cimetidine
(TAGAMET)
(TAGAMET)
TRUE OR FALSE: This drug blocks "Histamine 4" receptors on the parietal cells of the stomach to reduce the volume of gastric juice and its hydrogen ion concentration (in other words, by blocking Histamine 4 receptors,
this drug suppresses acid secretion to the stomach)
FALSE
[Note: Everything in this question's presentation of the MOA of cimetidine (Tagamet) is correct EXCEPT that it blocks Histamine 2 ("H2") receptors, it is an
H2 receptor antagonist, NOT H4...]
This drug is in an popular general
class of drugs that is called:
(a) Tetracyclines
(b) Beta Blockers
(c) H2 Receptor Antagonists
(d) Proton Pump Inhibitors
(e) Cytoprotectants
(D) PROTON PUMP INHIBITORS
Note: Many of the drugs in this class have generic names that
end in " -prazole"
(e.g. pantoprazole, esomeprazole...)
TRUE OR FALSE: This drug has no serious systemic side effects
TRUE
because of minimal systemic absorption
(Note: the only listed potential AR is constipation)
TRUE OR FALSE: This drug is safe for use during pregnancy
FALSE
It is counterindicated in pregnancy, and generally should only be taken by people who are certain they are not pregnant (e.g. drug therapy started on the 2nd or 3rd day of one's menstrual cycle, for those who menstruate), with a few exceptions
TRUE OR FALSE: Antacids have TWO different Methods of Action (MOA) depending on what they're used for: (1) protecting the stomach lining (for example protection from peptic ulcers); (2) neutralizing stomach acid (for example symptom relief to treat acute symptoms of heartburn, GERD, and dyspepsia)
TRUE
Which of the following is part of the important Patient Teaching for someone given cimetidine (Tagamet)?
(a) Always take before meals
(b) Always take with food
(c) Always take at least 30 minutes after a meal
(d) You can take this medicine at any time
without regard to food
A.TAKE BEFORE MEALS (in other words, on "empty" stomach)
because food in stomach decreases its rate of absorption
(Note: it also should be taken at least ONE HOUR apart from -- in other words, at least that long before or after -- taking an antacid, because antacids decrease the absorption of this med)
Why does the lecture slide show give a picture of a
glass of milk
on the Patient Teaching slide?
Part of the Patient Teaching should include:
MAINTAIN ADEQUATE INTAKE OF CALCIUM & VIT D
TRUE OR FALSE: This drug helps to decrease acid secretions into the stomach
FALSE
It does not neutralize acid, nor does it decrease acid secretion
Explain WHY this drug is considered very dangerous to take for people who
are or who can become pregnant?
BONUS: Name at least one of the uses of this drug by a person carrying a fetus that offers an important exception to this "rule"
BECAUSE IT CAUSES CERVICAL RIPENING AND UTERINE CONTRACTIONS, and, if one is pregnant,
CAN CAUSE PARTIAL OR COMPLETE EXPULSION OF A FETUS
Bonus question: Exceptions include use for helping the process of labor induction/cervical ripening for a person in the process of delivering a baby (a common usage we'll learn about Spring term); also, for medically-induced abortion
TRUE OR FALSE: As a general patient teaching, it is usually best for a patient to take antacids on a regular schedule to promote healing, not just take antacids now and then for symptom management
TRUE
How is this drug _commonly_ administered?
(a) PO
(b) IM injection
(c) sub Q injection
(d) IV
(e) transdermal patch
(A) = PO (in pill form, by mouth)
NOTE: It also comes in IV form, but that is a much less common route for its administration
This drug can be used for the long-term treatment of Zollinger-Ellison syndrome, and acute use in the ICU to treat stress ulcers in the stomach, but name the conditions that it is most commonly used for in short term therapy, often 2-4 weeks in duration (GIVE AT LEAST TWO SHORT TERM USES)
DUODENAL ULCERS (i.e. in the duodenum of the small intestine);
GASTRIC ULCERS (i.e. in the stomach);
EROSIVE ESOPHAGITIS;
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
Why does the lecture slide show give a picture of a
CLOCK
on the Patient Teaching slide?
BECAUSE ACCORDING TO LECTURE,
"THIS DRUG IS ALL ABOUT TIMING"
since it needs an acid environment for activation (take on an empty stomach; don't take with most other drugs to tx PUD including antacids), and also because it interferes with the absorption of many other meds so generally needs to be taken at least one to two hours apart from other meds
In other countries of the world, this drug can be used to treat Peptic Ulcer Disease (PUD) from a wide variety of causes, but in the United States, its use is limited to the treatment of gastric ulcers that are specifically caused by long term use of this class of pain-killer/anti-inflammatory drugs
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Common Over the Counter examples of NSAIDs include aspirin, ibuprofen (Advil, Motrin) and naproxen (Aleve)
plus prescription medications used to treat mild to moderate pain and/or inflammation in patients with arthritis or other conditions (e.g. menstrual cramps) such as diclofenac and celecoxib
We'll learn more about this class of drugs Spring term
What is the common brand name in the US for the antacid that is made up of
calcium carbonate
TUMS
Which of the following is NOT one of the "on label" prescribed uses for cimetidine (Tagamet):
(a) Peptic Ulcer Disease (PUD)
(b) Chemo-Induced Nausea and Vomiting (CINV)
(c) Heartburn and Acid Indigestion
(d) Gastro-Esophageal Reflux Disease (GERD)
(e) Active Duodenal Ulcers
"B" =CINV
is NOT one of this medicine's "uses"
(for addressing that condition, see the set of meds that are designed for the tx of nausea+emesis, specifically for CINV: ondansetron, aprepitant, dexamethasone, and olanzapine, plus possibly cannabinoids)
Part of the Patient Education for omeprazole (Prilosec) is that, if possible, one should not stop taking this drug abruptly but rather should taper down the daily amount taken gradually. Why? What unwanted Adverse Reaction (AR) could happen with abrupt discontinuation (DC) of this drug?
REBOUND HYPERACID SECRETION with abrupt DC
CREATES A PROTECTIVE BARRIER AGAINST ACID, PEPSIN, AND BILE SALTS
(effects last up to 6 hours)
Name AT LEAST THREE elements of Patient Education for this drug
(1) Take the full course of the drug therapy, as directed;
(2) Do not share this medication with others;
(3) Avoid alcohol and foods that may cause GI irritation;
(4) Do not take with antacids containing magnesium (such as "Milk of Magnesia")
(5) Notify provider if diarrhea persists longer than 1 week
Explain briefly why patient teaching and basic safety for all types of antacids is to separate the taking of antacids from any other medications by at least one hour (and in some cases, at least TWO hours)
(1) BECAUSE OF MANY DRUG INTERACTIONS BETWEEN ANTACIDS AND ALL OTHER MEDS;
(2) BECAUSE THEY DECREASE THE EFFECTIVENESS OF SOME GI MEDS (cemetidine/Tagamet) AND COMPLETELY COUNTER THE EFFECT OF OTHERS (sucralfate/Carafate)
Because this drug blocks histamine receptors NOT just in the stomach but also elsewhere in the body, it may cause a series of Adverse Reactions. List AT LEAST TWO
(1) CNS EFFECTS: Headache, dizziness, confusion, agitation, potential hallucinations;
(2) DIARRHEA or CONSTIPATION
(3) ANTIANDROGENIC EFFECTS, eg. gynecomastia, impotence
(4) Increased risk for pneumonia (PNA)
NOTE: The effect in the stomach increases the risk for PNA due to increased gastric bacteria allowed to flourish by this drug therapy
This class of drugs (as well as H2 Receptor Antagonists like cimetidine/Tagamet) is used for the long-term treatment of Zollinger-Ellison Syndrome. Describe briefly what this syndrome does to a person's body.
IT ARISES FROM A TUMOR THAT PRODUCES EXCESSIVE AMOUNTS OF GASTRIN, a hormone that when made in excess causes HYPER-SECRETION OF GASTRIC ACID IN THE STOMACH, leading to PEPTIC ULCERS
Which other drug(s) in this unit should not be taken at the same time as one takes sucralfate (Carafate), for one or more of those other drugs would harm this drug's effectiveness?
(a) cimetidine (Tagamet)
(b) omeprazole (Prilosec)
(c) misoprostol (Cytotec)
(d) calcium carbonate (Tums)
"A" (cimetidine) and "B" (omeprazole) and "D" (Tums)
because
sucralfate (Carafate) requires an acid environment in the stomach to be activated, and the above drugs each make the stomach more basic, negatively affecting this drug's absorption and/or activation.
NOTE: In this PPT presentation, it makes it seem as if (D) Antacids, is the only/best correct answer, so give yourself full points even if you only answered "D" (Tums)
(1) SUPPRESS GASTRIC ACID SECRETION;
(2) PROMOTE BICARBONATE SECRETION;
(3) PROMOTE SECRETION OF CYTOPROTECTIVE MUCUS;
(4) CAUSE VASODILATION TO MAINTAIN SUBMUCOSAL BLOOD FLOW;
(5) REPLACE THE BODY'S ENDOGENOUS (ORIGINAL) PROSTAGLANDINS
Match the type of antacid and its side effect:
(1) calcium carbonate (Tums)
(2) sodium bicarbonate (e.g. Alka-Seltzer)
(3) magnesium hydroxide (e.g. Milk of Mag.)
(4) aluminum hydroxide (e.g. forms of Mylanta)
side effects: (a) diarrhea; (b) constipation; (c) hypertension; (d) acid rebound and even hypercalcemia and/or metabolic acidosis when taken in excess
(1) calcium carbonate=D, acid rebound + other SEs
(2) sodium bicarbonate=C, potential HTN
(3) magnesium hydroxide=A, diarrhea
(4) aluminum hydroxide=B, constipation