Acid Controlling 1
What are adverse effects you want to monitor for antacids? (4)
N/V/D, abdominal pain. with calcium containing products constipation and acid rebound
Name 4 examples of PPIs.
lansoprazole (Prevacid)
omeprazole (Prilosec)-prototype
pantoprazole (Protonix)
esomeprazole (Nexium)
What are 3 side effects of Sucralfate?
constipation, dry mouth, nausea
What is the main drug under the anticholinergic drug category?
Scopolamine (Transderm-Scop, Scopace)
What is the main contrainication of scopolamine?
What is the mechanism of action for Histamine 2 receptors?
Reduces acid secretion, blocks H2 receptors on parietal cells (selectively) and keeps 70% of HCl being produced by increasing the pH of the stomach (increase pH=less acid). Also decreases pepsinogen production by chief cells. Relief of many symptoms associated with hyperacidity-related conditions. SUPPRESSES ACID SECRETION IN THE STOMACH
Name the mechanism of action with proton pump inhibitors.
The parietal cells release positive hydrogen ions (protons) during HCl production, process is called proton pump. This med inhibits this process. (h2 blockers and antihistamines have nothing to do with proton pump)
What are 2 nursing implications for Sucralfate?
impairs the absorption of other drugs-give other drugs 2 hours BEFORE sucralfate/do not administer with other meds
What is the mechanism of action for anticholinergic drugs?
Binds and blocks acetylcholine receptors in inner ear, preventing nauseating stimuli from triggering CTZ.
Name the 3 main H1 receptor blockers.
dimenhydrinate (dramamine)-dizziness
diphenhydramine (Benadryl)
meclizine (anitvert)- motion
What are the 4 most common H2 receptors?
cimetidine (Tagamet)/ nizatidine (Axid)/ famotidine (Pepcid)/ ranitidine (Zantac)
Name 2 drug interactions with H2 anatgonists.
smoking can decrease effectiveness because decreases gastric mucosal blood flow/ take h2 antagonist 1-2 hours BEFORE antacids
Name 2 nursing implications for PPIs. (5)
Assess for allergies and h/o liver disease/not all available for parenteral administration/may increase serum levels of diazepam and phenytoin/may increase chance of bleeding with warfarin/ng tube must be at least 16 gauge for pantoprazole granules/capsules CAN be opened and mixed with apple juice, do not chew or crush delayed-release granules
Name the general mechanism of action for antiemetics.
Agent that blocks the hyperactive response of the chemoreceptor trigger zone (CTZ) to various stimuli, the response that produces nonbeneficial nausea and vomiting (basically blocks response of CTZ)
Name the mechanism of action for H1 receptor blockers.
Binds to H1 receptors to prevent stimulation of CTZ. also prevents acetaylcholine.
Name the 4 indications for H2 antagonists.
Gastroesophageal reflux disease (GERD)
Peptic ulcer disease (PUD)
Erosive esophagitis
Adjunct therapy to control upper GI bleeding
Name 4 indications for PPIs. (6)
GERD
Erosive esophagitis
short-term tx of active duodenal and benign gastric ulcers
NSAIDs-induced ulcers
Stress ulcer prophylaxis
Tx of Helicobacter pylori-induced ulcers (with antibiotic)
Name the mechanism of action for Sucralfate (Carafate). Then name 2 indications.
goes to the base of ulcers and puts a protective layer. Also binds with phosphate that brings down with sucralfate, renal pts usually have high phosphate. 2 indications: stress ulcers and PUD
Name the mechanism of action of Phenothiazines (Antidopaminergic drugs)
Acts centrally -> change responsiveness of stimulation of CTZ -> reduces nausea. (works of inner ear and CTZ and very costic to veins)
Name the 3 examples of Phenothiazines (Antidopaminergic drugs).
prochlorperazine (Compazine)
promethazine (Phenergan)
Droperidol
Name 2 adverse effects for H2 anatgonists.
overall very few, CNS adverse effects in elderly pts including confusion and disorientation/thrombocytopenia with famotidine/inhibit the absorption of drugs that need acidic quality of stomach/h2 receptors work on heart too so a high level can cause cardiac arrythmias
Name the 4 adverse effects of PPIs.
Possible predisposition to GI tract infections (c. diff)
Osteoporosis and risk of wrist, hip, and spine fractures in long-term users (does not affect calcium absorption)
Pneumonia (compromises stomach ability to fight off bad bacteria)
Depletion of magnesium
What is the mechanism of action of Misoprostol (Cytotec)? What is the main indication for it?
Protects gastric mucosa from injury by enhancing local production of mucus or bicarbonate. Promotes local cell regeneration and helps maintain mucosal blood flow. Basically produces more mucus to protect. Indication: reduce incidence of ulcers from NSAIDs.
Name the main nursing implication for prochlorperzine.
tardive dyskinesia
Name the main nursing complication for droperidol.
controversial because associated with cardiac dyrhythmias.