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63 Cards in this Set
- Front
- Back
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What are the H2 receptor antagonists? |
Cimetidine (Tagament) Ranitidine (Zantac) Famotidine (Pepcid) Nizatidine (Axid) |
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Are PPIs renally dosed? |
NO |
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Are H2 blockers renally dosed? |
YES |
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What are H2 blocker effective for? |
gastroesophageal reflux disease peptic ulcer disease |
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ADR of H2 blockers |
mental status changes- only with ICU, IV, cimetidine thrombocytopenia endocrine issues |
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dose for H2 blocker |
Famotidine (Pepcid) 20mg BID |
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dose for H2 blocker for pt with Cr Cl <50% |
Pepcid 20mg qd |
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What is the gastric protectant |
Sucralfate (Carafate) |
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MOA for gastric protectant |
Carafate complexes with PRO-like exudate located at ulcerations, covers ulcer area |
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ADR of Carafate |
constipation rash, vertigo, HA, insomnia |
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dose for gastric protectant |
Sucralfate 1g QID on an empty stomach for 4-8wks |
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What kind of ulcers are gastric protectant for? |
duodenum |
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What can you not give with a gastric protectant? |
antacids |
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MOA of antacids |
neutralize or reduce gastric acidity protects gastric mucosa increases gastric pH, inactivates pepsin stimulates production of prostaglandins |
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ADR of antacids |
gastrointestinal: diarrhea, constipation, n/v |
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what are antacids good for? |
sx control and relief- not a permanent solution |
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What does sodium bicarb do? |
bicarbonate ion neutralize H ion produces CO2 (gas) affects blood pH well but not good for stomach issues |
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What does calcium carbonate do? |
neutralizes gastric acid like aluminum and/or Mg |
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dose for antacid |
aluminum/magnesium hydroxide suspension 30ml q 4h PRN epigastric pain |
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What is the prostaglandin? |
Misoprostol (Cytotec) |
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What do you use Cytotec for? |
pts who have a stomach ulcer from NSAID |
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MOA of Cytotec |
synthetic prostaglandin E1 analog that replaces gastric prostaglandin decreases gastric acid secretion
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ADR for Cytotec? |
diarrhea, abd pain |
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What pts can you not give a prostaglandin? |
pregnant women- can cause expulsion of viable fetus can be used to induce abortion |
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dose for Cytotec |
Cytotec 200mcg QID with food |
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What is the Prokinetic? |
Metoclopramide (Reglan) |
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MOA of pro kinetic? |
Reglan stimulation of release of acetylcholine at nerve ending to increase LES tone improve esophageal peristalsis |
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ADR of pro kinetic? |
Reglan CNS effects: restlessness, fatigue, drowsiness, mental depression at higher doses Neuroletptic malignant syndrome (very rare) |
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What is an acute use for a pro kinetic? |
induce vomiting- give small dose for 1d |
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What is common unapproved use of a prokinetic |
nausea in chemo pts |
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dose for prokinetic (we will never prescribe) |
Reglan 10mg QID 30m before meals and at bedtime |
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What do anticholinergics do? |
causes drowsiness, blurred vision impairs physical or mental ability |
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What are anticholinergics? |
Clidinium and chlordiazepoxide (Librax) Hyoscyamine, atropine, scopolamine, and phenobarbital (Donnatal) |
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What test can you do to look for H. pylori? |
urease |
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What can symptomatic H. pylori injection lead to if not tx? |
gastric CA |
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What bacterial usually causes duodenal ulcers (if not NSAID induced) |
H. pylori |
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How long is the regimen to eradicate H. pylori? |
10-14d |
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Most complicated regimen for H. pylori? |
pepto bismol, metronidazole QID for 2wk and H2 blocker for 4 wk |
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Least complicated regimen for H. pylori? |
prevacid, biaxin, and amoxicillin BID for 10d |
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Why do you not want to totally eradicate H. pylori in everyone? |
can cause stomach CA
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What is the typical regimen for H. pylori now a days? |
2 abx and PPI |
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What drugs can you use for bloating, fullness, abdm pain, or heartburn? (Intermittent dyspeptic sx) |
antacids OTC H2 blockers |
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What drugs can you use for gastritis, gastric ulcers, or duodenal ulcers? (non-ulcer dyspeptia) |
antacids OTC/Rx H2 antagonist |
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What drugs can you use for epigastric pain with n/v resulting from diffuse inflm of stomach caused by H. pylori (gastritis) |
discontinue NSAIDS antacids OTC/Rx H2 blockers Abx regimen |
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What drugs could you use for gastric pain 1-3h after eating with ulcers in stomach, n/v, belching, anorexia (gastric ulcer) |
discontinue NSAID Rx H2 blockers PPI abx cytotec |
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What drugs can you use for epigastric pain with an empty stomach that is relieved when eating and ulcers in duodenum (duodenum ulcer) |
discontinue NSAID Rx H2 blcoker PPI abx Carafate |
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What drugs could you use for heartburn (GERD) |
antacids (don't work) OTC/Rx H2 blockers (don't work) PPI prokinetic agents |
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What are alarm sx in GERD? |
dysphagia, odynophagia, anemia, wt. loss |
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What could be some causes of alarm sx in GERD? |
ulceration, erosive esophagitis, Barrett's esophagus, CA, normal |
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What are the 3 things that stimulate parietal cells? |
gastrin, ACh, histamine |
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Who are the PPI? |
Omeprazole (Prilosec) Esomeprazole (Nexium) Lansoprazole (Prevacid) Pantoprazole (Protonix) Rabeprazole (Aciphex) Dexlansoprazole (Dexilant) |
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What are the only 2 IV PPIs? |
nexium and protoinix |
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Are PPI good for the day or night? |
day |
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are H2 blockers good for day or night? |
night |
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What are things you need to be careful of when taking a PPI? |
fx risk after 1yr (hip, wrist, spine) PPIs and clopidogrel increased risk of C. diff |
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Which PPIs are currently approved for upper GI bleed? |
NONE |
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What is the only drug approved for an upper GI bleed? |
Zegarid |
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if your intragastric pH is btwn 5.1-7 what is altered? |
coagulation and plt aggregation |
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What is the dose for Protonix or Nexium IV |
80mg IV bolus loading dose 8mg/h |
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what are PPI metabolized by? |
cytochrome P-450 enzyme system |
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ADR for PPI |
diarrhea, abdm pain, HA, dizziness long term: inhibition of Ca absorption, rise in gastrin levels |
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What is the dose for PPI? |
Prilosec 20mg qd on an empty stomach |
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What is the only H2 blocker approved for H. pylori regimen? |
Ranitidine |
