocker]
or if nocturnal problems do once a day |
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Sucralfate [Carafate] |
1g take 4 times a day on empty stomach for 4-8wks [gastric protectant] |
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aluminum/magnesium hydroxide suspension [Maalox] |
30ml every 4 hours PRN for epigastric pain relief [antacid]
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Misoprostol[Cytotec] |
200 mcg one tablet 4 times a day with food [prostaglandin] |
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Metoclopramide [Reglan] |
10 mg one tablet 4 times a day 30 minutes before meals and at bedtime [prokinetic] |
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H2 blocker vs PPI
What drug works better at night? What works better overall? |
H2 blockers better at night PPI better over all at acid control |
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What drug do you only use for duodenal ulcers? |
sucralfate |
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What are risks of PPI use? |
fractures rises if on for 1yr+ clopidogrel intrxn C diff increased risk |
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true or false PPI are approved for treatment in upper GI bleed |
FALSE- none are approved
zegarid can be used it's a combo of H2 and PPI |
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What is IV dosing of PPI to get pH past 5.0 |
80 mg IV bolus then 8mg per hour infusion
(total 272 mg in a day)
nexium & protonix only ones |
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What are the ADR of PPIs |
diarrhea, abdom pain, headache, dizziness long term: calcium absorption loss, rise gastrin levels |
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why is a H2 blocker used in severe allergic response in ED |
the chemistry and shape is pretty much the same as an H1 blocker (antihistamine) |
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time until relief PPI vs H2 blockers |
PPI 24-48 hrs H2- 30 minutes |
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H2 blockers issues |
renal dosing <50 only give 1xday
class ADR: thrombocytopenia |
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how do gastric protectants work (sucralfate)?
ADR? |
coats the ulcerated area for duodenal ulcers only
ADR constipation, drug intrxn w/antacids |
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how do antacids work? |
neutralize or reduce gastric acidity, protects gastric mucosa
good-symptom control upper GI don't work well--last very short time 2-3 hrs GERD is every hour not worth it |
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antacids- MOA & examples of: sodium bicarb, calcium carbonate, Aluminum/magnesium hydroxide |
sodium bicarb- changes acid/base balance of body & blood and make a lot of gas
calc carbonate- TUMS immediate symptomatic release
Aluminum/magnesium hydroxide-maalox |
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ADR antacids |
diarrhea, constipation, N/V
nasty taste on tablets |
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how do prostaglandins work? |
decrease acid secretion, replaces gastric prostaglandins
only use for gastric ulcers in pt due to NSAIDS** |
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ADR of prostaglandins |
AVOID in PREGNANCY!!! can cause uterine contractions [abort fetus possible]
ADR: diarrhea, abdominal pain |
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How do prokinetics work? |
move gastric contents along, improve esophageal peristalsis & increase LES tone [prevent reflux]
injectable for 1day can be used to prevent vomiting (anesthesiologist do it often) |
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ADR of prokinetics (metoclopramide) |
CNS- restlessness, fatigue, drowsy, mental depression @ high doses
very rare- neuroleptic malignant syndrome |
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antispasmodics upper GI |
products: Librax Donnatal- sln green color- for acute GI cramping along with antacid (grasshopper) no data it works
anticholinergic cause drowsiness/blurred vision, don't use in tachy arrhythmias |
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H. Pylori |
H pylori bores through mucosal layer. Test for urease. Most people have it just a few have symptoms (can lead to gastric cancer though as you age)
create gastric ulcers. 100% of duodenal ulcers caused by them. |
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H pylori regiment recommendatiosn |
-variety.... could be 10-14 days -multiple drugs 2-4 times a day -2 antibiotics + PPI -pretty cheap treatment overall -eradication rate is 80-90% but rate of esophageal cancers go up after eradication |
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What are some antinausea |
antihistamines related [benadryl, dramamine] neuroleptic related- dopamine blockers 5HT3 antagonists- breakthru for chemo therapy no more N/V [zofran, anzemet, aloxi] cannabinoids receptors- help for chemo ther other- neurokinin, scopolamine, corticosteriods |
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ADR of antihistamine IV [promethazine] |
necrosis of tissue around injection site Reye syndrome connection |
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MOA antihistamine |
reversible, competitive H1 receptor strongly binds to central muscarinic receptor sites to produce an antiemetic effect |
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MOA dopamine blockers ADRs?
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dopamine blocker in the chemoreceptor trigger zone ADR extrapyramidal SE, sedation [long term only] rare torticolis |
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What are approved uses for 5HT3 blockers
ADRs? |
1) PONV- give it 30 min prior end of surgery and during recovery 2) CIE- infusion as a 3 drug cocktail w/ antihistamine & corticosteroids
ADR- HA, GI, brady/tachycardia |
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neurokinin 1 antagonists |
brand new so $$$$ MOA inhibit substance p/neurokinin 1 receptor ADR fatigue, nausea, constipation, weakness, hiccups, lots of drug intrxn DRUG emend |
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Cannabinoids |
MOA-unknown use in cancer chemo associated N/V ADR hallucinations, appetite DRUG; dronabinol sched III |
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corticosteroids |
MOA- unknown long effects useful 3-5 days used in cancer chemo associated N/V DRUG: dexamethasone |
